Clinical Case Database / Category: Case Based Discussion

Latrogenic abdominal pain

Publication details

Vijay Joshi MBBS MD, Shahid Noor FRCS FCEM, Ashis Banerjee MS FRCS FCEM
Foundation Years Journal, volume 2, issue 1, p.32 (123Doc Education, London, January 2008)


An 82-year-old woman was admitted from the outpatient clinic for evaluation of progressive breathlessness over the preceding four months. Examination revealed bilateral pitting oedema from the ankles to the knees, with raised jugular venous pressure. A tricuspid pansystolic murmur was noted on auscultation. Past medical history revealed atrial fibrillation, type 2 diabetes mellitus, hypertension and chronic renal failure. She had been investigated for iron deficiency anaemia four years previously, which was attributed to angiodysplasia of the midgut, and treated by electro-cauterisation. At the time of admission she was on gliclazide, bumetanide, diltiazem, pioglitazone, losartan, simvastatin. Anticoagulation for atrial fibrillation was withheld because of the previous history of angiodysplasia.

Access the Clinical Cases Database

A subscription is required to read the full article. Please subscribe using one of the options below.

Foundation Years Clinical Cases Database£29.006 months
Add to cart
Foundation Years Clinical Cases Database£39.0012 months
Add to cart


Vijay Joshi MBBS MD

Registrar in Integrated Medicine
Chase Farm Hospital

Shahid Noor FRCS FCEM

Consultant Physician
Chase Farm Hospital

Ashis Banerjee MS FRCS FCEM (Corresponding author)

Consultant in Emergency Medicine
Chase Farm Hospital
The Ridgeway


1. Khan, MI, Medhat, O, Popescu, O, et al. Rectus sheath haematoma mimicking acute intra-abdominal pathology NZ Med J 2005, 118
2. Klingler PJ, Wetscher G, Glaser K, et al. Use of ultrasound to differentiate rectus sheath hematoma from other acute abdominal disorders. Surg Endosc 1999;13:1129–34
3. Berna JD, Garcia-Medina V, Guirao J, et al. Rectus sheath hematoma: diagnostic classifiation by CT. Abdom Imaging 1996;21:62–4
4. Costello J, Wright J. Rectus sheath haematoma: ‘a diagnostic dilemma?’ Emerg Med J 2005 Jul; 22(7): 523-4
5. Tsapatsaris NP. Low dose heparin. A cause of haematoma of Rectus Abdominis. Arch Intern Med 1991;151:597–599
6. Berna JD, Zuazu I, Madrigal M, et al. Conservative treatment of large rectus sheath hematoma in patients undergoing anticoagulant therapy. Abdom Imaging 2000;25:230–4
7. Chatzipapas IK, Magos AL. A simple technique of securing inferior epigastric vessels and repairing the rectus sheath at laparoscopic surgery. Obstet Gynecol 1997;90:304–6


Conflict Of Interest

The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (

Financial Statement

The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.

Patient Consent statement

All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts ( The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.

Animal & Human Rights

When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.

About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.