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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}

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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

Figure 1

Axial and longitudinal view of ultrasound abdomen.


What is the diagnosis?

  1. Acute …

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  • 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.

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