The 18-year-old arrived at St Vincent's Hospital Sydney with severe abdominal pain, distension, and vomiting after eating at a buffet. He was not underweight. He stood 181 centimeters, weighed 71 kilograms, and had a body mass index of 22, with no significant medical history and no recent weight loss.
His bloods were alarming: lactate 13.7, pH 7.13, a white cell count over twice normal, and acute kidney injury. The CT scan explained why. His stomach measured 113 by 187 by 350 millimeters, distended all the way down to the pelvis, with a transition point at the third part of the duodenum where the bowel simply stopped. Gas had tracked into the wall of the stomach and into the portal vein, both signs that tissue was dying.
