Author: Lily Stanley, Tom Roberts/ Editor: Mark Winstanley / Reviewer: Lily Stanley, Debkumar Chowdhury / Codes: GP1, HP3, RP7, SLO3, SuC15, SuP1 / Published: 08/07/2021 / Reviewed: 25/10/2025
A 22-year-old man with a history of Asperger’s Syndrome but otherwise fit and well, presented to the Emergency Department (ED) following a collapse.
An ambulance was called when he collapsed on standing from the sofa after a 24 hour history of vague abdominal pain (but no history of trauma). Paramedics found him to be hypotensive, BP 50 systolic, tachycardic and GCS 14/15. The crew pre-alerted the ED that they had a young male with abdominal pain and profound hypotension. Differentials considered at this time were DKA and an acute abdomen secondary to perforated viscus.
On arrival to the ED, he was pale, confused and complaining of severe abdominal pain. IV access was gained and a venous blood gas revealed a haemoglobin of 45g/L. His abdomen was distended and tender with absent bowel sounds.
The Major Haemorrhage Protocol was activated and resuscitation was initiated and continued whilst diagnostic imaging was arranged.
19 responses
Challenging case
Not very common but I shall remember it.
Interesting case. Certainly wouldn’t be the most obvious cause for the patient’s presentation
Agree
Challenging but typical ED resus thrilling case.
Perfect emergency
A special case, interesting.
Though not at the forefront of my differentials; a useful cause to consider. Thanks.
Very rare , shall consider it as differential.
Thank you.
Interesting case
THE CASE IS VERY RARE; THE EXPLANATION, ESPECIALLY INDICATION FOR IR, IS SOMETHING VERY RELATED TO EMERGENCY MEDICINE
challenging case. Tku
Challenging but interesting
who knew?! Nice case. I’m in my 5th decade – awesome…
excellent
challenging case
Fascinating case!
Nice module thanks
Excellent learning