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An unusual cause of persistent vomiting
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  1. A G Acheson,
  2. J Collyer,
  3. G A McPherson
  1. Wycombe General Hospital, Alexandra Road, High Wycombe, Buckinghamshire HP11 2TT, UK
  1. Correspondence to:
 Mr Acheson; 
 austin.acheson{at}nottingham.ac.uk

http://dx.doi.org/10.1136/pmj.79.929.178-a

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    Answers on p 181.

    An 85 year old woman presented to the outpatient department with a three month history of persistent vomiting and weight loss with associated retrosternal and epigastric discomfort. She had undergone a partial gastrectomy for benign ulcer disease 40 years previously and had an Angelchik prosthesis inserted 14 years ago for gastro-oesophageal reflux. There was no other past medical history and she was currently taking no medication.

    On examination she looked cachectic but no other abnormalities were detected on general or abdominal examination. Routine blood tests (full blood count, urea and electrolytes, liver function tests, and erythrocyte sedimentation rate) were all within the normal range and after this a barium meal was organised in an attempt to make a diagnosis (fig 1).

    QUESTIONS

    1. What abnormality is shown on the barium meal?

    2. What are the options for dealing with this complication?

    3. What other complications have been reported after insertion of this prosthesis?

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