To cite: Hoekstra RJ, Smakman N, Sanders FBM, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013201991 DESCRIPTION An 84-year-old woman presented to our emergency room with abdominal symptoms since a couple of weeks. She reported vomiting and absence of defaecation for 3 days. Her medical history revealed myocardial infarction and an appendectomy. Physica...