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Sunnapwar A, Ojili V, Katre R, Shah H, Nagar A. Multimodality imaging of adult gastric emergencies: A pictorial review. Indian J Radiol Imaging 2021; 27:13-22. [PMID: 28515579 PMCID: PMC5385768 DOI: 10.4103/0971-3026.202957] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Acute gastric emergencies require urgent surgical or nonsurgical intervention because they are associated with high morbidity and mortality. Imaging plays an important role in diagnosis since the clinical symptoms are often nonspecific and radiologist may be the first one to suggest a diagnosis as the imaging findings are often characteristic. The purpose of this article is to provide a comprehensive review of multimodality imaging (plain radiograph, fluoroscopy, and computed tomography) of various life threatening gastric emergencies.
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Affiliation(s)
- Abhijit Sunnapwar
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Vijayanadh Ojili
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Rashmi Katre
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Hardik Shah
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Arpit Nagar
- Department of Body Imaging, Ohio State University Wexner Medical Center, Ohio, USA
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Runyan B, Caparelli ML, Batey J, Allamaneni S, Perlman S. Bouveret syndrome: A series of cases that illustrates a rare complication of chronic cholelithiasis. Ann Hepatobiliary Pancreat Surg 2021; 25:139-144. [PMID: 33649267 PMCID: PMC7952670 DOI: 10.14701/ahbps.2021.25.1.139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 12/28/2022] Open
Abstract
Bouveret syndrome is defined as gastric outlet obstruction secondary to the impaction of a large gallstone in the proximal gastrointestinal tract. The obstruction occurs as result of a bilio-enteric or bilio-gastric fistula. This clinical entity is a rare variant of the more commonly recognized gallstone ileus, which tends to cause small bowel obstruction of the terminal ileum. The typical presentation of Bouveret syndrome consists of nausea, vomiting and abdominal pain secondary to obstruction. Diagnosis often requires radiographic imaging with computed tomography, which typically shows pneumobilia or a cholecystoduodenal fistula. Herein is a series consisting of three cases of Bouveret syndrome involving a bilioenteric, cholecystoduodenal, and choledochoduodenal fistula, respectfully, all of which required operative management. A discussion of the current literature regarding management of this rare syndrome follows.
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Affiliation(s)
- Brianne Runyan
- Department of General Surgery, The Jewish Hospital of Cincinnati, Cincinnati, OH, USA
| | - Michael L Caparelli
- Department of General Surgery, The Jewish Hospital of Cincinnati, Cincinnati, OH, USA
| | - Jason Batey
- Department of General Surgery, The Jewish Hospital of Cincinnati, Cincinnati, OH, USA
| | - Shyam Allamaneni
- Department of General Surgery, The Jewish Hospital of Cincinnati, Cincinnati, OH, USA
| | - Steven Perlman
- Department of Radiology, The Jewish Hospital of Cincinnati, Cincinnati, OH, USA
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Bouveret's Syndrome: A Case-Based Review, Clinical Presentation, Diagnostics and Treatment Approaches. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 54:1-7. [PMID: 32377127 PMCID: PMC7192252 DOI: 10.14744/semb.2018.03779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/18/2018] [Indexed: 12/22/2022]
Abstract
Gastric outlet obstruction that arises from gallstones impacted in the distal stomach or proximal duodenum after passing through a cholecystoduodenal, cholecystogastric or rarely choledocoduodenal fistula is called as Bouveret’s syndrome and it accounts for approximately 1-3% of all the patients with gallstone ileus. Although treatment modalities, including stone removal or fragmentation with classical endoscopic devices, such as snares, and forceps or fragmentation of gallstones with new devices, such as electrohydraulic lithotripsy, laser, extracorporeal shockwave lithotripsy have been described. However, only 29% of the patients benefit from nonsurgical methods. Removal of the stone through a gastrotomy or enterotomy and performing cholecystectomy and fistula repair with a second operation is an approach recommended for older patients with comorbid diseases. In this paper, a case of Bouveret’s syndrome was presented. The authors also aimed to review the diagnosis, management and treatment of this rare disease and to update the previous reviews.
