16th July 2020

An 18-year-old man presents with severe right iliac fossa pain and raised inflammatory markers

An 18-year-old man presents with severe right iliac fossa (RIF) pain and raised inflammatory markers. Thirty-six hours ago he had centralised abdominal pain but delayed seeking medical advice. On examination he is found to have a temperature of 39⁰C, a heart rate of 90 and blood pressure of 142/90. He struggles to lie flat for the examination, but localised tenderness in the RIF, and decreased bowel sounds. There is no mass to be felt. He has not opened his bowels in 36 hours but is passing flatus.

Which complication is most likely to have occurred?

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