A 59-year-old man presented to the emergency department with a 5-day history of increasing abdominal pain, nausea and constipation. Medical histoiy was relevant for a left colos-tomy for diverticulitis with reversal and chronic obstructive pulmonary disease. On physical examination, he was obese with no acute distress. Abdominal examination revealed normal bowel sounds, a soft abdomen and a palpable mass that was mildly tender in the right upper quadrant, with a positive cough impulse.
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