A male aged 44 years presented to the emergency department with a 1-week history of intermittent right-sided abdominal pain radiating to the midline. Examination demonstrated a tender right upper quadrant with voluntary guarding and a low grade fever. One week previously, he had been admitted to hospital after an isolated, self-terminating seizure secondary to an deliberate venlafaxine overdose. His upper abdominal symptoms started immediately postseizure but at the time were attributed to musculoskeletal chest pain by the discharging team. Acute cholecystitis was suspected, but liver function tests, amylase and an erect chest radiograph were unremarkable.
The abdominal pain responded well to morphine, permitting a thorough reassessment of the patient, which revealed midthoracic spine tenderness, previously undetected. Prior to this, the patient had not complained of any back pain. A CT scan confirmed a burst fracture of T8 requiring urgent transfer to the local spinal unit for posterior stabilisation.
- Epilepsy and seizures
- General surgery
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Contributors RAJS was responsible for the conception, design and writing of the article and acquisition of images. NP helped to critically revise the article. SC helped to critically revise and approve the final version of the article.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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