Sudden-onset Severe Epigastric Pain in Surgery — 48yo Man | General Surgery | SMLE Q#829
SMLE Question #829
Surgery
General Surgery
Last updated: February 2026
A 48-year-old man presents to the emergency department with sudden-onset severe epigastric pain radiating to the back. He has been taking nonsteroidal anti-inflammatory drugs daily for chronic knee pain. The pain began abruptly after a large meal and has worsened. He lies still and says movement aggravates the pain. An upright chest radiograph shows free air under the diaphragm. What is the most likely diagnosis?
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