A 37 year old man presented with severe abdominal pain

Question Number 0595

A 37 year old man presented to the casualty department with a history of the sudden onset of severe abdominal pain three hours previously. He had injured his left shoulder one week prior to this and had been taking Naprosyn for that week. On examination The patient appeared to have severe pain and was lying still. His heart rate was 90/min and BP 140/80 mmHg. He had board-like rigidity of his abdomen on palpation with generalised tenderness and rebound tenderness. Bowel sounds were absent. The next appropriate investigation would be

a) ultrasound of the abdomen
b) manometry
c) small bowel enema
d) erect chest xray
e) gastroscopy

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