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Man with severe abdominal pain
  1. Chia-Wei Chen,
  2. Wei-Jing Lee
  1. Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
  1. Correspondence to Dr Wei-Jing Lee, Department of Emergency Medicine, Chi-Mei Medical Center, Tainan 710, Taiwan; saab931103{at}


Clinical introduction A 59-year-old man with no medical history presented to the ED with abdominal distension, vomiting and diffuse abdominal pain after drinking seven cups of white gourd drink (an authentic Asian drink composed mainly of white gourd). A chest radiograph was performed (figure 1).

Figure 1

Chest radiograph. AP, anteroposterior.

Question What is the most likely diagnosis?

  1. Crescent in doughnut sign, intussusception

  2. Falciform ligament sign, pneumoperitoneum

  3. Stepladder sign, small bowel obstruction

  4. Coffee-bean sign, sigmoid colon volvulus

  • abdomen
  • imaging
  • X-ray
  • resuscitation
  • clinical care

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  • C-WC and W-JL contributed equally.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.