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JAMA Surgery Clinical Challenge |

An Underappreciated Cause of Postprandial Abdominal Pain QUIZ

Reilly D. Hobbs, MD, MBS1; Jessica A. Cintolo, MD1; Robert E. Roses, MD2
[+] Author Affiliations
1Department of Surgery, University of Pennsylvania, Philadelphia
2Division of Endocrine and Oncologic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia
JAMA Surg. 2015;150(9):907-908. doi:10.1001/jamasurg.2015.0697.
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A 52-year-old woman with a history of diabetes mellitus and cigarette smoking who had a prior laparoscopic cholecystectomy was referred to our institution for severe postprandial epigastric abdominal pain that had been ongoing for several months and unintentional weight loss. What is your diagnosis?

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A, Endoscopic ultrasonography of the gastric antrum mass reveals an area of gastric thickening (arrowheads) corresponding to computed tomographic findings. During endoscopy, this area was visualized grossly as a bulge in the atrium along the incisura. A fine-needle aspiration biopsy was nondiagnostic, showing gastric antral-type mucosa without pathologic changes (inset). B, The coronal image in T2 phase reveals a 1.8 × 2.4 × 1.5-cm hypotense lesion (arrowhead) in the gastric antrum. The lesion was also enhanced on T1 arterial phase sequencing.

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