Endoscopic full-thickness resection of gastric ectopic splenic nodules
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CASE REPORT
Endoscopic full‑thickness resection of gastric ectopic splenic nodules Linfu Zheng, Dazhou Li and Wen Wang*
Abstract Background: Ectopic spleen is extremely rare. Most cases are congenital, acquired ectopic spleen may be a consequence of surgery or trauma to the spleen. The ectopic spleen in the gastric wall we reported is even rarer. Case presentation: We report a 41-year-old female patient, with a past history of splenectomy, who presented with heartburn. Gastroscopy revealed a swelling in the fundus in the stomach. Ultrasonography and computed tomographic examination suggested the possibility of gastrointestinal stromal tumor. We performed endoscopic resection of the mass. Pathological examination of the resected mass showed ectopic spleen. Conclusion: When a patient with a history of splenectomy presents with a gastric submucosal tumor, ectopic spleen should also be considered in the differential diagnoses. And minimally invasive endoscopic treatment can achieve the purpose of diagnosis and treatment for unobvious submucosal tumors. Keywords: Endoscopic full-thickness resection, Ectopic spleen, Gastric submucosal tumor Background Ectopic spleen is a rare condition that was first described in 1667 by a Dutch doctor, Van Horne [1]. Only about 500 cases of ectopic spleen have been reported so far. The clinical manifestations are nonspecific, and most cases of ectopic spleen are recognized only when complications such as bleeding or abdominal pain occur [2]. In previous reports, the ectopic spleens were mostly located in the pelvis. We present an extremely unusual case of a woman with ectopic splenic nodules in the wall of the stomach. Case presentation A 41-year-old woman with a history of splenectomy 8 years previously for aplastic anemia was admitted to the 900th Hospital of PLA, Fuzhou, China, with complaints of repeated attacks of heartburn over the last 6 months. The attacks generally occurred after meals. On physical *Correspondence: [email protected] Department of Gastroenterology, 900th Hospital of PLA, Oriental Hospital Affiliated to Xiamen University, Fujian Medical University, Fuzhou 350025, China
examination, a 13-cm surgical scar was seen on the left lower abdominal wall. No mass was palpable. Laboratory findings revealed red blood cell count 3.59 × 1012/L, platelet count 117.0 × 109/L, and normal blood coagulation parameters. Esophagogastroduodenoscopy (EGD) revealed a swelling protruding into the gastric fundus. Endoscopic ultrasonography (EUS) showed an approximately 20.0 mm × 9.6 mm, oval, slightly hypoechoic mass without calcification, originating from the fourth layer, and protruding into the lumen of the stomach; there was no obvious blood flow signal within the mass, and the boundary was clearly seen. Based on these findings, our provisional diagnosis was gastrointestinal stromal tumor (GIST). Computed tomography (CT) of the abdomen and pelvis showed a nodular soft tissue shadow on the greater curvature of the fundus of the stomach; the picture was consistent wi
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