RT Journal A1 Schorn VJ, Baquerizo A, Mason RJ T1 IMage of the month—quiz case JF Archives of Surgery JO Archives of Surgery YR 2010 FD August 1 VO 145 IS 8 SP 791 OP 791 DO 10.1001/archsurg.2010.138-a UL http://dx.doi.org/10.1001/archsurg.2010.138-a AB Upright chest radiography revealed pneumomediastinum, pneumopericardium, and a markedly distended stomach with air in the gastric wall (Figure 1). Abdominal computed tomography with intravenous and oral contrast revealed pneumoperitoneum, retroperitoneal gas, thickened gastric mucosa, and gas in the wall of the stomach (Figure 2).