Bourke, MGMc Cormack, O2014-09-222014-09-222014-09Bourke MG, McCormick O. Response to 'Desperate for a hot shower'. IMJ. 2014 107(8)http://hdl.handle.net/10147/326374The patient presented to the Emergency Department with a two day history of severe periumbilical pain, associated with persistent bilious vomiting. He was apyrexial and haemodynamically stable. Inflammatory markers were within normal limits. He admitted to a recent alcohol binge but denied using illicit drugs. Examination revealed tenderness in the right upper quadrant and epigastrium with mild guarding. Following a similar episode of pain two years prior to this presentation the patient had been diagnosed with gastritis and treated with a short course of proton pump inhibitors (PPI). Five weeks prior to the index admission, he had been admitted overnight with periumbilical pain and bilious vomiting that had resolved following PPI administration.enArticleIrish Medical Journal (IMJ)