Can vary from mild abdominal pain to shock. Common symptoms: (1) steady, boring pain in the epigastricand periumbilical region may radiate to the back, chest, flanks, and lower abdomen; (2) nausea, vomiting, abdominal distention.

Physical examination: (1) low-grade fever, tachycardia, hypotension; (2) erythematous skin nodules due to subcutaneous fat necrosis; (3) basilar rales, pleural effusion (often on the left); (4) abdominal tenderness and rigidity, diminished bowel sounds, palpable upper abdominal mass; (5) Cullen's sign: blue discoloration in the periumbilical area due to hemoperitoneum; (6) Turner's sign: blue-red-purple or green-brown discoloration of the flanks due to tissue catabolism of hemoglobin.