, Volume 59, Issue 2, pp 267-269
Date: 14 Sep 2013

Locally Advanced Gastric Cancer Complicated by Mesenteric Invasion and Intestinal Malrotation

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Case Presentation and Evolution

A 67-year-old female immigrant from India without significant medical history was initially evaluated in the emergency department with complaints of 2 months of progressive epigastric pain, early satiety, nausea, and recurrent emesis associated with a 5-kg weight loss. On physical examination, a firm epigastric mass was noted. Extensive circumferential thickening of the gastric antrum and pylorus accompanied by gastric distention, and the presence of a malrotated and dilated duodenum which was entirely located right of the midline was noted in the abdominal computed tomography (CT) report (Fig. 1). The patient was admitted to the hospital for expedited diagnosis. Esophagogastroduodenoscopy (EGD) demonstrated hypertrophic antral folds with hyperemia and friability, and a dilated proximal duodenum with an abrupt, angular transition point at the third segment (Fig. 2a, b). Numerous biopsies of the antrum and pylorus were interpreted as having extensive lymph ...