Posterior Wall Of Gastric Antrum Research Articles

S3641 Not Where You Want It! A Very Odd Occurrence of Fishbone Firmly Lodged in the Stomach

Introduction: Inadvertently ingesting fish bones is frequent, and most fish bones pass through the gastrointestinal tract without causing any symptoms or complications within a week. Only about 10% to 20% of foreign bodies necessitate an endoscopic procedure, and less than 1% necessitate surgery. Here, we present a case of fish bone impaction in the stomach and its delayed consequences Case Description/Methods: A 44-year-old female presented with an insidious onset of dull, aching left sided abdominal pain for the past 3 days with nausea and vomiting. She denies NSAIDs, no blood in stools or vomitus. She had eaten Tilapia for Christmas dinner 4 months prior and at that time felt a slight irritation in her throat that had passed, and no other symptoms until now. CT abdomen and pelvis showed a curvilinear foreign body in the pyloric region about 3cm in size. Subsequent EGD showed fishbone securely lodged in the posterior wall of gastric antrum, removed with snare through an overtube, to repair the defect the tissue edges were approximated and two hemostatic clips placed successfully. She was continued on Protonix orally for 4 weeks with complete resolution of symptoms (Figure) Discussion: Fish bones make up about two-thirds of foreign bodies, and 75 percent of ingested foreign bodies get impacted in the oral cavity and laryngopharynx. Moreover, fish bone ingestion might present with a variety of clinical symptoms, including upper GI impaction, dysphagia, bowel obstruction, and silent perforation, as well as frank peritonitis. In our case, it’s quite improbable that a fishbone was stuck in the pylorus for four months without any symptoms. Furthermore, foreign bodies lodged in the stomach are relatively unusual, as peristalsis normally drives them out. Complications have been reported in up to 35% of patients when sharp items pass through the stomach. Also, anything larger than 2 to 2.5 cm in diameter or longer than 5 to 6 cm in length should be removed immediately from the stomach since they will not pass through the pylorus, duodenum, or ileocecal valve. In conclusion, given its vague presentation and difficulties obtaining medical history (as only a small percentage of people recall eating them by mistake), we recommend through this case that clinicians must keep this possibility in mind and conduct timely investigations, as delayed intervention could result in bowel perforation.Figure 1.: A-C : Coronal view of a computed tomography (CT) image showing a linear, hyperdense, foreign body (arrow) which appeared to lodge in posterior wall of gastric antrum. Figure D-F: Endoscopy images of impacted fishbone and its retrieval. Figure G: Photograph of the removed fish bone.

Clinical and endoscopic features of 49 cases of gastric inflammatory fibroid polyp

Objective To summarize the endoscopic appearance, endoscopic ultrasound findings and histopathological characteristics of gastric inflammatory fibroid polyp (IFP) in order to improve diagnosis of IFP. Methods From September 2011 to November 2016, 49 patients with pathologically comfirmed gastric IFP, who underwent endoscopy in Taizhou Hospital of Zhejiang Province, were enrolled. The medical history, endoscopic examination, treatment and follow-up were retrospectively analyzed. Results Among 49 patients with gastric IFP (16 males and 33 females; average age 54 years) the maximum diameter of 33 cases (67.3%) was between 1.0 cm and 2.0 cm. Forty-eight cases had single lesion and one case had multiple lesions. The lesions of 17 cases (34.7%) were located at the anterior wall of gastric antrum, the lesions of seven cases (14.3%) were at the posterior wall of gastric antrum, the lesions of seven cases (14.3%) were at the lesser curvature of gastric antrum and the lesions of seven cases (14.3%) were at the great curvature of gastric antrum. Among the lesions of 41 patients who received endoscopic ultrasonography, 28 lesions were located in the submucosa of stomach, 13 lesions were located in mucosa and muscularis mucosa. The rate of misdiagnosis of endoscopic ultrasonography was 29.3%(12/41). The endoscopic ultrasound findings of the lesions included 26 hypoechoic structures, 11 hyperechoic structures and four slightly hypoechoic structures. The lesions of all the patients were successfully removed by endoscopic polypectomy without any complication. Thirty-seven lesions were treated by endoscopic submucosal dissection (ESD) and 12 lesions by endoscopic mucosal resection (EMR). All the patients were not clearly diagnosed before operation and were finally diagnosed by pathological examination. Postoperative pathological examination showed that in the suhmucosa and mucosa lamina propria, spindle-shaped cells proliferated and arranged in an interwoven pattern or cells around vessels or mucosal glands formed vortex-like or onion skin-like pattern. Forty-seven patients were followed up and the median follow-up time was 31 months. All patients survived withont recurrence or metastasis until the submission of this paper. Conclusions The rate of misdiagnosis of gastric IFP is high before operation, and the diagnosis is depended on histopathological examination. Endoscopic resection is the first choice because the diameter of most lesions are less than 5 cm. Key words: Gastrointestinal diseases; Diagnosis; Inflammatory fibroid polyp of the stomach; Endoscopic findings; Treatment

