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Sudden onset severe epigastric pain in a man aged 48 years
  1. Stephanie Dorothy P M Yu,
  2. James Siu Ki Lau,
  3. Ka Leung Mok
  1. Accident & Emergency, Ruttonjee Hospital, Hong Kong SAR, Hong Kong
  1. Correspondence to Dr Stephanie Dorothy P M Yu, Accident & Emergency, Ruttonjee Hospital, Hong Kong SAR, Hong Kong; rhaedsdy{at}gmail.com

https://doi.org/10.1136/emermed-2021-212147

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    Clinical introduction

    A man aged 48 years with untreated hypertension presented with sudden onset severe tearing epigastric pain and nausea with no radiation. He denied fever, vomiting, diarrhoea, tea-coloured urine, peptic ulcer disease or non-steroidal anti-inflammatory drugs use. He was afebrile but appeared distressed, with BP 164/109 mm Hg, HR 71 bpm and oxygen saturation 100% on room air. Abdomen was non-tender and bowel sounds active. Respiratory and cardiovascular examination was unremarkable. ECG, CXR and abdominal X-ray, urinalysis and blood tests were normal. He received parental hyoscine and tramadol without relief. Bedside ultrasound was performed (figure 1) (online supplemental video 1).

    Supplementary video

    [emermed-2021-212147supp001.mov]
    Figure 1

    Axial and longitudinal view of ultrasound abdomen.

    Question

    What is the diagnosis?

    1. Acute …

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    Footnotes

    • Contributors All authors contributed equally to the writing process.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.