Description
A 51-year-old man with new-onset hypertension presented with mild epigastric pain that started 3 days ago. The pain was associated with emesis, subjective fevers and diaphoresis. He denied haematemesis, haematochezia, melena, fatigue, night sweats, abnormal bowel movements, weight change, skin changes or neuropathy.
His vitals were significant for heart rate of 120 bpm. He appeared pale with peripheral cyanosis. Abdomen was diffusely tender with normal bowel sounds. There was no rebound tenderness. Complete blood count, comprehensive metabolic panel, amylase and lipase levels were normal. CT of the abdomen demonstrated an abdominal haematoma centred ventral to the third portion of the duodenum and bilateral renal wedge-shaped infarcts (figures 1–3). Abdominal angiogram showed irregular pancreaticoduodenal arcade with microaneurysms originating from a branch of the proximal superior mesenteric artery (figure 4). The rupture of one of the microaneurysms was presumed to be the...
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