Completely laparoscopic resection of a rare pyloric tumor with laparoscopically sutured gastroduodenostomy.
We report the case of a 31-year-old woman who presented with epigastric pain and weight loss. Esophagogastroduodenoscopy revealed a submucosal mass in the distal antrum and pylorus. Endoscopic biopsy of the mass was nondiagnostic. A CT scan confirmed a 3.0-cm mass in the posterior wall of the distal antrum. She underwent laparoscopic resection of the distal antrum and pylorus with end-to-end gastroduodenostomy. Pathologic examination showed an adenomyoma of the antrum and pylorus. Her postoperative course was uncomplicated, and she continues to do well 38 months postoperatively. Gastric adenomyoma is a rare, benign intramural tumor of the antrum and pylorus. Fewer than 40 cases have been described in the literature. The lesions are generally within 4 cm of the pylorus. Histologically, they are characterized by ductal structures lined by cuboidal to columnar epithelium surrounded by smooth muscle bundles and, occasionally, Brunner's-type glands and heterotopic pancreas. Treatment is by resection, and recurrence has not been reported. Laparoscopic resection of portions of the stomach has been reported. Side-to-side gastrojejunostomies (Billroth II) performed laparoscopically have been reported. This is the first report in the English-language literature of a completely laparoscopically performed sutured gastroduodenostomy. Technical details of the procedure and adenomyomas are discussed.
Reardon
P R
PR
Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
Schwartz
M R
MR
Fagan
S P
SP
Reardon
M J
MJ
Brunicardi
F C
FC
D018194:Adenomyoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D004385:Duodenostomy / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D011706:Pyloric Antrum; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D017792:Surgical Stapling; D013536:Suture Techniques