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A 76-year-old woman presented to the emergency department with a 3 day history of continuous pain in the upper abdomen and multiple episodes of non-projectile vomiting. The patient was dehydrated and physical examination revealed a firm right parasternal bulge and epigastric tenderness. There was a large air-fluid level in the retrocardiac area on the chest radiograph (figure 1). CT abdomen revealed an anteromedial defect in …
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