PMC3965945_01
Fullness at epigastrium due to gastric distension.
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fig1
Local examination revealed a soft and lax abdomen with fullness at epigastrium (Figure 1) with no palpable masses, organomegaly, or ascites.
Barium meal shows obstruction at pylorus (white arrow) and a crater of an ulcer (black arrow).
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fig2
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).
Ultrasound abdomen shows thickening of antral (asterisks) and pyloric wall.
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fig3
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.
Endoscopic view of obstruction at pylorus (long arrow) and a clean bed of an ulcer at lesser curvature (short arrow).
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fig4
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).
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).
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fig5
The biopsies obtained from the edge of the gastric ulcer demonstrated poorly differentiated signet-ring-cell adenocarcinoma (Figure 5).