A 67-year old male with a history of myocardial infarction status post percutaneous coronary intervention and stage IV bladder cancer status post radical cystoprostatectomy with ileal neobladder reconstruction and chemotherapy (cisplatin and gemcitabine) presented with progressive, severe epigastric and lower abdominal pain associated with nausea. The pain had intensified over the previous week and was associated with a recent fifteen pound weight loss in the setting of poor oral intake. He denied nausea or diarrhea. His physical exam was notable for abdominal tympany and tenderness. His labs were notable for mild hyperkalemia (potassium 5.0 mmol/L), normal white blood cell count, lipase of 28 U/L, normal liver function tests, and positive 2+ leukocyte esterase and 1+ blood in his urine. Upper endoscopy showed a small Schatzki's ring in the distal third of the esophagus with small hiatal hernia and gastritis. On CT, there was thickened, indurated mesentery and a mesenteric mass (Figure 1) with abdominal lymphadenopathy and a new adrenal nodule.