Gastric carcinoma is extremely rare in children representing only 0.05% of all gastrointestinal malignancies. Here, we report the first pediatric case of gastric cancer presenting with gastric outlet obstruction. Upper endoscopy revealed a markedly thickened antral mucosa occluding the pylorus and a clean base ulcer 1.5？cm × 2？cm at the lesser curvature of the stomach. The narrowed antrum and pylorus underwent balloon dilation, and biopsy from the antrum showed evidence of Helicobacter pylori gastritis. The biopsy taken from the edge of the gastric ulcer demonstrated signet-ring-cell type infiltrate consistent with gastric adenocarcinoma. At laparotomy, there were metastases to the liver, head of pancreas, and mesenteric lymph nodes. Therefore, the gastric carcinoma was deemed unresectable. The patient died few months after initiation of chemotherapy due to advanced malignancy. In conclusion, this case report underscores the possibility of gastric adenocarcinoma occurring in children and presenting with gastric outlet obstruction. 1. Introduction Malignancies of the gastrointestinal tract are very rare in children, accounting for 1.2% of pediatric malignancies [1]. Malignant gastric tumors that affect children are mostly lymphomas and soft-tissue sarcomas. Gastric carcinomas are extremely rare in children, accounting for 0.05% of gastrointestinal malignancies [2]. Because of the rarity of gastric carcinoma in children and nonspecificity of presenting symptoms, the diagnosis is usually made late and consequently the prognosis is poor due to established metastases by the time of diagnosis. Here, we report a child with gastric adenocarcinoma and a unique presentation of gastric outlet obstruction. We aim to increase awareness for this type of tumor and from that to improve the prognosis in pediatric patients. 2. Case Report A 10-year-old Saudi girl was referred to our hospital with a complaint of progressive intermittent vomiting for 6 months. The vomiting was projectile of semidigested food content and almost always after meals. It was associated with nonspecific nonradiating epigastric pain, undocumented weight loss, progressive fatigability, and bone aches. There was no history of fever, loose bowel motions, or hematemesis. Her family history was negative for tuberculosis, peptic ulcer diseases, or gastric carcinoma. At physical examination, she was emaciated, sick, pale, and severely dehydrated. There were no palpable pathologic lymph nodes, jaundice, or skin rash. She was afebrile with pulse rate 110 beats/minute, respiratory rate 20 breaths/minute,
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