2017-06-02 16:39:34 UTC

An Unusual Cause of Gastric Outlet Obstruction

June 7, 2017

A 50-year-old man presented with complaint of recurrent nonbilious vomiting for 4 months and a weight loss of 66 pounds in the same time frame.

Gastroenterology Clinical Image Challenge: A 50-year-old man presented with complaint of recurrent nonbilious vomiting for four months and a weight loss of 66 pounds in the same time frame. Physical examination revealed a tympanitic mass in the epigastrium. Laboratory testing revealed no remarkable abnormalities except for hypoalbuminemia and hypokalemia. In view of recurrent vomiting, a Ryle’s tube was inserted and the gastric contents were aspirated. EGD demonstrated a fistulous tract on the lesser curvature of the distal stomach in the region of antrum with undulating membranes gushing out from the communication (Figure A). CT scan revealed a 11.80 × 5.6 × 8.5-cm, well-defined, hypodense lesion of fluid attenuation epicentered in the right subphrenic location indenting superior surface of the liver with hyperdense nonenhancing linear strands with curvilinear areas of calcification within it (Figure B). Another cystic lesion measuring 10.3 × 8.8 × 10.5 cm was seen epicentered in the left subhepatic region closely abutting the lesser curvature of the stomach in the region of antrum with loss of fat planes (Figure C). This lesion showed peripheral wall calcification and a significant amount of air with evidence of breach in wall of the lesion in the posterior inferior aspect. There was evidence of circumferential wall thickening in the gastric antrum measuring up to 1 cm (Figure D). Air was seen in suprapancreatic common bile duct and intra hepatic biliary radicals. Serology for Echinococcus was negative.

After correction of hypoalbuminemia and dyselectrolytemia, he was taken up for surgery.

What is the diagnosis?

To find out the diagnosis, read the full case in Gastroenterology or download our Clinical Image Challenge app through AGA App Central, which features new cases each week. Sort and filter by organ, most popular or favorites. AGA App Central is available in both the Apple App Store and Google Play