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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

Reconstruction of the gastroesophageal junction with interposition of jejunum according to Merendino.
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Figure 4: Reconstruction of the gastroesophageal junction with interposition of jejunum according to Merendino.

Mentions: The hiatus was opened using the Harmonic knife for proper mobilization of the bulky esophagus. The decision was made to do proximal gastrectomy with distal esophagectomy and reconstruction using either the Merendino procedure or gastric pull up with esophagogastrostomy (Figure 4). Due to the young age of the patient and poor quality of life caused by intractable reflux, we decided to perform the Merendino procedure. After the esophagus was resected 2 cm above the proximal tumor edge, the proximal part of the stomach was resected using a linear stapler.


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)

Reconstruction of the gastroesophageal junction with interposition of jejunum according to Merendino.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Reconstruction of the gastroesophageal junction with interposition of jejunum according to Merendino.
Mentions: The hiatus was opened using the Harmonic knife for proper mobilization of the bulky esophagus. The decision was made to do proximal gastrectomy with distal esophagectomy and reconstruction using either the Merendino procedure or gastric pull up with esophagogastrostomy (Figure 4). Due to the young age of the patient and poor quality of life caused by intractable reflux, we decided to perform the Merendino procedure. After the esophagus was resected 2 cm above the proximal tumor edge, the proximal part of the stomach was resected using a linear stapler.

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