Ball Valve Syndrome Treated by Endoscopic Submucosal Dissection

Abstract

An 85-year-old female was diagnosed with cerebellar hemorrhage based on computed tomography (Figure A). She underwent a craniotomy to remove the hematoma. It has been 2 months since she started rehabilitation after the craniotomy but she still experiences repeated vomiting. Therefore, gastrointestinal transit disorders were considered a differential diagnosis. An esophagogastroduodenoscopy was performed for a detailed examination, which revealed an erythematous, mobile, and semi-pedunculated lesion approximately 40 mm in size near the pyloric ring in the gastric antrum. The lesion was entrapped in the duodenal bulb (Figure B and Figure C). With a diagnosis of early gastric cancer resulting in ball valve syndrome, endoscopic submucosal dissection was performed for symptom relief. A pathological examination demonstrated that the tumor was a mucosal gastric cancer and had been completely resected with free vertical and horizontal margins (Figure D and Figure E). The patient tolerated a progressive diet with no recurrence of vomiting after treatment. Although repeated vomiting is often an aftereffect of cerebrovascular disease, gastrointestinal transit disorders should be considered as possible causes in cases of persistent vomiting because elderly patients are also at the risk of the development of gastrointestinal neoplasms. Endoscopic submucosal dissection was effective for the treatment of ball valve syndrome caused by gastric cancer. We thank Natsuko Nakano for the pathological examination and Yo Matsui for the radiological diagnosis.