Esophageal leiomyomatosis combined with intrathoracic stomach and gastric volvulus.
METHODS
A 42-year-old female presented with long-standing symptoms suggestive of gastroesophageal reflux disease improved after proton pump inhibitor treatment. An upper endoscopy revealed an intrathoracic position of the stomach (type 4 hiatal hernia) with no mucosal abnormality. Barium swallow demonstrated gastric herniation with gastric volvulus without stenosis. A computed tomographic scan confirmed the intrathoracic location of the stomach associated with thickening and edema of the gastric wall due to gastric volvulus, but no evidence of malignancy. The patient was scheduled for laparoscopic gastric repositioning with anterior hemifundoplication. Due to the incidental intraoperative finding of a large distal esophageal tumor (frozen section: esophageal leiomyomatosis), the operation was converted to conventional distal esophagectomy and proximal gastrectomy with reconstruction using a Merendino procedure. Final histology revealed extensive circumferential leiomyomatosis of the distal esophagus with a diameter of 10 cm. Esophageal leiomyomatosis is an extremely rare pathological finding with <100 cases reported in the literature.


CONCLUSIONS
Any surgeon performing laparoscopic fundoplication has to be ready to deal with such unexpected findings, ie, converting the procedure and doing reconstruction with minimal morbidity. The Merendino procedure is a well-established reconstructive surgical option in cases of tumor formation at the gastroesophageal region with fewer postoperative morbidities like reflux symptoms.
Department of Surgery, University of Munich, Germany.
Firas W
FW
Obeidat
Reinhold A
RA
Lang
Florian
F
Löhe
Christian
C
Graeb
Carsten
C
Rist
Karl-Walter
KW
Jauch
Tanija K
TK
Hüttl
Thomas P
TP
Hüttl
D000328:Adult; D003287:Contrast Media; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System; D004938:Esophageal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D005743:Gastrectomy; D006801:Humans; D033162:Incidental Findings; D018231:Leiomyomatosis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D013277:Stomach Volvulus / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D014057:Tomography, X-Ray Computed
D003287:Contrast Media