Sudden Severe Epigastric Pain in Surgery — 45yo Man | General Surgery | SMLE Q#18347
SMLE Question #18347
Surgery
General Surgery
Objective: OBJ-TRACH-EMERG-01
Last updated: February 2026
A 45-year-old man presents to the emergency department with sudden severe epigastric pain that started 6 hours ago and became generalized. He has intermittent dyspepsia and frequent NSAID use for back pain. Examination shows a rigid abdomen with diffuse guarding and rebound tenderness. An upright chest radiograph shows free air under the right hemidiaphragm. What is the most likely diagnosis?
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