Some like it raw: an unwanted result of a sushi meal.

Gastroenterology 2014;146:e8–e9 Question: A 39-yearoldwoman presented to the emergency department with upper abdominal pain that had lasted for several hours. Her past medical history was unremarkable. On the history taking, she was found to have eaten sushi containing raw fish, including tuna, salmon, and mackerel, the previous night. Her stool passage was normal. Physical examination showed epigastric and periumbilical tenderness without rebound pain. Laboratory data indicated leukocytosis with a white blood cell count of 10,990/mL (neutrophil, 68%; lymphocyte, 28%; monocyte, 3%; eosinophil, 1%), and C-reactive protein was slightly elevated at 2.8 mg/dL. The results of other routine blood analyses were normal. Emergent abdominal computed tomography (CT) revealed diffuse gastric wall thickening of >1 cm (Figure A, B). What is the diagnosis? How should the patient be managed? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.