ABSTRACT
This patient was referred to your surgical take and brought in by his loyal canine friend in the early hours of the morning complaining of right upper quadrant pain. His friend was asked by the matron to wait outside due to the strict no dogs (except guide dogs) policy in the hospital. The pain is constant in nature and he has vomited once. He also feels very feverish. He is normally well, although he describes having pains on that side for several months, worse after a meal. He reports that the past few days he has been enjoying a ‘particularly good Wensleydale.’ On examination he is febrile at 38°C, looks flushed, with a heart rate of 105, BP 120/70 and RR of 15. His saturations are 100%. He is Murphy’s positive and the rest of his abdomen is soft. A rectal examination is unremarkable. His bloods show a markedly raised CRP and white cell count, with normal LFTs and a normal amylase. An erect chest radiograph does not show any free air.
