A 50-year-old, male North African immigrant presented with 3 hours of abdominal pain, initially diffuse, then migrating to the lower abdomen, with greater right-sided pain. He had nausea and anorexia but no fevers and no abnormal bowel movements. He had been admitted a month prior with several days of abdominal pain, vomiting, and melena. At that time, esophagogastroduodenoscopy revealed nonbleeding duodenal varices and abdominal ultrasonography was within normal limits. He was discharged home with treatment for Helicobacter pyloriand scheduled for a capsule study but was lost to follow-up.