No abstract

An elderly gentleman suddenly developed moderate to severe epigastric pain associated with hypotension and tachycardia. A supine abdominal X-ray was taken. Urgent CT abdomen performed after initial stabilisation revealed large amounts of free gas and fluid in the peritoneal cavity. Emergency Laparotomy revealed a perforated gastric ulcer. Review of the supine abdominal X-ray showed a number of radiological signs of pneumoperitoneum. As supine abdominal X-rays are commonly performed in emergency departments, doctors should be competent in interpreting the radiological signs.

We report on a case of splenic rupture that presented eleven days after a trivial injury. Possible explanations of the delay in presentation and ways for early detection are discussed. Emergency physicians should always bear this entity in mind before discharging patients with left thoracoabdominal injury.

Blunt pancreatic injury is an uncommon cause of traumatic abdominal pain. Early diagnosis is difficult due to its subtle initial presentation, both clinically and on imaging study. Dilemma between a watchful expectant management and thorough initial investigation may arise. The management of a 44-year-old man presenting to the emergency department because of generalised trunk pain after blunt trauma is reported. (Hong Kong