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Oesophagus and stomach
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Unusual cause of intra-abdominal perforation
  1. James Hong-En Kang,
  2. Matthew Williams
  1. Gastroenterology department, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
  1. Correspondence to Dr James Hong-En Kang, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK; james.kang{at}nhs.net

https://doi.org/10.1136/flgastro-2020-101730

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    A 57-year-old man presented with abdominal distension and severe abdominal pain, on a background of two stone unintentional weight loss over 4 months. Examination revealed a distended, tender and rigid abdomen. Cross-sectional imaging of the abdomen and pelvis was undertaken (figure 1A,B).

    Figure 1

    CT abdomen (A) demonstrating gastric dilatation with calibre change at the third part of the duodenum between the superior mesenteric artery and aorta. There is gastric intramural gas and intraperitoneal gas consistent with gastric perforation. CT abdomen (B) showing a dilated oesophagus, consistent with the diagnosis of achalasia.

    Question

    What is the diagnosis?

    Answer

    CT (figure 1A,B) shows gastric dilatation with calibre …

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    Footnotes

    • Contributors MW examined the patient and conceived the idea for the case report. JH-EK wrote the first draft of the manuscript. Both authors reviewed and amended the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.