Presentation
Weight loss and early satiety.
Patient Data
The stomach is distended down to the pylorus with food residues inside, enhancing circumferential pyloric-duodenal mural thickening (total segment length of 6-8 cm, 8-10 mm single wall measurement), interrupted mucosal enhancement/ulcers seen at the stenosed/ deformed duodenal bulb, no active bleeding noted, or perforation.
No significant surrounding fat stranding, more than four peripyloric lymph nodes, all are subcentrimetric (up to 4mm short axis), no nearby organ invasion
Several lymph nodes were seen at the mesenteric root largest measuring 6mm on the short axis, with no peritoneal nodules. No ascites.
Liver: the geographic hypodense area was seen occupying segment IV, replaced right hepatic artery arising from the SMA, normal portal vein.
The patient undergoes EGD in which the stomach contains a large amount of food residue despite fasting.
Erythema and nodularity of the gastric mucosa were noted, deformed duodenal bulb with narrowing thus the scope passed with difficulty. The duodenal mucosa showed erosions and ulcerations, a biopsy was taken and reported as a section of the superficial gastric mucosal lining showing benign-looking gastric mucosal glands embedded in fibrovascular stroma which was infiltrated by chronic inflammatory cells with no evidence of H.pylori infection at the superficial epithelial lining. A picture of chronic gastritis, no dysplastic or metaplastic changes.
Case Discussion
Findings of partial gastric outlet obstruction since exaggerated peristalsis noted on the US propelling the gastric content through the narrowed pylorus/ proximal duodenum. The hypodense liver lesion looks echogenic on ultrasound with the blood vessels seen traversing it without interruption indicating focal hepatic steatosis.
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