A 3-year-old boy presented with left upper abdominal pain mainly when eating. No nausea, vomiting or change in bowel habit. His exam showed a well-grown child with normal growth parameters. His vital signs were stable. He had no pallor or jaundice. His abdominal exam showed a fixed indentation at the left subcostal area. No tenderness or organomegaly and the rest of exam were not significant.

His basic work-up was normal. Abdominal CT scan showed that the anterior cartilaginous part of the left lower rib is abnormal, with indentation on the abdominal wall and compressing of the anterior wall of the stomach (Figure 1).

Figure 1: Abdominal CT scan.

During eating with the distention of the stomach, the compressing on the stomach wall exaggerated which seemed to cause him the pain. Patient was referred to surgery. The family refused any surgical intervention. The patient did well on follow-up, although the pain still present.