Sudden in Surgery — 54yo Man | General Surgery | SMLE Q#1337
SMLE Question #1337
Surgery
General Surgery
Objective: OBJ-TRACH-EMERG-01
Last updated: February 2026
A 54-year-old man presents to the emergency department with sudden, severe, continuous epigastric pain for 3 hours. He has taken high-dose NSAIDs daily for knee osteoarthritis. He reports nausea without vomiting, haematemesis, diarrhoea, or constipation. He lies still and appears distressed. Examination shows abdominal rigidity, marked epigastric tenderness with guarding, and reduced bowel sounds. What is the most likely diagnosis?
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