A 56-year-old man presents to the emergency department to be evaluated for severe diffuse abdominal pain
. He has associated nausea and vomiting. Past medical history is notable for four months of aching and burning epigastric pain
, which worsens after eating. He has been managing the epigastric pain by taking over-the-counter antacids
. At arrival, temperature is 37.9°C (100.2°F), pulse
is 120/min, respirations are 22/min, and blood pressure
is 120/66 mm Hg. Diffuse abdominal tenderness to palpation is noted on the physical examination. An upright abdominal radiograph is obtained and shown below. Which of the following best explains this patient’s underlying pathology?
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