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A 58-year-old man presented to our unit with intermittent epigastric pain that had developed since his involvement in a road traffic collision (RTC) 5 weeks earlier. The patient had been driving, and wearing a seatbelt, when his car collided head-on with a heavy goods vehicle (HGV). Apart from a fractured radius, sustained in the RTC, he was fit and well.
The patient appeared well. Aside from minimal tenderness of the epigastrium, physical examination was unremarkable. The following laboratory indices were abnormal; C-reactive protein 20 mg/l (0–5); haemoglobin 11.1 g/dl (13.4–16.6); amylase 295 U/l (0–90) and alkaline phosphatase (ALP) 226 U/l (30–130). A multidetector CT (MDCT) scan of the abdomen was undertaken …