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A 66-year-old woman was referred with a 2-month history of increasing abdominal pains which were central, colicky and associated with abdominal distension. Her symptoms were worse after food. Over this period she had also developed loose stools 2–3 times per day. She denied weight loss. Medical history included psoriasis complicated by a small joint arthropathy. There had been no previous abdominal surgery and she was taking prescribed slow-release diclofenac and sulphasalazine. On examination she was anaemic with a psoriatic rash on her elbows and shins. The distal interphalangeal joints were deformed. The abdomen was distended, more so …
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