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Gut. 2007 April; 56(4): 575.
PMCID: PMC1856847

Abdominal distention in a 36‐year‐old with a gastric ulcer

Monitoring Editor: Robin Spiller

Clinical presentation

A 36 year old man presented with 3 month history of pain in the abdomen and abdominal distension. He had no previous history of surgery, abdominal trauma or tuberculosis. On physical examination, the abdomen was distended and non‐tender. On palpation, a firm to hard, ill‐defined mass was found in the umbilical region. Cardiovascular, respiratory and neurological examinations were normal.

Laboratory tests revealed normal haemoglobin levels, leucocyte counts, blood urea and electrolyte levels. Chest x ray showed mild left pleural effusion.

Plain x ray of the abdomen was unremarkable.

An upper gastrointestinal (UGI) endoscopy was performed which revealed grade B oesophagitis, and a 1 cm2 deep ulcer along the greater curvature in the mid body of the stomach with folds radiating from it. An endoscopic biopsy was obtained and the report awaited.

Contrast enhanced computed tomography (CT scan) of abdomen was carried out (fig 1A–C).

figure gt86561.f1
Figure 1 (A, B) Contrast enhanced CT scan of the abdomen shows adherent small bowel loops and localised fluid collection, encased within a thickened enhancing peritoneal membrane (arrows). (C) CT scan reveals dilatation of duodenal loops (arrow) ...

Question

What does the CT scan show and what is the diagnosis?

See page 592 for answer


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