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Case 149: Xray for abdo pain

This man presents with a 4 hour history of severe upper abdominal pain. He was quite well previously apart from a shoulder problem for which he has been taking analgesics recently. This man is unwell, shocked with generalised peritonitis.

1. What is the likely diagnosis?

2. What may have been a precipitating factor from the history?

3. Are any further imaging studies required before operating?