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Eighty-nine-year-old woman with abdominal pain and vomiting
  1. Joerg Schramm1,
  2. Andreas Rickenbacher2,
  3. Dagmar Iris Keller1
  1. 1 Institut für Notfallmedizin, UniversitatsSpital Zurich, Zurich, Switzerland
  2. 2 Department of Surgery and Transplantation, UniversitatsSpital Zurich, Zurich, Switzerland
  1. Correspondence to Dr Joerg Schramm, Institut für Notfallmedizin, UniversitaetsSpital Zuerich, Raemistrasse 100, CH-8091 Zuerich, Switzerland; joerg.schramm{at}


Clinical introduction An 89-year-old female patient presented to the ED with mild abdominal pain and a history of vomiting for 3 days. Because of dementia, further history was unclear. Vital signs were normal. Clinical examination revealed mild abdominal pain without defence or signs of peritonism. Bowel sounds were normal. Lab results showed a white cell count of 16x109/L, otherwise normal. There was no episode of vomiting during the ED consultation. A supine AXR was performed (figure 1).

What is the diagnosis?

  1. Foreign body

  2. Gallstone ileus

  3. Colon obstruction

  4. Intestinal volvulus

  • abdomen-non trauma
  • gastro intestinal imaging
  • x-ray emergency departments

Statistics from


  • Contributors JS assessed the patient in the ED and wrote the article. AR was the involved surgeon. DIK planned and reviewed the article.

  • Competing interests None declared.

  • Patient consent Obtained.

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

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