A 38 year old man presented to ED with severe pain in upper abdomen. He has already taken course of triple therapy and now had elective endoscopy 2d ago. He is in shock. What is the most probable dx?

The key is C. Mediastinitis. [Mediastinitis usually results from an infection. It may occur suddenly (acute), or it may develop slowly and get worse over time (chronic). It most often occurs in person who recently had an upper endoscopy or chest surgery. A person may have a tear in their esophagus that causes mediastinitis].