Abdominal pain

Case history

A 52-year old gentleman was referred to acute medicine by an out-of-hours general practitioner, with an unexplained ‘collapse’. The patient stated to have just ‘tripped and fallen’ with no new preceding symptoms immediately beforehand. Closer questioning revealed that he also been suffering from general malaise, shortness of breath, and five days of right upper quadrant pain and abdominal swelling. In the last six months he had lost thirtyeight kilograms in weight. He was diagnosed with a deep vein thrombosis in 1999 for which he had been treated with Warfarin. Both his parents had deep vein thromboses in their late 60s. He was a non-smoker, drank minimal alcohol and worked as a janitor. He was no longer anti-coagulated.