Abstract
We present the case of a 79-year-old man admitted to the emergency room. Having anorexia and vomiting as main complaints, combined with abdominal distension and discomfort, diagnostic examination revealed a giant left inguinal hernia containing the antrum and pylorus of a dilated stomach, creating an outlet obstruction. This was complicated with free peritoneal air, gastric emphysema and air in the portal system due to ischaemia.