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Coffee-ground vomit and subdiaphragmatic air
  1. Ambrose Boles,
  2. Jack Pottle
  1. Ealing Hospital, Southall, London, UK
  1. Correspondence to Dr Jack Pottle, Ealing Hospital, Southall, London UB1 3HW, UK; jackpottle{at}

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A 90-year-old nursing home resident was admitted with confusion and reported ‘coffee-ground’ vomit. A chest radiograph was performed.

Coffee-ground vomit and subdiaphragmatic air

A 90-year-old female nursing home resident was found minimally responsive by her carers with a reported history of ‘coffee-ground’ vomit. She had a past medical history of Alzheimer's dementia and recent humeral fracture. Her only regular medication was lansoprazole 30 mg OD.

On arrival to the emergency department she was in circulatory shock with a blood pressure of 73/54 and pulse rate of 143 beats per minute. Respiratory rate was 44 and she was feverish at 38.2°C. …

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  • AB and JP contributed equally to this study.

  • Competing interests None declared.

  • Patient consent Verbal consent obtained and family willing to sign consent as legal guardians, due to patient's dementia. Awaiting return of consent form.

  • Ethics approval No intervention required—essentially a radiological case study. Verbal permission obtained and family willing to sign release of images.

  • Provenance and peer review Not commissioned; internally peer reviewed.