A patient is 62-year old man presented with an acute abdomen.
He had 3 days of mild epigastric discomfort. 6 hours before evaluation he developed acute onset of severe diffuse abdominal pain. He had been taking ibuprofen 600mg several times a day for joint pain.
Upon exam, he had diffuse peritonitis and involuntary contraction of the recuts and oblique musculature.
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