with Dr. Marta Jimenez Toscano, Dr. Dulce Momblán
An 82-year-old female patient, with a medical history of high blood pressure and an oncological left mastectomy, was evaluated due to a recent dysphagia and diagnosed with a tumor in the esophagogastric junction.
A 7 cm mass on the gastric fundus was found in the water-soluble study. The gastroscopy confirmed a 7 cm neoplasm with a short and wide pedicle and a pathological study was performed to confirm that it was a gastrointestinal stromal tumor.
To complete the study, a CT scan was performed, which confirmed that the tumor had no distal metastasis.
Due to the location of the tumoral mass and the characteristics of the patient, we decided to initiate Gleevec to reduce the tumoral mass, with a final size of 2.7 cm in the CT scan. After this good response to medical treatment, surgery was performed.
The patient was placed, under general anesthesia, in the supine position with open legs, in the Anti-Trendelenburg position. A twelve mm trocar was introduced supraumbilically for the camera and four 5 mm trocars were placed, two on the left side of the abdomen, one on the right side, and one in the subxiphoid region.
Firstly, a laparoscopy was performed and the greater and lower curvature and the angle of His were released from the surrounding tissue. Under endoscopic control, a 3 cm tumor was localized in the esophagogastric junction.
The endoscopic transillumination and the laparoscopic external pressure help to localize the tumor and evaluate the integrity of the viscera after the procedure. The neoplasm was resected by means of loop diathermy under intraabdominal visual control, and the specimen was extracted endoscopically with an endobag.
A small hemorrhage was solved using endoscopic clips. The integrity of the gastric wall was evaluated using methylene blue. Finally, a sero serosal-suture was made to protect the resected area and an anterior gastric flap was created. Blake drainage was placed in the abdominal cavity.
On the second postoperative day a water-soluble study was performed to check the absence of leakage and the patient was put on an oral diet.
The patient had an uneventful evolution with no short-term complications. The pathological result described a gastrointestinal stromal tumor with 1/50 mitosis and G1 low grade differentiation, T2 stage. The patient had no recurrence after three months of follow up.
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