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 …