Traumatic neuroma of remnant cystic duct mimicking duodenal subepithelial tumor:A case report

BACKGROUND Gastrointestinal subepithelial tumors(GSTs),incidentally detected during upper gastrointestinal(GI)endoscopy,may be lesions derived from the GI wall or may be caused by compression from external organs.In general,traumatic neuroma is a benign nerve tumor that results from postoperative nerve injury,occurring in the bile duct as one of the complications after cholecystectomy.This is the first case report demonstrating that neuroma of the cystic duct can be incorrectly perceived as a duodenal subepithelial tumor by compressing the duodenal wall.CASE SUMMARY We report the case of a 72-year-old man with traumatic neuroma of the cystic duct after cholecystectomy.This tumor was mistaken for a duodenal subepithelial tumor on preoperative upper GI endoscopy and endoscopic ultrasonography due to external compression of the GI wall.The patient had no symptoms,and his laboratory test results were normal.However,in a series of follow-up endoscopies,the tumor was found to have grown in size,so it was surgically resected.The lesion was completely removed by laparoscopic endoscopic cooperative surgery.The patient was discharged on postoperative day 7 without complications.CONCLUSION Traumatic neuroma of the cystic duct can be mistaken for GSTs in GI endoscopy.

High morbidity in myocardial infarction and heart failure patients after gastric cancer surgery

AIM:To evaluate to morbidity and mortality differences between 4 underlying heart diseases,myocardial infarction(MI),angina pectoris(Angina),heart failure(HF),and atrial fibrillation(AF),after radical surgery for gastric cancer.METHODS:We retrospectively collected data from 221 patients of a total of 15167 patients who underwent radical gastrectomy and were preoperatively diagnosed with a history of Angina,MI,HF,or AF in 8 hospitals.RESULTS:We find that the total morbidity rate is significantly higher in the MI group(44%) than the Angina(15.7%),AF(18.8%),and HF(23.1%) groups(P < 0.01).Moreover,we note that the risk for postoperative cardiac problems is higher in patients with a history of HF(23.1%) than patients with a historyof Angina(2.2%),AF(4.3%),or MI(6%; P = 0.01).The HF and MI groups each have 1 case of cardiogenic mortality.CONCLUSION:We conclude that MI patients have a higher risk of morbidity,and HF patients have a higher risk of postoperative cardiac problems than Angina or AF.

Management of post-gastrectomy anastomosis site obstruction with a self-expandable metallic stent

Post-gastrectomy anastomosis site obstruction is a relatively rare complication after a subtotal gastrectomy.We present a case of a 75-year-old man who underwent a truncal vagotomy, omental patch, gastrojejunostomy, and Braun anastomosis for duodenal ulcer perforation and a gastric outlet obstruction.Following the 10 th postoperative day, the patient complained of abdominal discomfort and vomiting.We diagnosed post-gastrectomy anastomosis site obstruction by an upper gastrointestinal series and an upper endoscopic examination.We inserted a self-expandable metallic stent(SEMS) at the anastomosis site.The stent was fully expanded after deployment.On the day following the stent insertion, the patient began to eat, and his abdominal discomfort was resolved.This paper describes the successful management of post-gastrectomy anastomosis site obstruction with temporary placement of a SEMS.