1st August 2023

A 48-year-old man presents to A&E with acute epigastric pain associated with vomiting and systemic upset.

A 48-year-old man presents to A&E with acute epigastric pain associated with vomiting and systemic upset. He is in significant pain and requires opioids to settle. On examination, he is guarding his epigastrium. He has a past medical history significant for HIV infection and asthma. He states his HIV is well-controlled, and he is compliant with his medication, which is a standard triple therapy regimen.

What is the most likely cause of this presentation?

Select the SINGLE most appropriate option from the list below. Select ONE option only.