Author: Zoe Hinchcliffe / Editor: Steve Corry-Bass / Codes: NepC2, NepC3, SLO1, SLO3, SuC4, SuP3, SuP7 / Published: 28/10/2021

A 66-year old male attends the Emergency Department (ED) with a 3-day history of abdominal pain, cramping and distension. He complains of generalised pain across the whole of his abdomen, associated with intermittent nausea and vomiting. He has attended today as the pain and bloating has worsened, with a pain score of 8/10. 

The patient mentions he has been feeling constipated for the past few days – his bowels were last opened 5 days-ago and does not recall passing any gas. 

His past medical history includes poorly controlled type-two diabetes mellitus, hypertension, hypercholesterolaemia and asthma. He currently takes simvastatin, Bendroflumethiazide, inhaled salbutamol and subcutaneous insulin. He has never had any abdominal surgery. 

His observations at triage are as follows:

RR – 25

SpO2 – 98% 

HR – 112 bpm

BP – 146/92 mmHg

CRT – 2 seconds

Temp – 37.4ºC

On examination, the patient’s abdomen is noticeably distended with tenderness in all four quadrants on both light and deep palpation. On percussion his abdomen sounds hyper-resonant in all areas and bowel sounds are infrequent and ‘tinkling’ in nature. Chest and heart sounds are normal. 

You decide to perform some investigations. 

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