A 56-year-old woman was presented to the emergency department, complaining of severe abdominal pain since the previous day. Initially, the pain was in the upper abdomen, which became progressive and more severe. The pain further radiated to the back. Her other symptoms included nausea and a step-ladder pattern of fever. History: Five years ago, the patient suffered from a duodenal ulcer, which was successfully treated with Helicobacter eradication therapy.
Social history: The patient used to smoke 15 cigarettes per day, and consumed half a bottle of wine daily. Physical examination: The patient was pale, dehydrated, febrile (38.5°C). Her weight was 115 kg. Vital signs were: Pulse: 108/min Blood pressure: 124/76 mmHg Cardiovascular and respiratory system examination was normal. The patient’s abdomen was tender in the right upper quadrant and epigastrium, with guarding and rebound…
