Raquel Bravo (Gastrointestinal Surgery Specialist)
Lilia Martínez (5th year Resident of General and Digestive Surgery)
Hospital Clínic, Barcelona, Spain
A 82 years old male with history of High blood pressure, chronic obstructive pulmonary disease, chronic infection of Hepatitis C Virus arrived in the emergency room suffering from vomiting and abdominal distention.
At physical examination the abdominal perimeter was increased, an X-Ray was ordered and showed an hydric level at the left upper quadrant (FIG 1), a nasogastric tube was placed obtaining 500 ml of gastric content so a CT-Scan was performed revealing a gastric dilatation with an asymmetric thickening of the antrum (FIG 2) that measured 40x29x30 mm also few pathological lymph nodes around and peritoneal implants.
A gastroscopy was performed with the intention to confirm the first diagnostic suspicion (advanced gastric cancer) but surprisingly the mucosa was normal even at biopsy, the stenosis seemed to be produced due to a submucosal lesion (FIG 3). Upper echoendoscopy visualized lesion that affected the submucosa and serosa of the antrum that had undefined borders and measured about 2.4 cm, deep biopsy by fine needle puncture demonstrated well differentiated pancreatic adenocarcinoma.
Due to the patient characteristics and the type of tumor palliative treatment was performed by a gastro-entero anastomosis by laparoscopy.
At the postoperative period the patient presented delayed gastric emptying that required nutritional support and prokinetics.