Vigorous coughing produced vivid consequences in a 76-year-old woman. She presented to the emergency department with a 1-week history of severe cough and a 2-day history of left abdominal pain. She had been healthy until the onset of symptoms. At a body mass index of 28.1 kg/m2, she was obese according to the body mass index standards for Asians and Asian Americans. She had not had any abdominal surgery or trauma and was not using anticoagulant drugs.
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