Abdominal examination revealed a distended abdomen with absent bowel sounds. A mass was palpable in the upper abdomen, and peritoneal signs were present. Cardiopulmonary examination was normal. Vital signs and laboratory results showed a temperature of 38°C, white blood cell count of 22 000/μL (to convert to ×109/L, multiply by 0.001) with 92% neutrophils, hemoglobin level of 16.3 g/dL (to convert to grams per liter, multiply by 10), a total bilirubin level of 3.2 mg/dL (to convert to micromoles per liter, multiply by 17.104), and a direct bilirubin level of 0.8 mg/dL (to convert to micromoles per liter, multiply by 17.104). Computed tomographic scan with contrast of the chest and abdomen was obtained (Figure 1 and Figure 2). Fluid resuscitation was initiated.