scholarly journals Syncope with Surprise: An Unexpected Finding of Huge Gastric Diverticulum

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Mauro Podda ◽  
Jenny Atzeni ◽  
Antonio Messina Campanella ◽  
Alessandra Saba ◽  
Adolfo Pisanu
Keyword(s):  
Ct Scan ◽  
Gastric Wall ◽  
Gastric Fundus ◽  
Upper Gastrointestinal Endoscopy ◽  
Unexpected Finding ◽  
Diagnostic Challenge ◽  
Medical Department ◽  
Postprandial Fullness ◽  
Gastric Diverticulum ◽  
Upper Gastrointestinal

A gastric diverticulum is a pouch protruding from the gastric wall. The vague long clinical history ranging between dyspepsia, postprandial fullness, and upper gastrointestinal bleeding makes this condition a diagnostic challenge. We present a case of large gastric diverticulum that has been diagnosed during clinical investigations for suspected cardiovascular issues in a patient admitted at the medical ward for syncope. A 51-year-old man presented to the medical department due to a syncopal episode occurring while he was resting on the beach after having his lunch, with concomitant vague epimesogastric gravative pain without any other symptom. A diagnosis of neuromediated syncopal episode was made by the cardiologist. Due to the referred epimesogastric pain, an abdominal ultrasound scan was carried out, showing perisplenic fluid. A CT scan of the abdomen was performed to exclude splenic lesions. The CT scan revealed a large diverticulum protruding from the gastric fundus. The upper gastrointestinal endoscopy visualized a large diverticular neck situated in the posterior wall of the gastric fundus, partially filled by undigested food. The patient underwent surgery, with an uneventful postoperative course. Histologic examination showed a full-thickness stomach specimen, indicative of a congenital diverticulum. At the 2nd month of follow-up, the patient was asymptomatic.

scholarly journals Chronic splenic artery occlusion with gastric wall arterial ectasia, an unusual cause of massive upper gastrointestinal hemorrhage

2021 ◽  
pp. 20200194
Author(s):  
Hassan Al-Balas ◽  
Zeyad A. Metwalli ◽  
David M. Sada
Keyword(s):  
Splenic Artery ◽  
Gastric Wall ◽  
Left Gastric Artery ◽  
Artery Occlusion ◽  
Gastric Fundus ◽  
Gastric Artery ◽  
Upper Gi ◽  
Life Threatening ◽  
Upper Gastrointestinal ◽  
Artery Branch

Life-threatening upper gastrointestinal (GI) hemorrhage can occur as a result of bleeding from a variety of arterial and venous sources. We present an unusual cause of life-threatening upper GI hemorrhage arising from ectatic gastric wall arterial branches in a 49-year-old male with previously unrecognized chronic splenic artery thrombosis. The patient developed a recurrence of bleeding despite coil embolization of an accessory left gastric artery branch supplying the gastric fundus suspected to be the site of active bleeding. The patient subsequently underwent splenectomy and surgical ligation of a bleeding gastric artery branch. This case emphasizes the importance of recognizing this unusual cause of upper GI hemorrhage for proper management and prevention of recurrence. Informed consent was obtained from the patient for publication of the case report including accompanying images.

scholarly journals Intramucosal esophageal dissection after esophagogastroduodenoscopy: two case reports

2021 ◽  
pp. 198
Author(s):  
Keyword(s):  
Ct Scan ◽  
Subcutaneous Emphysema ◽  
Case Reports ◽  
Upper Gastrointestinal Endoscopy ◽  
Conservative Approach ◽  
First Case ◽  
Esophageal Dissection ◽  
Dental Arcade ◽  
Sharp Foreign Body ◽  
Upper Gastrointestinal

