Case Report

A 77-year-old woman presented with a chief complaint of one day history of severe, acute abdominal pain. The patient described the pain as "intense," non-radiating, and located primarily in the left upper abdominal quadrant.The pain was associated with nausea and multiple episodes of non-bilious, non-bloody emesis. She denied melena and hematochezia. On physical examination, her abdomen was soft and exquisitely tender in the left upper quadrant and epigastric regions. Aside from trace lower extremity edema.the remainder of her physical examination was unremarkable. Laboratory results at the time of admission were notable for:hemoglobin 10.8 g/dL, alkaline phosphatase 459 U/L, aspartate transaminase 56 U/L, and alanine transaminase 66 U/L.

The patient's past medical history was significant for hypertension, gastroesophageal reflux disease, papillary thyroid carcinoma. and right eye uveal melanoma. The ocular melanoma was treated 16 years ago with radioactive plaque followed by transpupillary thermal therapy. The patient was diagnosed with metastatic disease to her liver approximately 6 years prior and she had received several rounds of hepatic radiation and chemotherapeutic embolizations. The patient's oncologist closely monitored her for disease progression through regular abdominal imaging studies.