Author: Natasha Nwosu / Editor: Jessie Lynch / Codes: / Published: 29/07/2026
A 49-year-old female presents to the Emergency Department (ED) with severe abdominal pain, persistent vomiting and 4-day history of constipation. She has a background of stage 4 ovarian cancer with no previous surgical history, as well as epilepsy, for which she takes Levetiracetam 500mg BD. She is due to see her neurologist next week, as her seizures have recently become uncontrolled.
Since waking up today, she noticed that she was no longer passing flatus and that her pyjamas felt tight around her abdomen, despite not having eaten yet. Shortly after having breakfast, she developed progressively worsening nausea, followed by vomiting from around 2 pm, occurring at least every 30 minutes. As a result, she has not eaten or drunk since then and feels dizzy on mobilisation.
She has longstanding lower abdominal pain which has been attributed to her cancer, for which she takes 30-60mg dihydrocodeine up to four times daily as needed.
Relevant bloods: eGFR 28 mL/min/1.73m , Hb 121 g/L, inflammatory markers normal, electrolytes within range.
On examination, she is alert and orientated, though in visible distress. Observations: oxygen saturations 95% on room air, respiratory rate 20 breaths/minute, blood pressure 129/88mmHg, heart rate 99 beats/minute, temperature 36.9 C.
Her abdomen is grossly distended but non-peritonitic, with quiet bowel sounds.
