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A 45 year old woman presented to the accident and emergency department with a six hour history of central abdominal pain. The pain was of sudden onset, was constant in nature, radiated into both loins but not the back and was associated with vomiting. There were no urinary symptoms at initial presentation. On examination the patient appeared well with no systemic upset, temperature 36°C, pulse 60, and blood pressure 115/70. Abdominal examination revealed generalised tenderness but there were no signs of peritonism nor was there a definite mass …