A 58-year-old man presented to our emergency department because of progressive epigastric pain to right upper quadrant pain, nausea, and vomiting that had persisted for 2 days. He denied specific contact and cluster history, but mentioned that he had undergone laparoscopic cholecystectomy more than 10 years prior. No particular family history, including cancer or autoimmune disease, was traced from the interview. In his initial presentation, the patient was afebrile, with stable vital signs.
