A Rare Cause of Periodic Vomiting With Hematemesis in a 36-Year-Old Man.

Gastroenterology 2015;149:870–871 Question: A 36-yearold man presented to the emergency department with 1day history of massive hematemesis. Previously, he had experienced a 2-month history of postprandial abdominal fullness, periodic vomiting, and poor oral intake. There was no significant surgical history but history of gout without control. Physical examination showed a mild, tender, distended abdomen. Initial blood tests were unremarkable except hypokalemia (potassium, 2.9 mEq/L). Upright chest radiography showed round bubble superimposed at left lower chest (Figure A). Upper gastrointestinal endoscopy showed pseudoobstruction of the gastric body and the endoscope was not able advanced further (Figure B). What is the diagnosis? Look on page 871 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.