Case 42-1964

Presentation of Case First admission. A sixty-seven-year-old man was admitted to the hospital because of pain in the abdomen. He had been well until the evening of admission, when severe epigastric pain, nausea and vomiting developed suddenly after he ingested a large meal. There was no history of hematemesis, melena, jaundice or previous abdominal pain. Physical examination revealed an obese man moaning with pain. The heart and lungs were normal. Examination of the abdomen revealed tenderness in the epigastrium and the right upper quadrant. The edge of the liver was felt 2 cm. below the right costal margin and . . .