Introduction: Intramucosal esophageal dissection (IED) is an uncommon disorder, described as the separation of the mucosa and/or submucosa from deeper muscular layers due to abrupt increase in intraesophageal pressure. Case presentation: The first case il that of a 52 – years old female patient who underwent an esophagogastroduodenoscopy for control. After the procedure an extensive subcutaneous emphysema of the neck and a massive pneumomediastinum occurred. The patient was successfully treated with a conservative approach. The second case is that of a 43-years old male patient affected by Down’s Syndrome, who underwent an esopagogastroduodenoscopy because of persisting dysphagia. The endoscopic showed the presence of a serrated stricture at 20 centimeters from dental arcade. After the procedure he fell dysphagia. A neck-chest TC-SCAN showed superior and posterior pneumomediastinum and subcutaneous emphysema, without signs of mediastinitis. The patient was successfully treated with conservative approach. After a few days, a new chest CT-SCAN showed the presence of an anomalous right subclavian artery arising from the descending part of the aortic arch, causing dysphagia lusoria. Discussion: The causes of IED include iatrogenic instrumentation, hemostatic applications, mucosal injuries from ingestion of sharp foreign body, or spontaneous. A fluoroscopic upper gastrointestinal series or upper gastrointestinal endoscopy has been widely used to diagnose IED. CT and magnetic resonance are useful for differential diagnosis. In the absence of signs of mediastinitis management is conservative. Conclusion: CT SCAN should be the first exam to perform in the suspicion of IED. The first line treatment should be conservative. In case of the onset of complications and in patients who are refractory to conservative management, endoscopic or surgical treatment are indicated.

A rare case of perforated gastric duplication cyst associated with gastric diverticulum

2021 ◽  
Vol 14 (3) ◽  
pp. e239971
Author(s):  
Joseph M Smith ◽  
Jessie A Elliott ◽  
Amy E Gillis ◽  
Paul F Ridgway
Keyword(s):  
Cystic Lesion ◽  
Gastric Wall ◽  
Duplication Cyst ◽  
Gastric Fundus ◽  
Posterior Aspect ◽  
Gastric Duplication ◽  
Ct Guided ◽  
Gastric Duplication Cyst ◽  
Gastric Diverticulum ◽  
Greater Curvature

A 50-year-old man presented to the emergency department with a 1-day history of severe epigastric pain, vomiting and fever. He had a background of alcohol excess and smoking. The patient was tachycardic and febrile with an elevated white blood cell count and C reactive protein. CT demonstrated extensive upper abdominal free fluid, without free air, with a large cystic lesion arising from the greater curvature of the stomach, and a second smaller cystic lesion arising from the posterior aspect of the gastric fundus. The patient was managed with nasogastric drainage, parenteral nutrition, intravenous antibiotics and proton pump inhibitors, and CT-guided abdominal drainage, with resolution of sepsis, and further outpatient care was transferred to our unit. Follow-up endoscopy demonstrated a diverticulum arising from the posterior aspect of the gastric fundus, with normal mucosa throughout the remaining stomach, while CT showed an additional cystic lesion arising from the greater curvature, with thickening of the adjacent gastric wall consistent with a gastric duplication cyst (GDC). Laparoscopy confirmed a small diverticulum at the fundus, and a large GDC anteriorly with associated omental adhesions consistent with prior perforation—two wedge resections were performed. Histology demonstrated no evidence of malignancy or ectopic mucosa. The patient recovered uneventfully and remained free from recurrent symptoms at 6 weeks postoperatively. GDC is a rare entity, which may be associated with ectopic mucosa, malignant transformation and upper gastrointestinal perforation. No previous report describes the coexistence of a GDC and gastric diverticulum. Herein we describe the investigation and management of this condition, and review the associated peer-reviewed literature.

scholarly journals Evaluation of gastric polyps in patients with upper gastrointestinal endoscopy

2019 ◽  
Author(s):  
Lie Zheng ◽  
Xinli Wen ◽  
Yan-Cheng Dai ◽  
Xiao-Xiao QianTu ◽  
Hai-Feng He ◽  
...  
Keyword(s):  
High Frequency ◽  
Gastrointestinal Endoscopy ◽  
Gastric Fundus ◽  
Upper Gastrointestinal Endoscopy ◽  
Bleeding Events ◽  
Polyp Size ◽  
Potential Harm ◽  
Gastric Polyps ◽  
Study Population ◽  
Upper Gastrointestinal

