Baloyi Eugene Richard Joweni, Rose David Morris, Morare Nolitha Makapi Tisetso
University of Witwatersrand, Klerksdorp Tshepong Hospital Complex, Benji Oliphant Street, North West, South Africa.
Int J Surg Case Rep. 2020;66:63-67. doi: 10.1016/j.ijscr.2019.11.030. Epub 2019 Nov 27.
Gastrointestinal upset is a common presentation to surgical departments, often requiring investigation with endoscopy. Pathologies such as gastritis or ulcers are common culprits. Occasionally, rare or unusual pathologies, such as gastric diverticula as was seen in the case presented, are found.
A 26 year old female, with no known co-morbid conditions presented with a two week history of abdominal pain associated with nausea and vomiting. On further inquiry, she had one episode of blood stained vomiting, prompting investigation with an oesophagogastroduodenoscopy (OGD). Findings included diffuse haemorrhagic gastritis with a single outpouching measuring 1-2 cm in the gastric fundus. A gastric diverticulum was confirmed on barium swallow. Investigation with sonar and a Computed Tomography (CT) scan reported the stomach as normal.
The patient was successfully treated non-operatively with proton pump inhibitor therapy for her concomitant gastritis. Gastric Diverticula are often associated with other gastric findings and their individual contribution varies from case to case.
Gastric Diverticula are the manifestation of a common condition in an unusual location. Their clinical implications vary from being insignificant to life threatening when complicated by haemorrhage, perforation or malignant transformation. The associated symptoms are non-specific and diagnosis may be challenging. The case highlights the importance of selecting appropriate imaging modalities for luminal structures, being only diagnosed in 2 (OGD, Swallow) of the four modalities (incl. ultrasound and CT scan) used. Treatment may be conservative or surgical and is patient dependent. Written consent and ethical approval was obtained. The work is reported in line with the SCARE criteria.
胃肠道不适是外科常见的就诊症状,通常需要进行内镜检查。胃炎或溃疡等病变是常见原因。偶尔也会发现罕见或不寻常的病变,如本例中的胃憩室。
一名26岁女性,无已知合并症,出现腹痛伴恶心、呕吐两周。进一步询问得知,她有一次呕血,促使进行了食管胃十二指肠镜检查(OGD)。检查结果包括弥漫性出血性胃炎,胃底有一个1-2厘米的单个袋状突出。钡餐检查证实为胃憩室。超声和计算机断层扫描(CT)检查报告胃正常。
患者通过质子泵抑制剂治疗其合并的胃炎,成功接受了非手术治疗。胃憩室常与其他胃部表现相关,其个体影响因病例而异。
胃憩室是常见情况在不寻常部位的表现。其临床意义从无明显影响到因出血、穿孔或恶变而危及生命不等。相关症状不具特异性,诊断可能具有挑战性。该病例强调了为管腔结构选择合适成像方式的重要性,在使用的四种方式(包括超声和CT扫描)中,仅通过两种(OGD、钡餐)得以诊断。治疗可能是保守的或手术的,取决于患者情况。已获得书面同意和伦理批准。本病例报告符合SCARE标准。