Case report:
A 52-year-old woman, with a history of hypertension, hospitalized in our
department of surgery for a 3-month history of epigastric pain and
discomfort, and weight loss. She had no fever either respiratory
symptoms. Physical examination revealed mild tenderness in the upper of
the abdomen, associated with an epigastric palpable and painful mass
measuring 4 cm. There is no cervical lymphadenopathy nor
hepatosplenomegaly. laboratory data were normal. and there are no
abnormalities on a chest Xray
On upper endoscopy showed a submucosal compression or anterior
submucosal lesion, erosive anterior gastropathy, and a fistulous orifice
located in the bulb. (figure1)
A biopsy of the lesion was performed and concluded to no malignancy and
had no evidence of tuberculosis
An abdominal CT scan was performed and showed an exophytic, heterogenous
gastric formation with an axial necrotic center measuring 44*24mm,
associated with multiple tissue nodules of enhanced infra centimeter
size after injection of contrast agent evoking peritoneal carcinosis
nodules, and coeliomesenteric lymph nodes, one of which has a necrotic
center measuring 9mm in diameter associated with hepatic hilum lymph
nodes. (figure2)
Endoscopic ultrasound demonstrated a rounded lesion of about 30*26mm
located in the antrum, hypoechogenic, discretely heterogeneous not
vascularized, and it is distant from the gastric wall whose 5 layers
appear of normal aspect(figure3). and by positioning the probe next to
the bulbar fistulous orifice, we found the lesion with a hypoechogenic
center corresponding to the necrosis described at the CT with a
hypoechoic fistulous path.
The patient was operated on for exploratory laparotomy due to the
prediagnosis of suspected gastric cancer. the surgical findings
indicated a bulky mass adjacent to the antrum with posterior development
invading the transverse mesocolon, associated with multiple adenopathies
of the mesentery, the transverse mesocolon, and the greater omentum,
organized inflows. (figure 4)
There is a second mass of 3 cm located in the small omentum in contact
with the left gastric artery, which is probably voluminous
adenopathy(figure 4). the biopsy was sent for frozen section examination
that concluded to tuberculous intraperitoneal lymphadenitis, so the
operation was terminated, gastrotomy was not performed because of the
benign nature of the pathology. The patient was administered
anti-tuberculosis treatment and was closely monitored.