Diagnosis: Crohn's disease - gastroduodenal involvement, antral aphthous ulcerations, sinus tract along greater curvature

History: persistent nausea

Findings: 1. Image 1- frontal radiograph from UGI - greater curvature demonstrates abnormal contour 2. Image 2 - magnified view of greater curvature abnormality 3. Image 3 - arrowhead demonstrates tethered outpouching of stomach along greater curvature; arrow demonstrates tiny sinus tract 4. Image 4 - compression spot image of same area taken during the UGI 5. Image 5 - magnified view of greater curvature/distal antrum 6. Image 6- same as 5, with arrows pointing to tiny barium collections surrounded by small collars of edematous mucosa of the proximal antrum consistent with aphthous ulcers 7. Image 7 - axial intravenous and enteric contrasted CT image at level of stomach 8. Image 8- magnified view of 7; arrow demonstrates fibrous band tethering greater curvature of stomach to abdominal wall and contrast protruding outside the confines of the stomach and tracking into the proximal portion of the fibrous strand. This was consistent with a sinus tract. No extrinsic mass or gastric wall mass was seen.

Ddx: Crohn's disease Gastric diverticulum Peptic ulcer disease/gastritis Adenocarcinoma of the stomach Corrosive ingestion gastritis Radiation gastritis Tuberculous infection of stomach Syphilitic infection of stomach

Dxhow: The patient already had a known history of ileocolic Crohn's disease. EGD, UGI, and CT findings were all consistent with gastroduodenal involvment.

Exam: normal bowel sounds soft, nontender abdomen