A lesson I've learnt...

Abstract

A 53 year old man of sound constitution, and with a past history of peptic ulcer disease and mild diabetes mellitus, suddenly developed severe epigastric pain with occasional vomiting over the weekend. I was called to examine him, but found no significant abnormal clinical signs except epigastric tenderness. He had opened his bowels, and appendicitis and intestinal obstruction were excluded. There was no icteric tinge, and his urinalysis was normal. He was an obese individual, known to be a mild diabetic well controlled with dietary measures alone. He was not on any regular medication, drank alcohol socially and smoked 5 or 6 cigarettes daily. After 48 hours of conservative treatment, the pain, which was the predominant presenting complaint had not settled down. I called in a consultant surgeon for a home visit, and he advised urgent admission for investigation at St. Luke's Hospital, due to a possible epigastric mass.