Clever duck diagnostics were required to identify a small bowel perforation in this elderly lady.

The 84-year-old — who, notably, had dentures — presented to a London ED feeling generally unwell, with little appetite and a three-day history of abdominal pain, fever and intermittent loose stool.

Initial investigations picked up a UTI and an elevated CRP of 24. She was treated with cefalexin and discharged.

However, at a follow-up review three days later, her symptoms were continuing.