Abdominal pain

A man in his late 50s presented to the emergency department with a 2-day history of progressively worsening abdominal pain, episodes of vomiting and lower back pain. He had suffered similar intermittent episodes over the last 2 weeks. His comorbidities included medication-controlled essential hypertension, an ex-smoker, and an ischaemic stroke, which caused expressive dysphagia 6 weeks prior to admission. On physical examination, he had tenderness in the right upper abdomen and right flank pain with no palpable masses or an aneurysm. He was apyrexial, and his observations were stable. He was found to have a systolic ejection murmur; its cause not clearly known then. Plain chest and abdominal X-ray films were normal. Contrast CT of the chest, abdomen and pelvis were conducted.