Had a night call (yes, some GPs still do them, although this was a while ago!) to a very obese gentleman in his fifties who was complaining of severe pain in the LIF and groin/scrotum, which was severe and colicky in nature. He was very restless and pacing around the room. He denied any chest or back pain and was not SOB. His T, P and BP were stable, chest was clear and he couldn't provide a urine sample at the time and appeared clammy due to the pain rather than clinically shocked. His abdomen was so obese it was impossible to palpate anything significant and his femoral pulses were intact. Thought he may be having renal colic with the stone impacted in the lower third of the ureter and sent him in to the RSO regardless, who concurred with the diagnosis after various investigations. The gentleman collapsed and died four hours later with a ruptured AAA. I have now seen this presentation three times - renal colic patients tend to roll around on the bed - all three of these paced around the room, so beware! The only pointers to the diagnossis were the pacing (another colleague has reported this also), size of his abdomen, which may have been distended as well as grossly obese (he was a patient of another practice, so didn't know him personally)and the lack of response to the Omnopon pain relief he was given by the hospital (although personally would have used pethidine or diclofenac). So glad I did not just give him analgesia, antibiotics and instructions to increase fluid intake, as the RSO had originally refused the admission due to the usual lack of available beds.