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Endgames Spot Diagnosis

Acute abdominal pain in an older patient

BMJ 2019; 365 doi: (Published 01 May 2019) Cite this as: BMJ 2019;365:l1337
  1. Joseph Keighley, ST3 radiology registrar,
  2. David Howlett, radiology consultant
  1. East Sussex Healthcare NHS Trust, Eastbourne, UK
  1. Correspondence to J Keighley joseph.keighley{at}

An 84 year old woman with a history of atrial fibrillation, angina, and transient ischaemic attack presented to the emergency department with vomiting and acute abdominal pain, most severe in the right iliac fossa. She reported no alteration in bowel habit. During a recent hospital admission following a fall at home, the patient had not reported any abdominal pains and she had been well at the time of discharge. Initial observations were within normal limits and clinical examination revealed generalised abdominal tenderness. Blood results showed a metabolic acidosis, elevated lactate, and raised inflammatory markers (table 1). She was referred for urgent …

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