A 21-Year-Old Man With Epigastric Pain After a Wild Party

Abraham A. Ayantunde, MB BS, FRCS; George G. Araklitis, MB BS, BSc

Disclosures

February 25, 2019

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to recognize accurately. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 21-year-old white man presents to the emergency department with a 10-hour history of epigastric pain that is radiating to the chest. The pain is constant, localized, and sharp in nature.

He was at a party the previous night and admits to drinking alcoholic beverages but denies any illicit drug use. He has no associated nausea, vomiting, or indigestion, and he denies ever having suffered from this pain in the past. The patient provides no history of shortness of breath, palpitations, or syncope. He has no history of trauma to the epigastrium, and the patient does not remember anything that may be causing his symptoms.

His past medical history is significant for an appendectomy 9 years ago and surgery for a deviated nasal septum 11 months ago. He is not currently on any regular medication. He has no history of allergies. His family history is negative for any cardiac or abdominal pathology. He smokes approximately 1 pack of cigarettes a day and admits to binge-drinking alcohol at weekend parties.

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