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Caldwell KM, Lee SJ, Leggett PL, Bajwa KS, Mehta SS, Shah SK. Bouveret syndrome: current management strategies. Clin Exp Gastroenterol 2018; 11:69-75. [PMID: 29497323 PMCID: PMC5819584 DOI: 10.2147/ceg.s132069] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Bouveret syndrome is a rare complication of cholelithiasis that usually presents with signs and symptoms of gastric outlet obstruction. Given the relative rarity of this condition, there are no standardized guidelines for the management of this condition. In this paper, we review the diagnosis and management options (endoscopic, laparoscopic, and open approaches) of patients with Bouveret syndrome, including a report of one case to illustrate some of the endoscopic and surgical principles of management.
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Affiliation(s)
- Kelly M Caldwell
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Seeyuen J Lee
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Phillip L Leggett
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kulvinder S Bajwa
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sheilendra S Mehta
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shinil K Shah
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.,Michael E. Debakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX, USA
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AL-Habbal Y, Ng M, Bird D, McQuillan T, AL-Khaffaf H. Uncommon presentation of a common disease - Bouveret's syndrome: A case report and systematic literature review. World J Gastrointest Surg 2017; 9:25-36. [PMID: 28138366 PMCID: PMC5237820 DOI: 10.4240/wjgs.v9.i1.25] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/30/2016] [Accepted: 12/07/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate and summarise the current evidence surrounding management of Bouveret's syndrome (BS). METHODS A MEDLINE search was performed for the BS. The search was conducted independently by two clinicians (Yahya AL-Habbal and Matthew Ng) in April 2016. A case of BS is also described. RESULTS A total of 315 articles, published from 1967 to 2016, were found. For a clinically meaningful clinical review, articles published before 01/01/1990 and were excluded, leaving 235 unique articles to review. Twenty-seven articles were not available (neither by direct communication nor through inter-library transfer). These were also excluded. The final number of articles reviewed was 208. There were 161 case reports, 13 reviews, 23 images (radiological and clinical images), and 11 letters to editor. Female to male ratio was 1.82. Mean age was 74 years. Treatment modalities included laparotomy in the majority of cases, laparoscopic surgery, endoscopic surgery and shockwave lithotripsy. CONCLUSION There is limited evidence in the literature about the appropriate approach. We suggest an algorithm for management of BS.
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Smolilo D, Bhandari M, Wilson TG, Brooke-Smith M, Watson DI. Bouveret's syndrome: gastric outlet obstruction caused by a gallstone. ANZ J Surg 2013; 83:996-997. [PMID: 24289055 DOI: 10.1111/ans.12227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- David Smolilo
- Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
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Yang D, Wang Z, Duan ZJ, Jin S. Laparoscopic treatment of an upper gastrointestinal obstruction due to Bouveret’s syndrome. World J Gastroenterol 2013; 19:6943-6946. [PMID: 24187475 PMCID: PMC3812499 DOI: 10.3748/wjg.v19.i40.6943] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 08/31/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
Bouveret’s syndrome is an extremely rare type of gallstone-induced ileus with atypical clinical manifestations, such as abdominal distension and pain, nausea and vomiting, fever or even gastrointestinal bleeding, which may easily be misdiagnosed. In the present case, a 55-year-old male was admitted to the hospital with upper gastrointestinal obstructive symptoms but without pain, fever, jaundice or melena. At first, gastrolithiasis and peptic ulcer combined with pyloric obstruction were suspected after gastroscopy revealed a large, hard stone in the duodenal bulb. A revised diagnosis of Bouveret’s syndrome was made following abdominal computed tomography. Subsequently, the patient exhibited a good postoperative recovery after laparoscopic duodenotomy for gallstone removal and subtotal cholecystectomy. The condition of the patient remained stable after being followed up for 6 mo. The successful application of laparoscopic therapy to treat Bouveret’s syndrome has seldom been reported. Laparoscopic enterolithotomy is safe and effective, with good patient tolerability, rapid postoperative recovery and few wound-related complications. The laparoscopic treatment of Bouveret’s syndrome is worth exploring.
