Question: A 75-year-old woman with celiac disease diagnosed 30 years ago who is not compliant with a gluten-free diet, and has gastroesophageal reflux disease and hypothyroidism, presented with gradually worsening abdominal distension, severe intermittent suprapubic cramping abdominal pain, nausea, vomiting, and nonbloody diarrhea of 10 days duration. Her past surgical history was notable for right inguinal herniorrhaphy. She denied fever and chills, but reported minimal weight loss. Her family history was notable for pancreatic cancer in her sister and lung cancer in her father.