Large gastric distension associated with pyloric stenosis due to infiltration of amyloid
Posted in Pictures on 28 February 2017
Sofia Espinoza (Gastrointestinal surgery resident) Ana Otero (Gastrointestinal surgery specialist) Hospital Clínic, Barcelona – Spain
We report a case of localized gastric amyloidosis with circumferential thickening of the pylorus and luminal stenosis due to amyloid substance.
A 59-year-old woman with a recent diagnosis of amyloidosis, with a serum monoclonal component of 16 g / L (IgG-kappa), and proteinuria of 257 mg / 24h. She came to the emergency department after 5 days of postprandial vomiting and constipation. The abdominal x-ray showed an apparent extensive pneumoperitoneum(FIG1, red arrow).
And urgent abdominal CT-Scan was performed in the portal phase after the administration of intravenous contrast (fig.2 -3). The Scanner showed significant gastric retention with circumferential thickening of the pylorus and luminal stenosis due to amyloid substance. No signs of pneumoperitoneum.
Early diagnosis of amyolidosis and appropriate remission has the potential to improve outcomes for these patients. In combination with digital image enhancement methods such as narrow band imaging and magnifying endoscopy, a precise diagnosis can be obtained for localized gastric amyloidosis, although a large number of cases with detailed images need to be accumulated. In these cases, a minimally invasive endoscopic or surgical treatment can be considered.