History A 33-year-old female office worker presents to the emergency department complaining of severe left-sided abdominal pain. The pain woke her in the early hours of the morning and has persisted throughout the day. She is unable to keep still and has vomited bilious material on five occasions. She reports no diarrhea or rectal bleeding. Previous medical history includes appendicectomy and irritable bowel syndrome. She has had a recent colonoscopy, which was normal. She takes the mebeverine for irritable bowel syndrome and multivitamin tablets.
She smokes 15 cigarettes per day. Examination On examination, she has a temperature of 37°C, a blood pressure of 125/88 mmHg and pulse rate of 96/min. There is marked left loin tenderness, but the rest of the abdomen is not tender. Heart sounds are normal and the chest is clear. Her urinalysis suggests microscopic haematuria. Other blood…
