case_images: PMC3965945_01
case_images: Fullness at epigastrium due to gastric distension.
case_images: CRIGM2014-527471.001.jpg
case_images: PMC3965945_01_CRIGM2014-527471.001.jpg
case_images: fig1
case_images: Local examination revealed a soft and lax abdomen with fullness at epigastrium (Figure 1) with no palpable masses, organomegaly, or ascites.
case_images: Barium meal shows obstruction at pylorus (white arrow) and a crater of an ulcer (black arrow).
case_images: CRIGM2014-527471.002.jpg
case_images: PMC3965945_01_CRIGM2014-527471.002.jpg
case_images: fig2
case_images: After correction of dehydration and electrolyte imbalance and establishment of total parenteral nutrition, she underwent barium meal which confirmed the clinical impression of gastric outlet obstruction and in addition showed a crater of an ulcer at lesser curvature (Figure 2).
case_images: Ultrasound abdomen shows thickening of antral (asterisks) and pyloric wall.
case_images: CRIGM2014-527471.003.jpg
case_images: PMC3965945_01_CRIGM2014-527471.003.jpg
case_images: fig3
case_images: Ultrasound of abdomen revealed marked thickening of antral wall (12 mm in diameter) and pyloric channel (Figure 3) and moderate amount of fluid within the pelvis.
case_images: Endoscopic view of obstruction at pylorus (long arrow) and a clean bed of an ulcer at lesser curvature (short arrow).
case_images: CRIGM2014-527471.004.jpg
case_images: PMC3965945_01_CRIGM2014-527471.004.jpg
case_images: fig4
case_images: Upper gastrointestinal endoscopy showed a markedly erythematous, fragile and erosive mucosa at lower esophagus, a markedly thickened antral mucosa occluding the pylorus, and a clean base ulcer 2 centimeters x 1.5 centimeters at the lesser curvature of the stomach (Figure 4).
case_images: Histopathology of a biopsy form edge of the gastric ulcer shows signet-ring-cell infiltrate (arrows) consistent with gastric adenocarcinoma. (Hematoxylin and eosin staining; magnification x40).
case_images: CRIGM2014-527471.005.jpg
case_images: PMC3965945_01_CRIGM2014-527471.005.jpg
case_images: fig5
case_images: The biopsies obtained from the edge of the gastric ulcer demonstrated poorly differentiated signet-ring-cell adenocarcinoma (Figure 5).