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An interesting case of acute abdomen

BMJ 2008; 337 doi: (Published 15 October 2008) Cite this as: BMJ 2008;337:a1953
  1. Rajaraman Durai, specialist registrar1,
  2. Sumantra Kumar, consultant radiologist 2,
  3. Sha-Nawaz Ruhomauly, consultant surgeon1,
  4. Happy Hoque, consultant surgeon1
  1. 1Department of Surgery, Queen Mary’s Hospital, Sidcup, Kent
  2. 2Department of Radiology Queen Mary’s Hospital, Sidcup, Kent
  1. dr_durai{at}

    A 61 year old man presented with a ten day history of right sided non-colicky abdominal pain radiating to the back, and four episodes of fever with rigor, each of which lasted an hour. He had no other gastrointestinal or urinary symptoms. His only medical history was a ureteric stone. He did not take any drugs, and drunk alcohol in moderate amounts regularly.

    On examination he seemed well, apyrexial but tachycardic with a pulse rate of 110 beats per minute. His blood pressure was normal. His chest was clear. Examination of his abdomen showed a tender 15×10 cm swelling in the right anterior lumbar region.

    Chest radiograph did not show pneumoperitoneum. His blood test showed neutrophilia (20×109/l and a raised C reactive protein of 200 mg/l. The rest of the blood tests including amylase were in the normal range. An abdominal radiograph and computed tomogram of the abdomen and pelvis were performed.


    1 What can you see in the abdominal computed tomogram?

    2 What is the diagnosis and why?

    3 How would you treat this condition?


    Short answers

    1 The abdominal computed tomogram shows an 11×7 cm abscess (figure 1) with an air fluid level. It adheres to the right anterior abdominal wall, medial to the caecum and the ascending colon.

    2 The abscess is separate from the small bowel and is most likely to be …

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