Background: A 36-year-old male presented to the emergency department with a 4-day history of vomiting, loss of appetite and gastric pain radiating to the back. He denied fever and diarrhea. His medical record includes a Billroth-II procedure in another hospital for gastric lymphoma in 1992, hepatitis C and ferriprive anemia. Vital signs in the emergency department were normal. The abdomen was soft and diffusely tender. There was voluntary guarding in response to palpation and decreased bowel sounds on auscultation. There was no palpable mass. Further clinical examination was normal. The WBC count was 6800 McL, CRP 14.7 mg/L and LDH 2516 U/L.