A 29-year-old man presented to the ED with 4 hours of colicky left lower quadrant pain. The pain came on rapidly, not long after breakfast, and was associated with nausea. It was aggravated by lying back, and eased by leaning forward and lying on his left side. He had passed flatus in the morning but not opened his bowels. He had no urinary or bowel changes, and no past medical history of note.
He also reported two similar episodes in the past ten days, both causing him to present to hospital, however the pain improved both times within 8h following treatment with analgesic and buscopan. He had been well in the intervening period. On examination his vital signs were unremarkable, but there was marked guarding over the left umbilical area, with a palpable boggy and tender mass, roughly the size of a fist. Bowel sounds were not detected. His FBP, UEC and CRP were all within normal limits.…