Abstract BACKGROUNDAccording to the study population, incidence of gastric polyps (GP) varies from 0.33% to 6.7% in various studies. Most GPs consist of proliferative polyps (HP), gastric fundus polyps (FGP) and adenomatous polyps (APs). Despite the high malignant AP potential, sporadic FGP has no malignant potential. On the contrary, HP has a lower risk of potential harm. It is not sufficient to perform biopsies to determine the presence of polyp types and displacements, therefore, some polyps may require extensive biopsy or complete resection. METHODS This retrospective study included GP patients or polyphenic lesions with polyps or malignant histology found in polyps or gastroscopy at the Department of Gastroenterology, Shaanxi Hospital of Traditional Chinese Medicine from 2017 to 2019.RESULTSIn a series of 10.000 upper gastrointestinal endoscopy, 384 patients (0.38%) were found to have GPs. Of these patients, 98 (25.5) were male and 286(74.5) were female. The average age of the patients was 62.8 ± 10.4 (36-75) years. HP, AP and FGP frequencies were 88.5%, 5.2% and 2.1%, respectively. The polyp size of 274 (71.3%) patients was ≤ 1 cm. Polyp was identified in 262 (68.2%) patients. The most common polyps are the antrum and the corpus. Endoscopic respiratory polypectomy was performed on 128 patients. Bleeding events have been observed and endoscopic treatment is required after ESP.CONCLUSIONIn current study, GP frequency was low (0.38%), and HP frequency may be high due to high frequency of Helicobacter pylori (HPy) infection in China. Due to the high frequency of HPy infection and the short-term use of proton pump use, FGP frequency may be low.

scholarly journals A Rare Cause of Dyspepsia: A Case Report of Gastric Diverticulum

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Ren Yi Kow ◽  
Dhauiddin Hai Ismail ◽  
Khatrulnada Md Saad ◽  
Ed Simor Khan Mor Japar Khan
Keyword(s):  
Medical Therapy ◽  
Gastrointestinal Endoscopy ◽  
Laparoscopic Resection ◽  
Upper Gastrointestinal Endoscopy ◽  
Contrast Study ◽  
Definite Diagnosis ◽  
Barium Study ◽  
Gastric Diverticulum ◽  
Upper Gastrointestinal ◽  
Rule Out

A gastric diverticulum is an outpouching from the gastric mucosa. It is extremely rare. It is normally asymptomatic, but some may present with non-specific abdominal pain. A combination of upper gastrointestinal endoscopy and radiological contrast study such as oral barium study and computed tomography are needed to make a definite diagnosis and to rule out other associated pathology. Although treatment with medical therapy has been reported to be effective, the use of open and laparoscopic resection also yields a good outcome in the management of complicated gastric diverticulum. We present a case of symptomatic gastric diverticulum which has been successfully treated with medical therapy.

scholarly journals Measurement of intragastric pressure: an objective method to ascertain whether gastric wall extension is sufficient for assessment of the non-extension sign

2021 ◽  
Vol 09 (04) ◽  
pp. E530-E536
Author(s):  
Kentaro Imamura ◽  
Motoko Machii ◽  
Kenshi Yao ◽  
Suketo Sou ◽  
Takashi Nagahama ◽  
...  
Keyword(s):  
Pressure Measurement ◽  
Gastrointestinal Endoscopy ◽  
Gastric Wall ◽  
Accurate Method ◽  
Upper Gastrointestinal Endoscopy ◽  
Intragastric Pressure ◽  
Strong Extension ◽  
Upper Gastrointestinal

Abstract Background and study aims The optimal intragastric pressure (IP) for strong gastric wall extension is unclear. We aimed to develop an accurate method to measure IP using endoscopy and determine the pressure required for strong gastric wall extension. Methods An in vitro experiment using an endoscope with a rubber attached at its tip was conducted. The process of inserting the pressure measurement probe into the forceps channel was skipped, and the tube of the pressure measurement device was directly connected to the forceps channel. In vivo, the pressure in 51 consecutive patients at the time of strong gastric wall extension was measured. Strong extension of the gastric wall was defined as when the folds in the greater curvature were flattened as a result of sufficient extension of the gastric wall by insufflated air during upper gastrointestinal endoscopy. The IP at that time was measured. Results In vitro, 20 mL of tap water was injected once into the forceps channel and then aspirated for 10 seconds. Pressure measurement after irrigation of the forceps channel as well as the measurement by inserting the probe procedure were accurately performed. In vivo, among the 51 included patients, the mean IP (range) was 14.7 mmHg (10–23). Strong extension of the gastric wall was obtained in 96.1 % of patients when the IP was 20 mmHg. Conclusions We developed an accurate method to measure IP using upper gastrointestinal endoscopy. Strong extension of the gastric wall was obtained in almost all patients when the IP was 20 mmHg.

