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BMJ 2009; 339 doi: (Published 21 September 2009) Cite this as: BMJ 2009;339:b3843
  1. Bettina Lieske, specialist registrar general surgery,
  2. Jeffrey Lim, core trainee in general surgery,
  3. Michael Booth, consultant general and upper GI surgeon
  1. 1Royal Berkshire NHS Foundation Trust, Reading RG1 5AN
  1. bettina_lieske{at}

    A 30 year old man presented as an emergency with shortness of breath, left sided abdominal and chest pain, and vomiting. Acute tension …

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