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Previous Volume 361:1387-1392 October 1, 2009 Number 14 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows.

A 52-year-old man presented to the emergency department with abdominal discomfort. His symptoms began 5 weeks earlier, when nonradiating discomfort developed in the epigastric region. The pain worsened after eating and was associated with nausea and bloating that were partially relieved by eructation. Two weeks before presentation, the patient's pain became more localized to the periumbilical area and was accompanied by early . . . [Full Text of this Article]

Commentary

Source Information

From the Clinical Pathological Conference Series, Department of Medicine, Brigham and Women's Hospital (B.M.W., J.T.K., B.D.L., J.L.); Beth Israel Deaconess Medical Center (P.F.W.); and Harvard Medical School (B.M.W., P.F.W., J.T.K., B.D.L., J.L.) — all in Boston.

An Interactive Medical Case related to this Clinical Problem-Solving article is available at NEJM.org.

Address reprint requests to Dr. Levy at the Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, or to blevy@partners.org.

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