Gatric oulet obstruction
Severe epigastric pain with generalised abdominal guarding and rigidity.
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The whole stomach is markedly dilated with air and fluid seen inside, the duodenum is seen partially collapsed, yet no CT evidence of definite masses. A small gastric focal protrusion is seen medially close to the gastro-esophageal junction that could be a gastric ulcer. The ileal small bowel loops are seen in the right side of the abdomen, mostly by the effect of the dilated stomach. Incidental uncomplicated small sigmoid colon diverticulae and small sized right kidney that shows tiny hypodensities suggestive of renal cysts.
No other gross abnormality seen.
The main findings are suggestive of gastric outlet obstruction.
As the patient has a history of duodenal ulcer and no definite mass detected by CT, so the first possible cause of gastric outlet obstruction in this case is duodenal ulcer.