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Acute Pancreatitis and Gastroduodenal Intussusception Induced by an Underlying Gastric Gastrointestinal Stromal Tumor: A Case Report.

Yildiz MS, Doğan A, Koparan IH, Adin ME - J Gastric Cancer (2016)

Bottom Line: Gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal system and comprise only 1% to 3% of all gastrointestinal tract tumors, with the majority of them arising in the stomach.In this report, we present the unique findings of a case of gastroduodenal intussusception caused by an underlying gastric GIST and complicated with severe acute pancreatitis.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Dunya Hospital, Batman, Turkey.

ABSTRACT
Gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal system and comprise only 1% to 3% of all gastrointestinal tract tumors, with the majority of them arising in the stomach. In this report, we present the unique findings of a case of gastroduodenal intussusception caused by an underlying gastric GIST and complicated with severe acute pancreatitis.

No MeSH data available.


Related in: MedlinePlus

(A) Gastroduedonal intussusception. (B, C) The mass protruding to the duedonum and causing obstruction (arrows). Also visible are stranding of the peripancreatic fat and fluid accumulation around heterogenously ehancing pancreas, a sign of early necrosis. (D) Macroscopic view of the mass arising from gastric corpus (arrow). (E) Perioperative view of pancreas. Please note relatively dark portion of the pankreas corresponding to pancreatic necrosis.
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Figure 2: (A) Gastroduedonal intussusception. (B, C) The mass protruding to the duedonum and causing obstruction (arrows). Also visible are stranding of the peripancreatic fat and fluid accumulation around heterogenously ehancing pancreas, a sign of early necrosis. (D) Macroscopic view of the mass arising from gastric corpus (arrow). (E) Perioperative view of pancreas. Please note relatively dark portion of the pankreas corresponding to pancreatic necrosis.

Mentions: An 85-year-old woman complaining of abdominal and epigastric discomfort, nausea, and weight loss during the last 6 months was referred to a gastrointestinal clinic for further evaluation. Her body mass index was 27 kg/m2. Laboratory tests including complete blood count and biochemistry panel were within the normal range. A 6 by 5 cm epigastric mass was found by abdominal ultrasonography using an Aplio XG scanner equipped with a 5-MHz convex transducer (Toshiba Medical Systems, Tokyo, Japan). An intravenous (IV) contrast-enhanced computed tomography (CT) demonstrated a diffusely enhancing luminal mass at the gastric fundus (Fig. 1). There was no sign of extraluminal invasion or metastasis. The patient did not provide consent for gastric endoscopy and was discharged from the hospital upon her demand. One month after the initial presentation, the patient presented at the emergency department with severe acute abdominal pain radiating to the back, accompanied with nausea and vomiting. Laboratory findings were suggestive of an acute inflammatory response (white blood cell 21.66×109/L, C-reactive protein 0.9 mg/L, serum albumin 2.6 g/dl, serum glucose 185 mg/dl, and serum chlorine 110 mmol/L). Amylase and lipase values were elevated (1,974 IU/L and 1,503 IU/L, respectively), whereas liver enzymes and bilirubin values were within the normal range. A control IV contrast-enhanced CT study showed a gastric mass protruding toward the duodenum and obliterating the gastric exit and duodenal lumen. Gastric wall thickening and gastroduodenal intussusception were evident. The common biliary duct was compressed by the mass and resulted in dilation of the proximal biliary system. Pancreatic swelling, edema, and irregular peripancreatic mesenteric fat stranding were suggestive of acute pancreatitis (Fig. 2). Abdominal laparotomy revealed gastroduodenal intussusception due to a gastric mass arising from the superior part of the corpus. The obstruction of the ampulla vateri and consequent edema and necrosis in the pancreas were also visible during surgery after exploration of the retrocolic region. Because of the location, size, and extent of the mass, wedge resection was opted out as a surgical option. The patient underwent subtotal gastrectomy and Roux and Y anastomosis (Fig. 2). Histopathologic evaluation of the tumor specimen was most compatible with benign gastric GIST demonstrating proliferation of spindle cells with long oval nuclei.


