A rare intraabdominal emergency

A sixty-seven year old male patient admitted to the emergency department with complaints of epigastric pain and dark colored vomit which occurred while eating. The pain had a colic-like characteristic and spread to the chest. The patient vomited only once and continued to retch. No comorbid disease was present. The patient's blood pressurewas 167/101mmHg, pulsewas 67/min, respiratory rate was 22/min, body temperature was 35.5 C (95.9 F) and oxygen saturation was 93%. The physical examination was normal except for epigastric tenderness. The electrocardiogramwas normal. The biliary system and aorta were normal, and there was no free fluid in the abdomenwith bedside ultrasonography. There was no decrease in pain, despite the intravenous spasmolytic (hyoscine-N-butyl bromide, 20 mg) and morphine (3 mg) administration. Complete blood count, blood amylase, glucose, electrolytes, kidney and liver function tests were normal. The patient's abdominal computerized tomography images are shown in Fig. 1.