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Perplexing plain abdominal x-ray
  1. L Crush1,
  2. O J O'Connor1,
  3. W Plant2,
  4. M R Clarkson2,
  5. F Shanahan2,
  6. M M Maher1
  1. 1Department of Radiology, Cork University Hospital and University College Cork, National University of Ireland, Ireland
  2. 2Department of Medicine, Cork University Hospital and University College Cork, National University of Ireland, Ireland
  1. Correspondence to Professor Michael M Maher, Department of Radiology, University College Cork, Cork, Ireland; m.maher{at}ucc.ie

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Clinical presentation

A 62-year-old man presented with generalised abdominal pain of 4 h duration with associated cough and pyrexia for 2 days. He had developed nephrotic syndrome 17 years previously due to focal segmental glomerulosclerosis and progressed to end-stage kidney disease for which he required haemodialysis three times a week for 6 years. The patient had undergone resection of 10 cm of his distal small bowel due to obstruction secondary to a benign stricture 5 years previously. Oesophagogastroduodenoscopy, colonoscopy, barium meal and enema studies in the previous 2 years were normal apart from the detection of a small sliding hiatus hernia. Examination revealed diffuse abdominal tenderness without …

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