Antral mucosal diaphragm as a misdiagnosed cause of gastric outlet obstruction: case report and review of the literature

  • Marcela Del Carlo Bernardi Universidade de São Paulo, Faculdade de Medicina
  • Ernesto Sasaki Imakuma Universidade de São Paulo, Faculdade de Medicina, Departamento de Cirurgia
  • Anna Carolina Bastista Dantas Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia
  • Alyne Korukian Freiberg Universidade de São Paulo, Faculdade de Medicina
  • Fabio Pinatel Lopasso Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia
  • Bruno Zilberstein Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia
  • Ivan Cecconello Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia
Palavras-chave: Antral web, Antral diaphragm, Surgery, Gastric surgery, Gastric outlet obstruction.

Resumo

The antral web is a thin septum with an aperture varying from 2 to 30 mm usually discovered in middle or late life because of associated gastric outlet obstruction or peptic ulcer. It is commonly mistaken for a pyloric obstruction. Since surgical excision of the antral diaphragm can cure patient’s symptoms, a correct diagnosis is important for not delaying treatment. However, the diagnosis is difficult even after adequate investigation with barium upper gastrointestinal x-ray series or endoscopy.  Therefore, the present study seek to notify this pathology as a possible cause of gastric outlet obstruction providing an illustrative case report and review the pertinent literature. Case Report: A 56 years old man presented complaint of pyrosis, epigastric fullness after eating and loss of weight for over three years. His past clinical history revealed a perforated peptic ulcer surgery three years ago.  Investigation was initially performed with barium upper gastrointestinal x-ray  which suggested pyloric stenosis secondary to the previous surgery. Gastric endoscopy  identified a mucous tunnel formation with a 10 mm diameter aperture in the pre-pyloric region. The patient was also submitted to a computerized tomography (CT) of the abdomen and pelvis for surgical planning for correction of pyloric stenosis and demonstrated an apparently thickening of the gastric wall and reduction of the diameter of the antropyloric region. The patient was then submitted to lapartomy with  resection of the antral web. After 6 months, the patient is asymptomatic.

Downloads

Não há dados estatísticos.

Biografia do Autor

Marcela Del Carlo Bernardi, Universidade de São Paulo, Faculdade de Medicina

1o lugar Prêmio Oswaldo Cruz - Área Relato de Caso no 33o COMU - Congresso Médico Universitário da FMUSP, SP, 31 de out. a 02 de nov. de 2014.
Hospital das Clínicas – University of São Paulo Medical School. 
Undergraduate, University of São Paulo Medical School. Email: madelcb@gmail.com, alyne.freiberg@gmail.com.

Ernesto Sasaki Imakuma, Universidade de São Paulo, Faculdade de Medicina, Departamento de Cirurgia
Departament of Surgery, University of São Paulo Medical School, Brazil. Email: eimakuma@gmail.com
Anna Carolina Bastista Dantas, Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia

1o lugar Prêmio Oswaldo Cruz - Área Relato de Caso no 33o COMU - Congresso Médico Universitário da FMUSP, SP, 31 de out. a 02 de nov. de 2014. 

Departament of Gastroenterology, University of São Paulo Medical School, Brazil. E-mails: carolbatista.med@gmail.com

Alyne Korukian Freiberg, Universidade de São Paulo, Faculdade de Medicina
1o lugar Prêmio Oswaldo Cruz - Área Relato de Caso no 33o COMU - Congresso Médico Universitário da FMUSP, SP, 31 de out. a 02 de nov. de 2014. 
Hospital das Clínicas – University of São Paulo Medical School. 
Undergraduate, University of São Paulo Medical School. Email: alyne.freiberg@gmail.com
Fabio Pinatel Lopasso, Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia

1o lugar Prêmio Oswaldo Cruz - Área Relato de Caso no 33o COMU - Congresso Médico Universitário da FMUSP, SP, 31 de out. a 02 de nov. de 2014. 

Departament of Gastroenterology, University of São Paulo Medical School, Brazil. E-mails: fabio_lopasso@uol.com.br

Bruno Zilberstein, Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia

1o lugar Prêmio Oswaldo Cruz - Área Relato de Caso no 33o COMU - Congresso Médico Universitário da FMUSP, SP, 31 de out. a 02 de nov. de 2014. 

Departament of Gastroenterology, University of São Paulo Medical School, Brazil. E-mails: brunozib@uol.com.br

Ivan Cecconello, Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia

1o lugar Prêmio Oswaldo Cruz - Área Relato de Caso no 33o COMU - Congresso Médico Universitário da FMUSP, SP, 31 de out. a 02 de nov. de 2014. 

Departament of Gastroenterology, University of São Paulo Medical School, Brazil. E-mails: icecconello@hotmail.com

Publicado
2015-03-05
Como Citar
Bernardi, M., Imakuma, E., Dantas, A. C., Freiberg, A., Lopasso, F., Zilberstein, B., & Cecconello, I. (2015). Antral mucosal diaphragm as a misdiagnosed cause of gastric outlet obstruction: case report and review of the literature. Revista De Medicina, 94(1), 15-20. https://doi.org/10.11606/issn.1679-9836.v94i1p15-20
Seção
COMU - Prêmio Oswaldo Cruz