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Ribeiro I, Pinho R, Agzamov F, Fernandes C, Sousa M, Ferreira A, Carvalho J, Dias V, Fraga J. Síndrome de Bouveret como forma de apresentação de doença de Crohn: relato de uma associação rara. GE JORNAL PORTUGUÊS DE GASTRENTEROLOGIA 2013; 20:167-171. [DOI: 10.1016/j.jpg.2012.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Bouveret's Syndrome: 64-Slice CT Diagnosis and Surgical Management-A Case Report. Case Rep Radiol 2012; 2012:701216. [PMID: 23346445 PMCID: PMC3512245 DOI: 10.1155/2012/701216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 10/26/2012] [Indexed: 12/20/2022] Open
Abstract
Gastric outlet obstruction caused by duodenal impaction of a large gallstone migrated through a cholecystoduodenal fistula has been referred to as Bouveret's syndrome. We present a case of gallstone-induced duodenal obstruction in an elderly female patient, diagnosed on a 64-slice MDCT scanner. One-stage surgery, that is, stone removal and cholecystectomy, was performed resulting in relief of obstruction and complete cure. Clinical features, multidetector computed tomography (MDCT) findings, and surgical management are discussed.
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Baloyiannis I, Symeonidis D, Koukoulis G, Zachari E, Potamianos S, Tzovaras G. Complicated cholelithiasis: an unusual combination of acute pancreatitis and bouveret syndrome. Case Rep Gastroenterol 2012; 6:459-464. [PMID: 22855661 PMCID: PMC3398075 DOI: 10.1159/000341512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Bouveret syndrome is a rare form of gallstone ileus. The purpose of the present study was to present the unusual case of a female patient with complicated cholelithiasis manifested as a combination of acute pancreatitis and concomitant Bouveret syndrome. A 61-year-old female patient was admitted to the emergency department complaining of mid-epigastric and right upper quadrant abdominal pain radiating band-like in the thoracic region of the back as well as repeated episodes of vomiting over the last 24 h. The initial correct diagnosis of pancreatitis was subsequently combined with the diagnosis of Bouveret syndrome as a computed tomography scan revealed the presence of a gallstone within the duodenum causing luminal obstruction. After failure of endoscopic gallstone removal, a surgical approach was undertaken where gallstone removal was followed by cholecystectomy and restoration of the anatomy by eliminating the fistula. The concomitant pancreatitis complicated the postoperative period and prolonged the length of hospital stay. However, the patient was discharge on the 45th postoperative day. Attempts for endoscopic removal of the impacted stone should be the initial therapeutic step. Surgery should be reserved for cases refractory to endoscopic intervention and when definite treatment is the actual challenge.
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Affiliation(s)
- Ioannis Baloyiannis
- Department of General Surgery, University Hospital of Larissa, Larissa, Greece
| | | | - Georgios Koukoulis
- Department of General Surgery, University Hospital of Larissa, Larissa, Greece
| | - Eleni Zachari
- Department of General Surgery, University Hospital of Larissa, Larissa, Greece
| | - Spyros Potamianos
- Department of Gastroenterology, University Hospital of Larissa, Larissa, Greece
| | - George Tzovaras
- Department of General Surgery, University Hospital of Larissa, Larissa, Greece
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Affiliation(s)
- Rajeev M Joshi
- Department of General Surgery, B.Y.L. Nair Ch. Hospital, Mumbai, India
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Abstract
We present the case of a 76-year-old man referred to our hospital with a round stone in central mediastinum and pneumomediastinum in chest radiography and computed tomography. He had a previous history of attempt of endoscopic retrievement of a gallstone that had caused a gastric outlet obstruction (Bouveret syndrome). To our knowledge, this is the first imaging description of mediastinal gallstone caused by esophagus perforation during complicated endoscopic lithotomy.
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Crespo Pérez L, Angueira Lapeña T, Defarges Pons V, Foruny Olcina JR, Cano Ruiz A, Benita León V, Gónzalez Martín JA, Boixeda de Miquel D, Milicua Salamero JM. [A rare cause of gastric outlet obstruction: Bouveret's syndrome]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 31:646-51. [PMID: 19174082 DOI: 10.1016/s0210-5705(08)75813-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Accepted: 06/10/2008] [Indexed: 12/21/2022]
Abstract
Bouveret's syndrome is a rare type of gallstone ileus in which a gallstone enters the intestinal tract via a cholecystoenteric fistula and is lodged in the duodenum or the stomach. Since the first description by León Bouveret in 1896, fewer than 200 cases have been described in the worldwide literature. Mortality is high, at 25%, but may be related to the advanced age of the typical patient and comorbidities, as well as diagnostic delay. Diagnosis may be made with radiological (abdominal X-ray, ultrasound, computed tomography or magnetic resonance imaging) and endoscopic techniques. Endoscopy is preferred as the first therapeutic option but is frequently unsuccessful and surgery is often required. We present the case of a patient admitted to hospital with a history of vomiting after eating and epigastric pain. The management of this rare cause of gastric outlet obstruction is discussed.
