TO THE EDITOR A 79-year-old man was hospitalized because of worsening upper abdominal pain which started two days before admission and was continuously present. His personal and family history was uneventful, he did not smoke and denied toxic habits or using any medications, including over-the-counter medications, herbal remedies or any vitamin supplements. At admission, the patient was fully alert and oriented, afebrile, but distressed due to severe abdominal pain; his vital parameters were normal. On physical examination, there was abdominal guarding and rebound with hypoactive bowel sounds, rectal examination revealed no masses, liver and spleen were normal, and a stool sample was guaiac negative. The remaining physical examination was unrevealing. Laboratory tests showed a leukocyte count of 12×109 cells/L, 90% of which were neutrophils; electrolytes, amylase, lipase, and liver and renal function tests were normal. An electrocardiogram and a chest X-ray were also normal. A color Doppler ultrasonography and an TO THE EDITOR A 79-year-old man was hospitalized because of worsening upper abdominal pain which started two days before admission and was continuously present. His personal and family history was uneventful, he did not smoke and denied toxic habits or using any medications, including over-the-counter medications, herbal remedies or any vitamin supplements. At admission, the patient was fully alert and oriented, afebrile, but distressed due to severe abdominal pain; his vital parameters were normal. On physical examination, there was abdominal guarding and rebound with hypoactive bowel sounds, rectal examination revealed no masses, liver and spleen were normal, and a stool sample was guaiac negative. The remaining physical examination was unrevealing. Laboratory tests showed a leukocyte count of 12 × 109 cells / L, 90% of electrocardiogram and a chest X-ray were also normal. A color D oppler ultrasonography and an