The “scarf-ring sign” of ball valve syndrome

Abstract

A 53-year-old man presented with severe epigastric pain and vomiting after eating breakfast. Over the previous 6 months he had experienced intermittent mild epigastric pain and anorexia. On examination, mild tenderness was elicited in the epigastrium. He was not anemic. EGD revealed a deformed pyloric ring; the appearance suggested a scarf held by a ring (A). A polypoid lesion was pulled from the pyloric ring with a biopsy forceps. It proved to be a large, soft, submucosal tumor arising in the antrum (B and C).