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A 61-year-old woman presented to the emergency department with a 3-day history of vomiting, abdominal distension and pain plus anorexia. This was on a background of morbid obesity, non-alcoholic fatty liver disease and previous laparoscopic cholecystectomy. An elective procedure to enhance weight loss had been performed 5 months before the acute admission, without complication before presentation.
On examination her abdomen was soft, tender and with a palpable epigastric mass. Blood tests and vital signs were unremarkable. Chest radiography revealed no subdiaphragmatic free air but abdominal radiography revealed a significant abnormality (figure 1).
What is the diagnosis and next management step?
CT findings (figures 2 and 3) were reported …
Contributors KVP, JO and SR identified the case, and drafted and critically revised the article for content. All three were also responsible for managing the patient's case in the capacity as trainees while the patient was in hospital (KVP and SR provided emergency endoscopy provision and were the emergency gastroenterology trainees providing on-call cover, JO was the admitting doctor). JAO critically revised the manuscript and was the responsible attending physician during the course of the patient's admission, and the consultant responsible for the overall care of the patient. NG was the principal radiologist involved, reviewed the manuscript and provided all the radiology images for the article.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.