The patient presented to the Emergency Department with a two day history of severe periumbilical pain, associated withudpersistent bilious vomiting. He was apyrexial and haemodynamically stable. Inflammatory markers were within normaludlimits. He admitted to a recent alcohol binge but denied using illicit drugs. Examination revealed tenderness in theudright upper quadrant and epigastrium with mild guarding. Following a similar episode of pain two years prior to thisudpresentation the patient had been diagnosed with gastritis and treated with a short course of proton pump inhibitorsud(PPI). Five weeks prior to the index admission, he had been admitted overnight with periumbilical pain and biliousudvomiting that had resolved following PPI administration.
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