ABSTRACT
A 42-year-old man presented to the emergency department complaining of recurrent episodes of abdominal pain. He had attended the emergency department twice previously over the past 2 months, complaining of abdominal pain that had resolved with simple analgesia on each occasion. The pain was dull and cramping in nature and came on intermittently three to four times daily, lasting for approximately 20 minutes. The pain was relieved by opening his bowels. The patient also complained of 4 months of passing loose stools mixed with mucus, but denied any rectal bleeding or melaena. He had not vomited and had maintained a normal appetite. The patient had no past medical history and took no regular medications, although he had been occasionally using loperamide to relieve his diarrhoea over recent weeks. He was an ex-smoker with a 3 pack year smoking history. He drank around 8–10 units of alcohol per week. He worked as a train guard and lived with his wife and daughter. His last travel abroad was to Geneva 1 year ago. He denied feeling feverish or losing weight, but the patient's wife reported that he appeared flushed in the evenings.
