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JAMA Surgery Clinical Challenge
June 2015

Symptomatic Abdominal Mass

Author Affiliations
  • 1University of Illinois, Department of Surgery, Presence Saint Francis Hospital, Evanston
JAMA Surg. 2015;150(6):593-594. doi:10.1001/jamasurg.2015.0247

A man in his mid-20s with a history of alcohol abuse presented with abdominal pain after 3 days of drinking. He described the pain as a sharp, left upper-quadrant pain migrating to the epigastric region for 24 hours. The patient had a history of multiple episodes of hematemesis attributed to alcoholic gastritis; however, at this admission, he indicated he had not experienced vomiting. He admitted to early satiety over the past few months. Physical examination revealed a soft nondistended abdomen, but it was very tender in the epigastric region without rebound or guarding. There was no palpable mass. Elevated results of liver function tests, as well as amylase and lipase levels consistent with alcoholic pancreatitis, were noted. Magnetic resonance imaging, computed tomographic imaging, and upper endoscopy findings are shown in Figure 1. Biopsy results of the mass were reported as normal gastric mucosa.