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December 16, 2019

Image challenge: overeating and a wandering spleen

What caused a healthy patient severe chest pain and vomiting after overeating?
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Gastroenterology clinical image challenge: A previously fit and healthy 28-year-old man presented to the emergency surgical team with severe chest pain and vomiting after an excessively large meal. He described three previous identical episodes in the last three months, all exclusively after overeating. However, on each of these former occasions, his symptoms had settled at home after a brief period of starvation.

On examination, the patient was dehydrated and tachycardic with a rate of 120 bpm, but normotensive, apyrexial, and had a normal respiratory examination. The abdomen was neither distended, nor tender.

Admission laboratory tests and an arterial blood gas, including a lactate, were within normal parameters. An electrocardiogram showed an isolated sinus tachycardia. A chest radiograph was performed and revealed an air fluid level in the stomach. A subsequent computed tomography scan showed medial displacement of the spleen (figure), and confirmed the abnormality.

What is the diagnosis?

To find out the diagnosis, read the full case in Gastroenterology.

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