A 40-year-old man with no significant medical history arrived at a Michigan emergency department with a distended belly and pain that had exploded overnight. The day before, during what his surgical team described as mild blunt trauma, another person had landed directly on his abdomen with significant force. He had walked it off. Twenty-four hours later, his white blood cell count had climbed to 23.7 x 10⁹ per liter, a CT scan showed free air loose in his abdominal cavity, and surgeons were opening him up expecting a torn bowel.
What they found instead was a tumor roughly the size of a grapefruit that had been growing silently inside his small intestine and had just split open.
