Male patient, 62 years old, with a history of untreated hypertension, obesity (BMI 32) and smoking cessation.
She presented with a 4-month history of abdominal pain, abdominal distension, persistent vomiting and weight loss of 9 kg during this period.
There was no evidence of gastrointestinal bleeding or anemia.
Upper endoscopy revealed a submucosal gastric tumor located in the antrum of the lesser curvature and occupying an important part of the antral lumen.
The mucosa was examined endoscopically and had a normal appearance, so no biopsies were taken.
Abdominal ultrasound showed a homogeneous, hyperechogenic gastric mass with defined borders.
The study was completed with an abdominal computed axial tomography that revealed a fat density lesion of 11 x 6 cm, occupying an important part of the gastric antral lumen, with low contrast capture.
GIST was suspected for malignant differentiation or gastric polyposis.
Surgical resection was recommended.
1.
Laparoscopic distal subtotal gastrectomy was performed.
Five trocars were used; 12 mm supraumbilical for the right fixation; 5 mm subxiphoid mass was confirmed for hepatic separation and 12 mm left subcostal trocars, 12 mm left flank and 10 mm left antral.
Intraoperative endoscopy was performed to define the proximal resection margin.
The duodenum and stomach were sectioned with linear loads of 60 mm and a D1 lymphadenectomy was performed.
The specimen was extracted by a Pfannenstiel incision and negative margins were confirmed by rapid biopsy.
Traffic was restored with a 50 cm long Roux-en-Y gastric-jejunal anastomosis, mechanically and intracorporealally performed.
Operative time was 5 h and bleeding was 200 cc.
Postoperative recovery was uneventful.
The patient was discharged on postoperative day 5.
The macroscopic study of the lesion was consistent with a submucosal gastric tumor, measuring 11.5 x 6x7 cm, with appearance defect.
Pathologic diagnosis was compatible with lymphocytic colitis with normal margins.
