Abstract
Epigastric pain is a common complaint in patients who present to the emergency department (ED); abdominal pain is the most common chief complaint in older adult patients who request treatment by a provider (A. B. Friedman et al., 2022). These patients may experience atypical presentations, which can result in delayed or missed diagnosis altogether, increasing morbidity, and mortality. This is the case of an older adult man who presented with chest and epigastric pain. The clinical presentation, atypical signs, and symptoms of gangrenous gallbladder are presented herein along with the differential diagnoses and diagnostics for this patient. The care for and the "what not to miss" in the management of this patent are also examined in this article. It is imperative that ED providers diagnose gangrenous gallbladder early on, especially in the older adult population, who may present with covert signs and symptoms to prevent complications and avoid poor outcomes including death in this age group.