A 52-year-old man with a myocardial infarction and percutaneous coronary intervention in his medical history underwent perioperative chemotherapy and a gastrectomy because of a poorly differentiated adenocarcinoma of the stomach. Unfortunately, two months later metastatic disease was diagnosed in his diaphragm and peritoneum with malignant ascites. The patient was not eligible for palliative chemotherapy because of a low performance status. Four weeks later, he was admitted to the hospital because of a severe but symptom-free hypopotassaemia caused by persistent vomiting due to a soft tissue swelling suspicious for local recurrence in the stomach. The hypopotassaemia was corrected with supplements and the vomiting decreased slowly. However, two days after admission, acute severe generalised abdominal pain developed and imaging of the abdomen was performed (figures 1 and 2).