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Case 19

61 year old lady with post prandial abdominal pain

Li Foong Foo

A 61 year old lady presented at the Gastroenterology Clinic with a 4 month history of central abdominal pain which seemed to occur several hours after eating. She described it as very severe, lasting 3-4 hous at a time, with apparent relief by flatulence. There had not been any vomiting or change in bowel habit. Although she felt hungry, she had been scared to eat and as a result had lost one and a half stone in weight.

Prior to this, she had always enjoyed good health. Her only regular medication was hormone replacement therapy. She smoked 12 cigarettes a day and drank moderate amounts of alcohol only.

Except for evidence of recent marked weight loss, her physical examination was unremarkable.

Ultrasound revealed normal liver, gallbladder, pancreas, spleen and kidneys.

What is the likely diagnosis? What investigation would you perform to confirm it?