Abdominal pain in the emergency department: the importance of history taking for common clinical presentations

A 26‐year‐old man presented to the emergency department (ED) overnight with severe and disabling abdominal pain. On initial assessment, he described sudden onset sharp pain in the right iliac fossa 6 hours earlier, with subsequent generalisation across the abdomen and the development of nausea and vomiting, subjective fevers, profuse diaphoresis and pleuritic chest pain. On examination, there was general abdominal discomfort without rebound tenderness; clinical observations and the remainder of the examination were unremarkable. Basic investigations demonstrated a normal full blood count, electrolytes and liver function tests. The history and examination were not typical of an acute abdomen, appendicitis or cholecystitis. The patient provided a past medical history notable for gastro‐oesophageal reflux disease and a diagnosis of irritable bowel syndrome following a normal colonoscopy with a gastroenterologist. Intravenous analgesia was provided and resulted in symptomatic improvement.