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Case historyA previously healthy 31-year-old Polish male presented to the accident and emergency department with suddenonset of abdominal pain. The pain followed an alcohol binge 8 h prior to his presentation and was generalised and constant in nature. There was no history of trauma related to his excessive alcohol intake. There was one episode of vomiting but no other bowel or urinary symptoms. He also complained of pain in his left shoulder.On physical examination, the abdomen was soft and non-distended. Tenderness was elicited all over the abdomen but was more severe in the epigastric region and right loin with mild guarding. There was no rebound tenderness or rigidity. There were no masses or organomegaly to find. He was afebrile and no abnormalities were detected in the cardiovascular and respiratory examinations. His blood pressure was 130/85 mmHg and heart rate was 83 bpm.Laboratory tests demonstrated a raised white blood cell count of 13.7 × 10 9 /l (normal range, 4.5-11.0 × 10 9 /l) and a C-reactive protein of 16 mg/l (normal range, 0-8 mg/l). Renal, liver function tests, serum amylase and clotting profile were all within normal limits. An erect chest and abdominal radiograph did not reveal any abnormalities. Abdominal ultrasound showed a large amount of abdominopelvic free fluid. The liver was normal in echoic texture with no focal lesions, and the pancreas and kidneys were also normal. The spleen was 'Not just another appendicitis!' -a case report of acute abdominal pain caused by splenic rupture secondary to isolated splenic peliosis ABSTRACTWe present the case of a 31-year-old man admitted with acute abdominal pain who was subsequently found to have a ruptured spleen. A splenectomy was performed as an emergency and he was discharged from hospital 4 days later. Histological analysis revealed isolated splenic peliosis as the underlying condition predisposing to his splenic rupture.

The IC-OSAF is a practical, easy-to-use tool for the analysis of local obesity management strategies. The framework can help identify gaps and limitations in strategies to help reduce variations in obesity management between PCTs.

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