Sharon, 52, presents with 24 hours of worsening generalised abdominal pain, bloating, vomiting and constipation.

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<p>Sharon, 52, presents with 24 hours of worsening generalised abdominal pain, bloating, vomiting and constipation.</p><p>She reports intermittent abdominal pain and nausea for the past week. She is usually very well.</p><p>She has a remote past history of conservatively managed cholecystitis and hypertension that is well controlled with an ACEI.</p><p>On examination, she looks uncomfortable and is mildly febrile with no icterus. The abdomen is generally tender and bowel sounds absent.</p><p>The GP suspects small bowel obstruction and requests urgent investigations.</p><p>Pathology shows only slightly elevated bilirubin. The erect abdominal X-ray is pictured.</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.