dr darshan jain

8/3/2019 Dr Darshan Jain

1/25

St Stephen Hospital

Tis Hazari

Delhi


2/25

Did?you?

take?the?

follow-up?


3/25

55 yrs femaleUpper abdominal pain ,non colicky

Recurrent vomiting-contained food particles, nonbilious, non projectile

No blood in vomitus or stools

No change in bowel, bladder habits

No H/O fever, jaundice or coughNo H/O Koch's, DM, Hypertension

No other major medical or surgical illness in the past.


4/25

Pulse ,B.P-normal

P/A- soft, non-tender, mild hepatomegaly,no lumppalpable and bowel sounds normal.

Rest of the systems-WNL

Serum lipase and amylase levels were raised

With these inv. a CECT Abdomen with oral contrast was

requested


5/25


6/25


7/25


8/25


9/25


10/25


11/25


12/25


13/25


14/25


15/25

Then an UGI Endoscopy was done which showed apolypoidal growth in the antral region.

Biopsy revealed it to be hamartomatous hyperplasic

polyp.


16/25

Managed conservatively in ICU till pancreatitis wassettled.

Hence an exploratory laprotomy was done whichrevealed the gastric antrum and duodenum upto the 3rd

part was studded with polyps along withgastroduodenal intussusception which could not bereduced

gastro duodenectomy with gastrojejunostomy was done


17/25

Gastro duodenal intussusceptionMultiple polyps extending from gastric antrum to 3rd

part of duodenum


18/25


19/25


20/25

Rarest form of all types of gastrointestinal intussusception

First case reported-Chiari in 1888.prolapse of all three layers of the stomach and caused by prolapse of a gastric tumor(mostly benign and rarely malignant) resulting in invagination of a portion of thestomach into the duodenum 1-3.

40%- polyps40%- intramural smooth muscle tumors(leiomyoma,

leiomyosarcoma)20%-other lipoma, hamartoma, adenoma, carcinoma.Menetrier's diseasePeutz-Jeghers syndrome

Symptoms can be episodic epigastric discomfort, intermittent nausea, vomiting and

acute or chronic blood loss.The diagnosis can be made by CT scan, barium study or endoscopy.computed tomography-modality of choice. Provide information regarding the locationof the lesion in relation to surrounding internal organs and can characterize the leadingtumor.


21/25

5. Typical CT findings classic target or bull`s eye

appearance. The outstanding criteria for a diagnosis ofgastroduodenal intussusception are: (a) a space-occupying

mass which changes its anatomical position in relation to the

stomach and duodenum, thus establishing prolapse; (b) a

concentric appearance of the intussuscipiens containing the

intussusceptum. These two findings establish the diagnosis.

Other criteria such as straightening of the pyloric canal,

ribbon-like defect, etc., are of relatively minor importance.includes

lumen narrowing,


22/25

infolding and outpouching of the gastric wall,

gastric intussusceptum presenting as a filling defect, and leading

tumor in the duodenum

foreshortening and narrowing of the gastric antrum.converging or telescoping of mucosal folds in the

antrum or duodenum.

prepyloric collar-shaped outpouchings.

widening of the pyloric canal and the duodenum.with an associated lead point

Treatment involves the treating the underlying cause by either

endoscopic removal of the endoscopically resectable tumor or bysurgical excision in case of unresectable tumor by endoscopy,


23/25

For all my junior and colleagues please take follow-up ofyou cases.

All cases would be ideal or atleast the interesting and

rare onesKeep in mind there's no best way to learn radiology thanby taking follow-up of your cases.


24/25


25/25

Thank you

dr darshan jain

Documents