17th August 2020

A 31-year-old woman presents to the A&E department with acute abdominal pain

A 31-year-old woman presents to the A&E department with acute abdominal pain. She has a background of polycystic ovarian disease, which she manages with the combined oral contraceptive pill. Routine bloods are normal, a urine pregnancy test is negative, and urinalysis shows trace amounts of blood and protein. She is tachycardic and tachypnoeic, saturating 99% on room air, afebrile, and normotensive. The pain remains severe despite paracetamol, ibuprofen and morphine – and she has vomited three times. There is no associated change in bowel habit, and she last opened her bowels a few hours previously. On examination, she is tender across the lower abdomen and pelvis bilaterally, and demonstrates guarding in the left iliac fossa.

Which of the following would be the most appropriate next investigation?

Select the SINGLE most appropriate option from the list below. Select ONE option only.