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JAMA Surgery Clinical Challenge
September 2015

An Underappreciated Cause of Postprandial Abdominal Pain

Author Affiliations
  • 1Department of Surgery, University of Pennsylvania, Philadelphia
  • 2Division of Endocrine and Oncologic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia

Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Surg. 2015;150(9):907-908. doi:10.1001/jamasurg.2015.0697

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. She had been prescribed total parenteral nutrition prior to referral. On presentation, her physical examination was remarkable for mild epigastric tenderness. The results of laboratory testing, including a complete blood cell count, chemistry values, liver function tests, and amylase and lipase levels, were unremarkable. Computed tomography demonstrated focal gastric thickening. Esophagogastroduodenoscopy with endoscopic ultrasonography was performed that confirmed a submucosal gastric mass (Figure, A). A fine-needle aspiration biopsy revealed benign and reactive glandular cells and debris. Magnetic resonance cholangiopancreatography demonstrated a 2.4-cm hypervascular and exophytic mass in the gastric antrum and locoregional lymphadenopathy (Figure, B).

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