Dr.

Jones Jiminez

Surgeon

Melbourne Private Hospital

19 Grange Road

Melbourne

22/01/07

Dear Dr. Jiminez,

Re: Mrs. Ann Howard, 36 year old

I am writing to refer Mrs. Howard, who has been diagnosed with proximal intestinal obstruction due to
diverticulitis or cancer for further assessment and possible surgical management.

Mrs. Howard is a married woman with 3 children. She had her last menstrual period in October 2006.
Her past surgical history includes ovarian cystectomy and appendectomy

On 18/12/06, Mrs. Howard experienced pain in the left inguinal region for the first time. Then, on
09/01/07, she presented in emergency with complaints of abdominal cramps and vaginal bleeding.

On 20/01/07, Mrs. Howard presented at my clinic with a sharp and persistent pain in her lower left
abdominal region which worsened on movement. Her pain was not associated with vomiting, urinary
and bowel symptoms. On examination, her abdomen was tender and a mass was appreciated in the left
lower abdomen.

On 21/01/07, Mrs. Howard presented with mild but persistent pain. She had be constipated for the last
3 days after which she passed a hard, bright red blood streaked stool. On 22/01/07, she reported that
pain increased after every meal. Her abdomen was tense and bowel sounds were absent. Her
Hemoglobin levels were 9.3 g/dl

In view of the above, Mrs. Howard requires your expertise for further management and possible surgical
intervention.
If you have any queries, kindly contact me.

Yours sincerely,

Doctor