A 24-Year-Old Man with Vomiting and Abdominal Pain

Saad A. Shebrain, MD; Hailey Chang, MD

Disclosures

September 14, 2017

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 accurately recognize. 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 24-year-old man presents to the emergency department with generalized weakness, progressive weight loss, intractable nausea, vomiting, and abdominal pain over the past few years. He describes his abdominal pain as intermittent episodes of sharp, intense pain localized to the epigastric region. In the past 2 days, he has had over 10 episodes in which his symptoms are exacerbated by food. He denies fevers, chills, shortness of breath, chest pain, hemoptysis, hematemesis, diarrhea, constipation, hematochezia, and melena.

His medical history is significant for asthma, gastroesophageal reflux disease, and a hiatal hernia for which he underwent repair a few years ago. He smokes cigarettes daily, with a 1.8–pack-year smoking history; he drinks alcohol occasionally and uses marijuana daily for chronic pain relief.

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