Case summaries in three women presenting with lower abdominal pain

	Case 1	Case 2	Case 3
Age (years)	37	24	32
Presenting symptoms	Vague lower abdominal pain, 72 hour history; symptoms of cystitis; history of fall during alcohol use	Lower abdominal pain and associated bilateral loin pain; unable to pass urine; feverish; offensive urine	Sudden onset of suprapubic pain; previous attendance and discharge on same night; symptoms worsening
Findings on examination	Lower abdominal tenderness; no peritonism	Abdomen generally tender; no peritonism	Localised tenderness in right iliac fossa; no peritonism
Alcohol use	Alcohol misuse; 72 hours of drinking	Binge drinking on previous night	10 units/week; binge drinking 24 hours previously
Temp (°C)	37.2	37.9	36.6
Pulse (beats/min)	95	110	87
Blood pressure (mm Hg)	112/78	102/88	99/44
White cell count (×109 cells/l)	13.2	17.4	13.7
Urea (mmol/l)	7.5	7.2	2.3
Creatinine (µmol/l)	145	219	129
Findings on:
Abdominal x ray	Normal	Normal	Normal
Ultrasonography	Pelvic ascites	Pelvic ascites; unable to fill bladder despite bladder catheterisation	No ultrasonography performed
Initial catheterisation	Not catheterised	Dark urine (500 ml)	Not catheterised
Cystography	Leak from dome of bladder	Leak from left anterior margin bladder	No cystogram performed
Site of perforation at laparotomy	Rupture at dome of bladder	Rupture anterior wall of bladder	Longitudinal rupture at dome
Bladder repair	Open; two layer	Open; two layer	Laparoscopic; two layer