A man with intolerant vomiting

Case presentation A 57-year-old man was in a healthy state until 6 hours before presenting to the emergency department, when he suffered from more than 10 episodes of vomiting after a large meal at lunchtime. On physical examination, vital signs were unremarkable. Tenderness was noted over the epigastrium on palpation. Point-of-care ultrasound (POCUS) of the abdomen is shown in figure 1 and online supplementary video 1. 10.1136/emermed-2019-208863.supp1 Supplementary video Figure 1 Transverse (A) and longitudinal (B) ultrasonography of the epigastrium. Question What is the most likely diagnosis? Hypertrophic pylorus stenosis Aortic dissection Superior mesentery artery (SMA) syndrome Volvulus For answer see page 2