A 53-year-old woman with obesity (body mass index 39 kg/m 2 ) presented to the emergency department with nausea, vomiting, and inability to tolerate oral intake for 5 days. She had had an intragastric balloon placed 1 week ago for weight loss. She was in mild distress but hemodynamically stable. Physical examination revealed mild epigastric tenderness. Laboratory studies showed normal WBC count, as well as normal liver enzyme, lipase, and lactate levels. Computed tomography (CT) of the abdomen was performed.For the diagnosis and teaching points, see page 39. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com