scholarly journals Mucormycosis of stomach

2019 ◽  
Vol 6 (11) ◽  
pp. 4173
Author(s):  
Gaurav Joshi ◽  
Devender Singh ◽  
Yashwant Singh Rathore ◽  
Bhanupratap Singh
Keyword(s):  
Foreign Body ◽  
Early Diagnosis ◽  
Fungal Infection ◽  
Gastrointestinal Endoscopy ◽  
Upper Gastrointestinal Endoscopy ◽  
Diagnostic Challenge ◽  
Food Material ◽  
High Index Of Suspicion ◽  
Upper Gastrointestinal ◽  
Very High

Gastrointestinal mucormycosis is invasive fungal infection with very high mortality if not treated. Early diagnosis is critical. We managed a case of mucormycosis of stomach which was a diagnostic challenge. As symptoms are not specific an upper gastrointestinal endoscopy plays the most important role in the diagnosis of mucormycosis of stomach. Upon endoscopy it may be confused with food material (bread) or a foreign body (Bezoars). Diagnosis is easily missed unless there is very high index of suspicion. Surgical resection of involved organ in combination with systemic administration of amphoterecin B is treatment of choice.

scholarly journals Pre-Endoscopy Drink of Simethicone and N-Acetylcysteine Significantly Improves Visualization in Upper Gastrointestinal Endoscopy

2021 ◽  
Vol 12 (01) ◽  
pp. 011-018
Author(s):  
Shrihari Anil Anikhindi ◽  
Ashish Kumar ◽  
Noriya Uedo ◽  
Vikas Singla ◽  
Akshay Anikhindi ◽  
...  
Keyword(s):  
Gastrointestinal Endoscopy ◽  
Duodenal Bulb ◽  
Gastric Fundus ◽  
Gastric Body ◽  
Upper Gastrointestinal Endoscopy ◽  
Optimal Outcomes ◽  
The Mean ◽  
The Difference ◽  
Upper Gastrointestinal ◽  
Control Study

Abstract Introduction With the advancements in diagnostic and therapeutic upper gastrointestinal endoscopy (UGIE), clear mucosal visualization is essential to ensure optimal outcomes. Though routinely followed in Japan and Korea, pre-endoscopic preparation is seldom used in India. We evaluated the efficacy of a pre-endoscopic drink of N-acetylcysteine (NAC) and simethicone in improving mucosal visibility during UGIE. Patients and Methods This study was a retrospective, investigator blind study with a case–control study design. Cases included patients who received a pre-endoscopy drink of NAC and simethicone in 100 mL water administered 10 to 30 minutes prior to UGIE. Controls only had mandatory fasting for 6 to 8 hours prior to UGIE. Propensity score matching was done to ensure comparability between the groups. Digital images were taken at six standard landmarks during UGIE and stored. A blinded investigator subsequently analyzed the images and rated the mucosal visibility on a 3-point scale. The difference in the mean mucosal visibility between the cases and controls was compared. Results Mean mucosal visibility during UGIE was significantly better using NAC with simethicone as compared with no preparation at esophagus (1.14 [0.37] vs. 1.47 [0.62], p < 0.05), gastric fundus (1.10 [0.30] vs. 1.55 [0.64], p < 0.05), gastric body (1.22 [0.50] vs. 1.62 [0.73], p < 0.05), gastric antrum (1.13 [0.37] vs. 1.47 [0.62], p < 0.05), and duodenal bulb (1.13 [0.34] vs. 1.33 [0.56], p < 0.05). In distal duodenum, though visibility improved with NAC with simethicone, the difference was insignificant. There were no adverse events related to the pre-endoscopy drink. Conclusion A pre-endoscopy drink of NAC with simethicone can significantly improve mucosal visibility during UGIE. It is safe, cheap, easily available and maybe considered for routine utilization for ensuring optimal endoscopic outcomes.

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