Imaging appearance of malignancy associated gastrogastric intussusception in an elderly woman

Description 

A 70-year-old woman who was a known case of gastric malignancy under treatment in complementary medicine presented with epigastric pain and multiple episodes of vomiting for 5 days. On examination, her vitals were stable, and she was afebrile. Slight pallor (+/4) and bilateral pedal oedema were seen. Abdominal examination revealed epigastric tenderness and guarding rigidity. Chest radiograph (figure 1A) showed crescentic lucencies under both hemidiaphragms suggestive of pneumoperitoneum. Abdominal ultrasound (figure 1B–D) showed a large lobulated gastric mass having frond-like margins arising from the upper part of the body of the stomach and seen telescoping into its lumen, carrying the omentum and gastric vessels along, suggestive of gastrogastric intussusception. CT of the abdomen (figure 2) confirmed the ultrasound findings and detected one more lesion along the lesser curvature. The site of perforation was detected in the fundus of the stomach, and few necrotic metastatic lymph...

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