Gastric outlet obstruction in a patient

An 81-year-old man with a history of hypertension presented to the emergency department with epigastric pain, vomiting, hiccups, anorexia, and obstipation for 3 days. Physical examination was notable for a painful epigastric tenderness. Laboratory examinations revealed a white blood cell count of 22.1 (3.4–9.7)(10 × 9/L).

Plain abdominal radiography showed pneumobilia and an enlarged gastric bubble (Figure 1), and abdominal ultrasound also demonstrated an enlarged stomach with a large amount of content within a curvilinear focus of increased echogenicity with posterior shadowing in duodenal bulb (Figure 2). Subsequent computed tomography (CT) image is shown in Figure 3.

The authors declare no conflicts of interest.