45

Case 45


History



A 55-year-old gentleman presents with epigastric discomfort which he has had for 2 years. He denies tarry stools, haematemesis, dysphagia or weight loss. He has a past history of hypertension and ischaemic heart disease. He is taking aspirin and nifedipine. He has had no previous endoscopic work-up.


Physical examination


Temperature 37.1°C, pulse 72 bpm, BP 135/85mmHg, SaO2 98-100% on RA.


Hydration is satisfactory.


Examination of the hands reveals no clubbing and normal-appearing palmar creases.


Head and neck examination is unremarkable.


Cardiovascular: HS dual, no murmur.


His chest is clear on auscultation.


Abdominal examination reveals a soft, non-tender abdomen.


No signs of oedema.


Investigations


CBC:


WBC 5.9 x 109/L;


haemoglobin 12.5g/dL;


platelets 285 x 109/L.


What is your differential diagnosis of his epigastric discomfort?


Peptic ulcer disease.


Gastro-oesophageal reflux disease (GORD).


Malignancy (e.g. liver, oesophageal, gastric).


Pancreatic disease (chronic pancreatitis).


Gastroparesis.


Functional dyspepsia.


An oesophagogastroduodenoscopy (OGD) is performed showing the following (Figures 45.1 and 45.2).






images






images


Please describe what you see


The endoscopic photos show an antral submucosal nodule with an umbilicated appearance. The overlying mucosa appears normal.


What is the differential diagnosis?


Ectopic pancreas.


Carcinoid tumours.


Lymphomas.


Gastrointestinal stromal tumours (GISTs).


Which of the above is more likely, and why?


An ectopic pancreas.

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Oct 23, 2019 | Posted by in GASTROENTEROLOGY | Comments Off on 45
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