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A 68-year-old man presented to our hospital with a 2-day history of upper abdominal pain and non-bilious vomiting. Twenty years previously he had undergone a subtotal gastrectomy with Billroth II reconstruction because of a gastric ulcer. He denied alcohol consumption or trauma. Physical examination revealed that his upper abdomen was tender with muscle guarding and rebound tenderness. Laboratory tests showed the following: haemoglobin 11 g/dl (normal, 14–16 g/dl), white blood count 12.9×109/l …
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