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Affiliation(s)
- Laura Crespo Pérez
- Servicio de Gastroenterología, Unidad de Endocscopia Digestiva, Hospital Universitario Ramón y Cajal, Madrid, Spain.
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Thompson RJ, Gidwani A, Caddy G, McKenna E, McCallion K. Endoscopically assisted minimally invasive surgery for gallstones. Ir J Med Sci 2007; 178:85-7. [PMID: 17973154 DOI: 10.1007/s11845-007-0096-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 10/04/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND We present a case report of Bouveret syndrome followed by a review of the recent literature regarding the management of this condition. Bouveret syndrome is a form of gastric outlet obstruction secondary to a gallstone which has eroded through the gallbladder into the duodenum. It is an uncommon variant of gallstone ileus. Endoscopic methods have been described to extract the stone from the duodenum. METHODS This is a case of an 85-year-old female patient who presented with a 1-week history of nausea, intermittent bilious vomiting and anorexia. Imaging confirmed the diagnosis of Bouveret syndrome caused by two large gallstones. Conventional endoscopic methods successfully extracted the impacted stones from the duodenum into the stomach but were unable to extract the stones from the stomach. A mini-transverse laparotomy and gastrotomy were performed to finally extract the stones.
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Affiliation(s)
- R J Thompson
- Departments of General Surgery, Gastroenterology and Radiology, Ulster Hospital, Dundonald, Northern Ireland.
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Abstract
AIM The aim of the study was to characterize the clinical presentation, evaluation, and therapy of Bouveret's syndrome, by comprehensively reviewing all the identified previously reported cases, to facilitate early diagnosis and thereby to improve the prognosis. METHODS Relevant articles were identified by MEDLINE computerized searches, by consultation with all available reference books, and by review of the first author's teaching files. A new case in which the diagnosis of Bouveret's syndrome was missed at esophagogastroduodenoscopy (EGD)--despite endoscopic findings of gastric outlet obstruction caused by a hard, nonfleshy, and convex pyloric mass--prompted this review. RESULTS Review of 128 reported cases identified syndromic characteristics. Patients on average were 74.1 +/- 11.1 (SD) yr old. The female-to-male sex ratio was 1.86. Prominent symptoms were nausea and vomiting in 87%, abdominal pain in 71%, hematemesis in 15%, recent weight loss in 14%, and anorexia in 13% of patients. Prominent signs were abdominal tenderness in 44%, signs of dehydration in 31%, and abdominal distention in 26% of patients. Endoscopy revealed gastroduodenal obstruction in nearly all cases, but identified the obstructing stone in only 69%. Abdominal ultrasound or computerized tomography was diagnostic in about 60% of cases. CONCLUSIONS The following endoscopic findings are suggestive of Bouveret's syndrome: a dilated stomach containing old digested food from gastrointestinal obstruction together with a hard and nonfleshy mass at the obstruction. These endoscopic findings, in the setting of the currently reported characteristic epidemiologic and clinical findings, should strongly suggest this syndrome. Abdominal ultrasound or computerized tomography is recommended to confirm and extend the endoscopic diagnosis.
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Affiliation(s)
- Mitchell S Cappell
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141, USA
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Tseng D, Hunter J. Surgery of the Biliary Tract. ZAKIM AND BOYER'S HEPATOLOGY 2006:1201-1217. [DOI: 10.1016/b978-1-4160-3258-8.50070-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Kaushik N, Moser AJ, Slivka A, Chandrupatala S, Martin JA. Gastric outlet obstruction caused by gallstones: case report and review of the literature. Dig Dis Sci 2005; 50:470-3. [PMID: 15810628 DOI: 10.1007/s10620-005-2460-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Neeraj Kaushik
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
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Gencosmanoglu R, Inceoglu R, Baysal C, Akansel S, Tozun N. Bouveret’s syndrome complicated by a distal gallstone Ileus. World J Gastroenterol 2003; 9:2873-5. [PMID: 14669357 PMCID: PMC4612076 DOI: 10.3748/wjg.v9.i12.2873] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: Gastric outlet obstruction caused by duodenal impaction of a large gallstone migrated through a cholecystoduodenal fistula has been referred as Bouveret’s syndrome. Endoscopic lithotomy is the first-step treatment. However, surgery is indicated in case of failure or complication during this procedure.
