PT - JOURNAL ARTICLE AU - Joerg Schramm AU - Andreas Rickenbacher AU - Dagmar Iris Keller TI - Eighty-nine-year-old woman with abdominal pain and vomiting AID - 10.1136/emermed-2017-207359 DP - 2018 Sep 01 TA - Emergency Medicine Journal PG - 576--576 VI - 35 IP - 9 4099 - http://emj.bmj.com/content/35/9/576.short 4100 - http://emj.bmj.com/content/35/9/576.full SO - Emerg Med J2018 Sep 01; 35 AB - 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).Figure 1 Supine AXR.What is the diagnosis?Foreign bodyGallstone ileusColon obstructionIntestinal volvulus