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A female, aged 22 years, with alopecia presented with acute onset left upper quadrant abdominal pain and hypotension (blood pressure 80/40). There was no history of trauma. Abdominal examination demonstrated guarding in the left upper quadrant and urgent blood investigations revealed neutrophil leucocytosis with a normal serum amylase. There was no free air under the diaphragm on an erect chest x ray and an abdominal radiograph was unremarkable. In view of the unexplained localised peritonitis, an abdominal computed tomography (CT) scan was requested.
What conclusions can you draw from this CT scan?
See page 1266 for answer
This case is submitted by:
Robin Spiller, Editor