METHODS: We report herein an 84-year-old woman presenting with features of gastric outlet obstruction due to impacted gallstone. She underwent an attempt of endoscopic retrieval which was unsuccessful and was further complicated by distal gallstone ileus. Physical examination was irrelevant.
RESULTS: Endoscopy revealed multiple erosions around the cardia, a large stone in the second part of the duodenum causing complete obstruction, and wide ulceration in the duodenal wall where the stone was impacted. Several attempts of endoscopic extraction by using foreign body forceps failed and surgical intervention was mandatory. Preoperative ultrasound evidenced pneumobilia whilst computerized tomography showed a large stone, 5 × 4 × 3 cm, logging at the proximal jejunum and another one, 2.5 × 2 × 2 cm, in the duodenal bulb causing closed-loop syndrome. She underwent laparotomy and the jejunal stone was removed by enterotomy. Another stone reported as located in the duodenum preoperatively was found to be present in the gallbladder by intraoperative ultrasound. Therefore, cholecystoduodenal fistula was broken down, the stone was retrieved and cholecystectomy with duodenal repair was carried out. She was discharged after an uneventful postoperative course.
CONCLUSION: As the simplest and the least morbid procedure, endoscopic stone retrieval should be attempted in the treatment of patients with Bouveret’s syndrome. When it fails, surgical lithotomy consisting of simple enterotomy may solve the problem. Although cholecystectomy and cholecystoduodenal fistula breakdown is unnecessary in every case, conditions may urge the surgeon to perform such operations even though they carry high morbidity and mortality.
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Affiliation(s)
- Rasim Gencosmanoglu
- Unit of Surgery, Institute of Gastroenterology, Marmara University, Istanbul, Turkey.
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Singh AK, Shirkhoda A, Lal N, Sagar P. Bouveret's syndrome: appearance on CT and upper gastrointestinal radiography before and after stone obturation. AJR Am J Roentgenol 2003; 181:828-30. [PMID: 12933489 DOI: 10.2214/ajr.181.3.1810828] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Ajay K Singh
- Department of Diagnostic Radiology, William Beaumont Hospital, 3601 W. 13 Mile Rd., Royal Oak, MI 48073, USA
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Gencosmanoglu R, Sen-Oran E, Kurtkaya-Yapicier O, Tozun N. Antral hyperplastic polyp causing intermittent gastric outlet obstruction: case report. BMC Gastroenterol 2003; 3:16. [PMID: 12831404 PMCID: PMC166166 DOI: 10.1186/1471-230x-3-16] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2003] [Accepted: 06/27/2003] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Hyperplastic polyps are the most common polypoid lesions of the stomach. Rarely, they cause gastric outlet obstruction by prolapsing through the pyloric channel, when they arise in the prepyloric antrum. CASE PRESENTATION A 62-year-old woman presented with intermittent nausea and vomiting of 4 months duration. Upper gastrointestinal endoscopy revealed a 30 mm prepyloric sessile polyp causing intermittent gastric outlet obstruction. Following submucosal injection of diluted adrenaline solution, the polyp was removed with a snare. Multiple biopsies were taken from the greater curvature of the antrum and the corpus. Rapid urease test for Helicobacter pylori yielded a negative result. Histopathologic examination showed a hyperplastic polyp without any evidence of malignancy. Biopsies of the antrum and the corpus revealed gastritis with neither atrophic changes nor Helicobacter pylori infection. Follow-up endoscopy after a 12-week course of proton pomp inhibitor therapy showed a complete healing without any remnant tissue at the polypectomy site. The patient has been symptom-free during 8 months of follow-up. CONCLUSIONS Symptomatic gastric polyps should be removed preferentially when they are detected at the initial diagnostic endoscopy. Polypectomy not only provides tissue to determine the exact histopathologic type of the polyp, but also achieves radical treatment.
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Affiliation(s)
- Rasim Gencosmanoglu
- Department of Gastrointestinal Surgery, Marmara University Institute of Gastroenterology, Istanbul, Turkey
| | - Ebru Sen-Oran
- Department of Gastrointestinal Surgery, Marmara University Institute of Gastroenterology, Istanbul, Turkey
| | | | - Nurdan Tozun
- Department of Gastroenterology, Marmara University Institute of Gastroenterology, Istanbul, Turkey
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