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A rare cause of abdominal pain
  1. W H Chan1,
  2. I Zerizer1,
  3. N Shergill2,
  4. I Shergill2,
  5. S Dougan2
  1. 1Emergency Department, St Thomas Hospital, London, UK
  2. 2Department of General Surgery, Watford General Hospital, Watford, UK
  1. Correspondence to:
    Dr W H Chan
    Emergency Department, St Thomas’ Hospital, Lambeth Palace Rd, London SE1 7EP, UK;

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Clinical presentation

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:

Figure 1

 Abdominal computed tomography.


  • Robin Spiller, Editor

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