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The patient is a 54-year-old woman who presents with a one-day history of abdominal pain and nausea.
On exam, you note distended abdomen with diffuse tenderness and rebound.

View the image taken (Figure 1) and consider what your diagnosis and next steps would be.
Resolution of the case is described on the next page.

Clinical Challenge 2: December, 2010

Nahum Kovalski, BSc, MDCM

Clinical Researcher at TEREM Emergency Services