An 86-year-old female presented at the emergency room with abdominal pain, nausea and vomiting. She had been without symptoms until she fell on her buttocks one hour before. The pain gradually increased with time. She had no fever, diarrhoea or blood loss.Her medical history revealed a hysterectomy and several fall accidents. Because of constipation she used macrogol if necessary.On examination she was an ill-looking lady in obvious pain. Pulse rate, temperature and blood pressure were within the normal range. There was no audible peristalsis over her abdomen, all regions were extremely painful with guarding and rebound tenderness. Abdominal pain precluded rectal digital examination and optimal examination of the lower extremities.
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