A 27-year-old African American female with no significant medical history presented with left upper quadrant pain radiating to the back, which had been worsening over several months. She had an inability to tolerate oral intake, progressive nausea and vomiting. A review of her symptoms revealed palpitations, mild shortness of breath and two episodes of recent bilious vomiting without haematernesis. Physical examination showed diffuse abdominal tenderness on palpation and mild tachycardia. Laboratory evaluation showed no significant abnormalities, including normal pancreatic and liver enzymes. The chest radiograph was normal.
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