Case 9-1990

Presentation of Case A 39-year-old man was admitted to the hospital because of left-sided abdominal pain, malignant hypertension, and proteinuria. The patient was in excellent health until 27 days earlier, when he experienced the acute onset of pain in the left upper abdominal quadrant. He was seen at another hospital, where an x-ray film of the chest was reported to be normal. The pain resolved in three hours, and the patient was discharged. Five days later severe pain recurred in the left upper abdominal quadrant, was "knife-like," and radiated slightly to the left side of the midabdomen; nausea and vomiting . . .