A referral call was received regarding an 11-year-old boy who had presented to the A&E of his local hospital about 2 hours earlier. The boy, who appeared well grown, had been on a school rugby trip the week before and had broken his finger during a tackle. During the tour he felt he had performed disappointingly, and admitted that his running seemed ‘heavy’. The week following the tour, he had developed increasingly severe abdominal pain and become breathless playing on the trampoline with his sister. His parents felt he had also become pale and quieter than usual.