Introduction

A previously fit and well 36-year-old male presented with sudden-onset severe epigastric pain that woke him from sleep, fever and rigors. This was preceded by 1 month history of mild abdominal pain that was unrelated to eating. He reported reduced appetite and one stone weight loss over the past week. He denied any nausea or vomiting. He usually suffered with diarrhoea, but had not moved his bowels for several days. He was taking no regular medications. He had been taking paracetamol as required and denied the use of non-steroidal anti-inflammatory drugs. He drank alcohol occasionally and smoked 15 cigarettes a day. His physical examination demonstrated epigastric tenderness but no peritonism. He was febrile at 37.9°C. White blood cells were raised at 20.4×10⁹ /L and C-reactive protein was 225 mg/L. The patient was commenced on intravenous antibiotics. A CT …