A difficult diagnosis of severe loin abdominal pain: another imitation of other pathology

Working in the emergency department you see a different, and generally more severe, spectrum of presentations than you do in your general practice. One of the positives is that by having access to diagnostic techniques and specialist opinions, a reasonable working diagnosis can often be made. However, this does not always happen, and at times classic presentations turn out to be something very different and totally unexpected.

One Saturday day shift you attend to a 57-year-old man who had sudden severe (10/10) sharp pain in his right flank, with no urinary symptoms. His observations, examination and full blood count work up was normal.