Abdominal Pain With Vomiting for 1 Day After Subtotal Gastrectomy More Than 20 Years Ago

Abstract

Question: A 70-year-old man presented to the emergency department because of abdominal pain with vomiting for 1 day. The patient had a past history of peptic ulcer disease and underwent subtotal gastrectomy 20 years ago; he was afebrile and the blood pressure was 181/110 mmHg. He reported no bloody stool or tarry stool in recent days. However, after nasogastric tube decompression, some coffee-ground material was observed. Physical examination showed a midline scar at the epigastric region. Severe tenderness and distention of the upper abdomen with hyperactive bowel sounds were noted. The laboratory values of liver functions and lipase were within normal limits, but it showed a leukocytosis with a white blood count of 11,440/ L. The hemoglobin was 13 g/dL (normal, 13–17). Computed tomography (CT) was then carried out (Figure A). What is the diagnosis? What is the appropriate management? Look on page 272 for the answer and see the GASTROENTEROLOGY web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.