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Esophageal leiomyomatosis combined with intrathoracic stomach and gastric volvulus.

Obeidat FW, Lang RA, Löhe F, Graeb C, Rist C, Jauch KW, Hüttl TK, Hüttl TP - JSLS (2009 Jul-Sep)

Bottom Line: A 42-year-old female presented with long-standing symptoms suggestive of gastroesophageal reflux disease improved after proton pump inhibitor treatment.Any surgeon performing laparoscopic fundoplication has to be ready to deal with such unexpected findings, ie, converting the procedure and doing reconstruction with minimal morbidity.The Merendino procedure is a well-established reconstructive surgical option in cases of tumor formation at the gastroesophageal region with fewer postoperative morbidities like reflux symptoms.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University of Munich, Germany.

ABSTRACT

Case report: A 42-year-old female presented with long-standing symptoms suggestive of gastroesophageal reflux disease improved after proton pump inhibitor treatment. An upper endoscopy revealed an intrathoracic position of the stomach (type 4 hiatal hernia) with no mucosal abnormality. Barium swallow demonstrated gastric herniation with gastric volvulus without stenosis. A computed tomographic scan confirmed the intrathoracic location of the stomach associated with thickening and edema of the gastric wall due to gastric volvulus, but no evidence of malignancy. The patient was scheduled for laparoscopic gastric repositioning with anterior hemifundoplication. Due to the incidental intraoperative finding of a large distal esophageal tumor (frozen section: esophageal leiomyomatosis), the operation was converted to conventional distal esophagectomy and proximal gastrectomy with reconstruction using a Merendino procedure. Final histology revealed extensive circumferential leiomyomatosis of the distal esophagus with a diameter of 10 cm. Esophageal leiomyomatosis is an extremely rare pathological finding with <100 cases reported in the literature.

Conclusion: Any surgeon performing laparoscopic fundoplication has to be ready to deal with such unexpected findings, ie, converting the procedure and doing reconstruction with minimal morbidity. The Merendino procedure is a well-established reconstructive surgical option in cases of tumor formation at the gastroesophageal region with fewer postoperative morbidities like reflux symptoms.

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Related in: MedlinePlus

Barium swallow study showing intrathoracic stomach with organo-mesenteric volvulus.
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Figure 2: Barium swallow study showing intrathoracic stomach with organo-mesenteric volvulus.

Mentions: The results of all blood tests were within normal ranges. Upper endoscopy showed an intrathoracic stomach (type 4 hiatus hernia) with the possibility of gastric volvulus, but no mucosal abnormalities or stenosis. The barium swallow demonstrated herniation of the stomach associated with organo-mesenteric volvulus (Figures 1 and 2). Contrast-enhanced computed tomographic (CT) scan of the chest and abdomen confirmed the presence of an intrathoracic stomach associated with thickening and edema of the gastric wall most likely due to gastric volvulus (Figure 3). The patient was scheduled for laparoscopic gastric repositioning and anterior hemifundoplication.


Esophageal leiomyomatosis combined with intrathoracic stomach and gastric volvulus.

Obeidat FW, Lang RA, Löhe F, Graeb C, Rist C, Jauch KW, Hüttl TK, Hüttl TP - JSLS (2009 Jul-Sep)

Barium swallow study showing intrathoracic stomach with organo-mesenteric volvulus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3015975&req=5

Figure 2: Barium swallow study showing intrathoracic stomach with organo-mesenteric volvulus.
Mentions: The results of all blood tests were within normal ranges. Upper endoscopy showed an intrathoracic stomach (type 4 hiatus hernia) with the possibility of gastric volvulus, but no mucosal abnormalities or stenosis. The barium swallow demonstrated herniation of the stomach associated with organo-mesenteric volvulus (Figures 1 and 2). Contrast-enhanced computed tomographic (CT) scan of the chest and abdomen confirmed the presence of an intrathoracic stomach associated with thickening and edema of the gastric wall most likely due to gastric volvulus (Figure 3). The patient was scheduled for laparoscopic gastric repositioning and anterior hemifundoplication.

Bottom Line: A 42-year-old female presented with long-standing symptoms suggestive of gastroesophageal reflux disease improved after proton pump inhibitor treatment.Any surgeon performing laparoscopic fundoplication has to be ready to deal with such unexpected findings, ie, converting the procedure and doing reconstruction with minimal morbidity.The Merendino procedure is a well-established reconstructive surgical option in cases of tumor formation at the gastroesophageal region with fewer postoperative morbidities like reflux symptoms.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University of Munich, Germany.

ABSTRACT

Case report: A 42-year-old female presented with long-standing symptoms suggestive of gastroesophageal reflux disease improved after proton pump inhibitor treatment. An upper endoscopy revealed an intrathoracic position of the stomach (type 4 hiatal hernia) with no mucosal abnormality. Barium swallow demonstrated gastric herniation with gastric volvulus without stenosis. A computed tomographic scan confirmed the intrathoracic location of the stomach associated with thickening and edema of the gastric wall due to gastric volvulus, but no evidence of malignancy. The patient was scheduled for laparoscopic gastric repositioning with anterior hemifundoplication. Due to the incidental intraoperative finding of a large distal esophageal tumor (frozen section: esophageal leiomyomatosis), the operation was converted to conventional distal esophagectomy and proximal gastrectomy with reconstruction using a Merendino procedure. Final histology revealed extensive circumferential leiomyomatosis of the distal esophagus with a diameter of 10 cm. Esophageal leiomyomatosis is an extremely rare pathological finding with <100 cases reported in the literature.

Conclusion: Any surgeon performing laparoscopic fundoplication has to be ready to deal with such unexpected findings, ie, converting the procedure and doing reconstruction with minimal morbidity. The Merendino procedure is a well-established reconstructive surgical option in cases of tumor formation at the gastroesophageal region with fewer postoperative morbidities like reflux symptoms.

Show MeSH
Related in: MedlinePlus