22nd July 2023

An 84-year-old woman presents to the emergency department with sudden onset abdominal pain

An 84-year-old woman presents to the emergency department with sudden onset abdominal pain. The pain started 6 hours ago and has progressively worsened. She describes it as a stabbing pain across the whole abdomen that is “worse than childbirth”. She feels nauseous but denies vomiting, haematemesis, diarrhoea, PR bleeding, fever and lower urinary tract symptoms. She had a normal bowel movement 12 hours ago. She has a history of hyperlipidaemia for which she takes atorvastatin 40mg ON. She is an ex-smoker with a 40-year pack history and does not drink alcohol. On examination, she is noted to be in a considerable amount of pain, clutching her abdomen. She is warm and well perfused, and her radial pulse is irregularly irregular at a rate of 100 bpm. Chest and heart auscultation is normal. Her abdomen is soft but diffusely tender with no distension, rebound tenderness or guarding. Her observations: HR 104 bpm, BP 112/72 mmHg, RR 21, oxygen saturation 97% RA and temperature 37.2°C. A 12 lead ECG shows atrial fibrillation with a ventricular rate of 110 bpm.

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