Author: Ayaa Eltayeb / Editor: Sarah Edwards / Codes: IP1, MuC7, SLO1 / Published: 02/08/2022

A male in his seventies presents to the Emergency Department (ED) with abdominal pain that has progressively worsened over the last 8 weeks. It is mainly in the epigastric area and oftentimes radiates to the back. He describes it as a dull ache, which worsens with movement and is associated with nausea as well as a reduced appetite. He has been feverish at the start and received two separate courses of antibiotics for a urine infection – his urine at the time had grown E.coli. He denies any current lower urinary tract symptoms or weight changes.

He has a history of hypertension.

He is a non-smoker and denies any recreational drug use. He is usually fully independent and is still working as a carpenter. This is up until the last few weeks, due to his mobility becoming reduced.

His pulse is sinus tachycardia with a rate of 117 bpm.

Examination reveals a soft abdomen with mild tenderness over the right iliac fossa and epigastrium, his bowel sounds are present. He also has tenderness over T8/9. There is focal neurological deficit.

Amongst other investigations, a CT abdomen due to right iliac fossa pain is undertaken. It shows degenerative changes along his spine and inflammatory/ infective changes around the intervertebral disc of T8/9. There is soft tissue enhancement and prominence in the paravertebral region at this level.