Successful treatment of liver abscess secondary to foreign body penetration of the alimentary tract: A case report and literature review

Hepatic abscess caused by foreign body penetration of the alimentary tract is rare. We report a case of gastric antrum penetration due to a toothpick complicated by liver abscess formation. A 41-year-old man was admitted to our hospital with the chief complaint of upper abdominal pain for 2 mo. Esophagogastroduodenoscopy performed at a local clinic revealed a toothpick penetrating the gastric antrum. Computed tomography (CT) of the abdomen at our hospital revealed a gastric foreign body embedded in the posterior wall of gastric antrum with regional phlegmon over the lesser sac and adhesion to the pancreatic body without notable vascular injury, and a hepatic abscess seven cm in diameter over the left liver lobe. Endoscopic removal of the foreign body was successfully performed without complication. The liver abscess was treated with parenteral antibiotics without drainage. The patient's recovery was uneventful. Abdominal ultrasonography demonstrated complete resolution of the hepatic abscess six months after discharge. Relevant literature from the PubMed database was reviewed and the clinical presentations, diagnostic modalities, treatment strategies and outcomes of 88 reported cases were analyzed. The results showed that only 6 patients received conservative treatment with parenteral antibiotics, while the majority underwent either image-guided abscess drainage or laparotomy. Patients receiving abscess drainage via laparotomy had a significantly shorter length of hospitalization compared with those undergoing image-guided drainage. There was no significant difference in age between those who survived and those who died, however, the latter presented to hospitals in a more critical condition than the former. The overall mortality rate was 7.95%.

Gastric adenomyoma

Gastric adenomyoma is a rare, hamartomatous tumor localized most frequently in the gastric antrum. Review of the available literature shows only sporadic reports or smaller series. We presented a 72-year-old woman admitted due to epigastric pain with dyspeptic difficulties. Biochemical parameters and tumor markers were within the referential limits. Diagnostic procedures (upper endoscopy, endoscopic ultrasonography and computerized tomography) revealed an intramural tumor prominence with intact mucosa on the posterior wall of gastric antrum, not accessible for biopsy. Surgical treatment was performed with total extirpation of the tumor. Histopathological examination verified adenomyoma with focal low grade epithelial dysplasia. Cytologic immunophenotype was consistent with smooth muscle stromal and epithelial tumor (CK7 and CK20 ++ immunophenotype). Stromal component revealed low proliferative index (Ki-67 protein immunoexpression level 3%), and p53 less than 0.1% in both epithelial and stromal components. Following the operation, the patient remained in good condition. Uncertain malignant potential of the gastric adenomyoma in the presented case indicates that timely diagnostics with adequate surgical treatment is crucial for an adequate treatment.

Laparoscopic Transgastric Resection of a Gastric Lipoma Presenting as Acute Gastrointestinal Hemorrhage

A 71-year-old man was admitted to the emergency unit with upper gastrointestinal bleeding, due to a gastric lipoma, which was controlled with conservative measures. Endoscopy and computed tomography revealed a 4-cm submucosal mass located in the posterior wall of gastric antrum. The patient underwent an elective laparoscopic transgastric resection of the lipoma and discharged on postoperative day 6. Gastric lipomas are uncommon tumors that can be incidentally found. They produce symptoms similar to peptic ulcer disease and can lead to obstruction. Gastric lipomas, which may lead to life-threatening complications such as bleeding, can be safely and reliably treated by laparoscopic transgastric resection.