Case presentation A 2-year-old boy with a known Chromosome Alignment-Maintaining Phosphoprotein 1 (CHAMP1) mutation presented with hematemesis, repeated dry heaving, and reduced oral intake. Four months earlier, he had been hospitalized with similar symptoms. At that time, upper gastrointestinal endoscopy had revealed two stage 3 gastric ulcers based on the Forrest classification.
He recovered with conservative management and remained symptom-free until this recurrence. Vital signs : Notable for tachycardia Laboratory findings Hyperchloremic hypokalemia Serum potassium: 3.1 mmol/L (Reference: 3.5-5.1 mmol/L) Serum chloride: 119 mmol/L (Reference: 99-107 mmol/L) Hemoglobin: 15.7 g/dL (Reference: 10.5-13.5 g/dL) Imaging studies Abdominal radiograph Enlarged gastric bubble (Figure 1) Figure 1 . Abdominal radiograph of the patient CT scan Demonstrated a markedly distended stomach rotated…
