**4. Symptoms and signs**

The most common symptom in these patients is intermittent abdominal pain and copious vomiting. The abdominal pain can be postprandial and the nausea, vomiting can lead to anorexia and weight loss. Early satiety, eructations, and at times sub-acute small bowel obstruction can develop. The symptoms are relieved when patient lies in left lateral decubitus, prone or knee-to-chest position (Geer 1990, Wilkie 1927, Raissi et al 1996). They are often aggravated by in an asthenic patient in supine position. Examination of the abdomen may reveal a succussion splash. Peptic ulcer disease is found in 25-45% of the patients and hyperchlohydria in 50 %( Geer 1990, Ylinen et al 1989). Dilated duodenum and stomach could predispose a patient to aspiration pneumonia and acute gastric rupture.
