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A 40-year-old man presents to the emergency room complaining of severe abdominal pain that radiates to his back accompanied by several episodes of vomiting. He drinks alcohol daily. On physical examination, the patient is found on the stretcher lying in the fetal position. He is febrile and appears ill. The skin of his abdomen has an area of bluish periumbilical discoloration. There is no flank discoloration. Abdominal examina- tion reveals decreased bowel sounds. The patient has severe midepigastric tenderness on palpation and complains of exquisite pain when your hands are abruptly withdrawn from his abdomen. Rectal examination is normal. Which of the following is the most likely diagnosis?

  1. Acute cholecystitis

  2. Pyelonephritis

  3. Necrotizing pancreatitis

  4. Chronic pancreatitis

  5. Diverticulitis

  6. Appendicitis 


in General Surgery by

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Necrotizing pancreatitis