Acute Pancreatitis and Gastroduodenal Intussusception Induced by an Underlying Gastric Gastrointestinal Stromal Tumor: A Case Report.

Yildiz MS, Doğan A, Koparan IH, Adin ME - J Gastric Cancer (2016)

(A) Gastroduedonal intussusception. (B, C) The mass protruding to the duedonum and causing obstruction (arrows). Also visible are stranding of the peripancreatic fat and fluid accumulation around heterogenously ehancing pancreas, a sign of early necrosis. (D) Macroscopic view of the mass arising from gastric corpus (arrow). (E) Perioperative view of pancreas. Please note relatively dark portion of the pankreas corresponding to pancreatic necrosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834622&req=5

Figure 2: (A) Gastroduedonal intussusception. (B, C) The mass protruding to the duedonum and causing obstruction (arrows). Also visible are stranding of the peripancreatic fat and fluid accumulation around heterogenously ehancing pancreas, a sign of early necrosis. (D) Macroscopic view of the mass arising from gastric corpus (arrow). (E) Perioperative view of pancreas. Please note relatively dark portion of the pankreas corresponding to pancreatic necrosis.
Mentions: An 85-year-old woman complaining of abdominal and epigastric discomfort, nausea, and weight loss during the last 6 months was referred to a gastrointestinal clinic for further evaluation. Her body mass index was 27 kg/m2. Laboratory tests including complete blood count and biochemistry panel were within the normal range. A 6 by 5 cm epigastric mass was found by abdominal ultrasonography using an Aplio XG scanner equipped with a 5-MHz convex transducer (Toshiba Medical Systems, Tokyo, Japan). An intravenous (IV) contrast-enhanced computed tomography (CT) demonstrated a diffusely enhancing luminal mass at the gastric fundus (Fig. 1). There was no sign of extraluminal invasion or metastasis. The patient did not provide consent for gastric endoscopy and was discharged from the hospital upon her demand. One month after the initial presentation, the patient presented at the emergency department with severe acute abdominal pain radiating to the back, accompanied with nausea and vomiting. Laboratory findings were suggestive of an acute inflammatory response (white blood cell 21.66×109/L, C-reactive protein 0.9 mg/L, serum albumin 2.6 g/dl, serum glucose 185 mg/dl, and serum chlorine 110 mmol/L). Amylase and lipase values were elevated (1,974 IU/L and 1,503 IU/L, respectively), whereas liver enzymes and bilirubin values were within the normal range. A control IV contrast-enhanced CT study showed a gastric mass protruding toward the duodenum and obliterating the gastric exit and duodenal lumen. Gastric wall thickening and gastroduodenal intussusception were evident. The common biliary duct was compressed by the mass and resulted in dilation of the proximal biliary system. Pancreatic swelling, edema, and irregular peripancreatic mesenteric fat stranding were suggestive of acute pancreatitis (Fig. 2). Abdominal laparotomy revealed gastroduodenal intussusception due to a gastric mass arising from the superior part of the corpus. The obstruction of the ampulla vateri and consequent edema and necrosis in the pancreas were also visible during surgery after exploration of the retrocolic region. Because of the location, size, and extent of the mass, wedge resection was opted out as a surgical option. The patient underwent subtotal gastrectomy and Roux and Y anastomosis (Fig. 2). Histopathologic evaluation of the tumor specimen was most compatible with benign gastric GIST demonstrating proliferation of spindle cells with long oval nuclei.

Bottom Line: Gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal system and comprise only 1% to 3% of all gastrointestinal tract tumors, with the majority of them arising in the stomach.In this report, we present the unique findings of a case of gastroduodenal intussusception caused by an underlying gastric GIST and complicated with severe acute pancreatitis.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Dunya Hospital, Batman, Turkey.

ABSTRACT
Gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal system and comprise only 1% to 3% of all gastrointestinal tract tumors, with the majority of them arising in the stomach. In this report, we present the unique findings of a case of gastroduodenal intussusception caused by an underlying gastric GIST and complicated with severe acute pancreatitis.

No MeSH data available.


Related in: MedlinePlus