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A rare presentation of a common disease

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A previously well 77 year old man presented with acute left iliac fossa pain. He was pyrexial and tachycardic with localised abdominal guarding but there was no palpable mass or generalised peritonitis. Respiratory examination revealed tachypnoea with normal bilateral air entry and no tracheal deviation. Blood investigations showed a leucocytosis with raised serum C reactive protein and erythrocyte sedimentation rate. Serum amylase was normal and he was hypoxic with reduced oxygen saturation in the blood. His abdominal and erect thoracic radiographs are shown (figs 1 and 2). He also underwent abdominal computed tomography (fig3).

Figure 1

Abdominal radiograph.

Figure 2

Erect thoracic radiograph.

Figure 3

Abdominal computed tomogram.

Questions

(1) What are the radiographic findings?

(2) What is the most likely diagnosis?

(3) What are the treatment options?

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