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Girish Gopal, Keerthan N, Veeresh H, Sudha Rudrappa
Department of Pediatrics, Mysore Medical College and Research Institute, Mysore, Karnataka, India

Address for Correspondence: Dr. Girish Gopal, Senior Resident, Department of Pediatrics, Mysore Medical College and Research Institute, Irwin Road, Mysore – 570021, Karnataka, India. Email:

A 5 year old female child presented to the emergency room with 15-20 episodes of non bilious, non-blood stained vomiting associated with mild abdominal pain of 4 hours duration prior to admission. Vomiting was not associated with fever, abdominal distension, loose stools or constipation. At admission, she was given symptomatic treatment with intravenous fluids, anti-emetics and antacids. Within 3 hours of admission, she became restless, developed severe abdominal pain and retching, progressive generalized distension of the abdomen, respiratory distress and signs of decompensated shock. We were unable to pass a nasogastric tube to decompress her abdomen. Erect x-ray abdomen showed massive dilatation of the stomach, paucity of distal gas shadow and significant pneumoperitoneum shifting the intra-abdominal viscera to the midline.

What is the diagnosis_?

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