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A man with intolerant vomiting
  1. Ya-Chin Liang,
  2. Tou-Yuan Tsai
  1. Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
  1. Correspondence to Dr Tou-Yuan Tsai, Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan; 96311123{at}


Case presentation A 57-year-old man was in a healthy state until 6 hours before presenting to the emergency department, when he suffered from more than 10 episodes of vomiting after a large meal at lunchtime. On physical examination, vital signs were unremarkable. Tenderness was noted over the epigastrium on palpation. Point-of-care ultrasound (POCUS) of the abdomen is shown in figure 1 and online supplementary video 1.

Figure 1

Transverse (A) and longitudinal (B) ultrasonography of the epigastrium.

Question What is the most likely diagnosis?

  1. Hypertrophic pylorus stenosis

  2. Aortic dissection

  3. Superior mesentery artery (SMA) syndrome

  4. Volvulus

For answer see page 2

  • abdomen- non trauma
  • diagnosis
  • emergency department
  • ultrasound
  • gastro-intestinal

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  • Contributors Y-CL (first author) was a major contributor in writing the manuscript. T-YT (corresponding author) revised the manuscript for intellectual content, as well as the figures and the video.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

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