CASE 36: ABDOMINAL PAIN
History
A 74-year-old woman has a 10-year history of intermittent lower abdominal pain. The
pain has been colicky in nature and is associated with a feeling of distension in the left
iliac fossa. It is generally relieved by passing flatus or faeces. She tends to be constipated
and passes small pieces of faeces. Four years previously she passed some blood with her
bowel motion and had a barium enema performed. This is shown in Fig. 36.1. Over the last
week her pain has worsened and now she has continuous pain in the left iliac fossa and
feels generally unwell. Her appetite has been poor over this same time. She has not had
her bowels open over the last 2 days. In her previous medical history she had a hysterec-
tomy for fibroids 20 years ago. There is a family history of ischaemic heart disease and
diabetes mellitus. She lives alone and does her own cooking and shopping.
Examination
She has a temperature of 38.5°C and is tender with a vague impression of a mass in the
left iliac fossa. There is no guarding or rebound tenderness and the bowel sounds are nor-
mal. Her pulse is 84/min and blood pressure is 154/88 mmHg. There are no abnormalities
to find in the respiratory system.
Figure 36.1Barium enema.