Updated 01 June 2015

What's your diagnosis? - Case 12: severe tummy pain

This week we meet Mr E, a generally healthy 45-year-old social worker, who presents to his doctor with sudden severe abdominal pain. Put your X-ray goggles on and try solve this week’s case.


Mr E arrives at his GP’s rooms in agony. Since the early hours of the morning he has had severe abdominal pain. He went out for dinner to a local seafood restaurant the night before and had a glass of wine and seafood pasta.

He is unable to lie still and vomits twice. The following is a summary of the doctor’s notes:


Sudden onset abdominal pain: started around the navel, moved down to the right lower abdomen.(Patient describes pain as dull and aching; occasional cramping)

Vomiting and nausea; no reports of diarrhoea

Smoker, and used some alcohol one day ago

No previous medical or surgical history

On Examination

Patient appears to be in severe pain; restless and sweating

General examination:
Patient is not dehydrated; no signs of jaundice; not pale; no enlarged lymph nodes; no signs of cyanosis (oxygen deprivation); no signs of oedema.          

Abdominal examination:

On inspection: no obvious swelling; no previous surgical scars; no hernias noted

On palpating the abdomen: very tender abdomen – especially in the right lower quadrant. Abdomen feels hard; guarding on palpating the abdomen

On listening for bowel sounds: present, but obviously decreased

Cardiovascular and Respiratory exam:  clear, except for fast breathing and a rapid heart rate

Vital signs and side room investigations:

Heart rate: 112

Respiratory rate: 16

Haemoglobin: 13

Finger prick blood sugar: 3.1

Urine dipsticks: clear

Based on the above information, what is your diagnosis?

What’s your diagnosis? Join the guesswork on our Facebook page, or comment below. 

NOTE: Health24's on-site GP Dr Owen Wiese will reveal new cases on Thursdays. We'll post the answer with the story on Mondays, or you can get it via the Daily Tip – sign up here.

Previously on What's Your Diagnosis

What's your diagnosis? -  Case 1: vomiting and weight loss
What's your diagnosis? -  Case 2: eye pain
What's your diagnosis? -  Case 3: strange behaviour and a bullet in the back
What's your diagnosis? -  Case 4: seeing odd things
What's your diagnosis? - Case 5: mysterious lungs
What's your diagnosis? - Case 6: runner with seizures
What's your diagnosis? - Case 7: swollen knee
What's your diagnosis? - Case 8: bloody semen
What's your diagnosis? - Case 9: confusing neurological signs
What's your diagnosis? - Case 10: diabetic teenager with unusual signs and symptoms
What's your diagnosis? - Case 11: bruising with no apparent reason

Dr. Owen J. Wiese is Health24's resident doctor. After graduating from Stellenbosch University with additional qualifications in biochemistry and physiology he developed a keen interest in providing medical information through the media.


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