TY - JOUR T1 - Young patient with periumbilical pain JF - Emergency Medicine Journal JO - Emerg Med J SP - 540 LP - 564 DO - 10.1136/emermed-2019-208645 VL - 36 IS - 9 AU - Konstantinos Parperis AU - Christina Flourou Y1 - 2019/09/01 UR - http://emj.bmj.com/content/36/9/540.abstract N2 - A 32-year-old woman with a medical history of deep vein thrombosis (DVT) presented to the ED with a 2-day history of gradually worsening periumbilical pain. She denied fever, nausea, vomiting or diarrhoea. On examination the patient was found to have dilated veins on the anterior thoracic and abdominal wall with tenderness on periumbilical area (figure 1). Murphy’s sign and McBurney’s sign were negative. No ascites was detected. Complete blood count, liver and renal function tests, lipase and urinalysis were all in the normal reference range. CXR showed dilation of upper mediastinum.Figure 1 On inspection the patient had dilated veins on the … ER -