Abstract
Question: A middle-aged Chinese gentleman with a background of hyperlipidemia and coronary artery disease, with no significant family history of cancer, presented with right-sided abdominal discomfort for 1 week, associated with worsening bloating, abdominal distention, and bilious vomiting. Before the acute presentation, he also experienced constitutional symptoms (loss of appetite and weight) and early satiety. He has not had any previous endoscopic evaluation. Physical examination revealed upper abdominal distension with no signs of peritonism and after insertion of a nasogastric tube, which yielded 1.0–1.5L of bilious fluid; the distension resolved.
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