Transpyloric prolapse of a pedunculated polypoid gastric carcinoma.

A patient with transpyloric prolapse of a pedunculated polypoid gastric carcinoma is reported. Only three previous cases have been reported in the international literatures. However, in Japan, 33 cases of prolapsed gastric carcinoma have been reported during the past 30 years. Prolapsed gastric carcinoma should be included in the differential diagnosis of localized intraluminal filling defects in the duodenal bulb. Endoscopy and biopsy are essential for correct diagnosis.

Hemorrhage due to retrograde prolapse of stomach. An endoscopic diagnosis.

A case of recurrent hemorrhage due to localized gastric mucosal congestion from retrograde prolapse during severe retching is described. Historically, this condition may mimic the "Mallory-Weiss syndrome" and endoscopically, this lesion may be mistaken for "gastritis". This rarely recognized condition may be an explanation for some cases of cryptic hematemesis.

Duodenal pseudotumor with ball-valve syndrome.

Prolapse of the gastric mucosa into the duodenum must be considered when a round soft tissue mass is seen in the right upper quadrant on scout abdominal film. Gastric prolapse may mimic tumor in the duodenum when the prolapse is large. Examination with barium meal is necessary to exclude prolapse of the gastric mucosa into the duodenum as a cause of epigastric pain and vomiting. Medical treatment is suggested for patients with mild symptoms, but patients with severe symptoms, repeated hemorrhage, anemia, severe intermittent epigastric pain and vomiting due to ball-valve syndrome should have operation.

[Combination of a hiatal hernia and a transpyloric prolapse of gastric mucosa]. / Gemeinsames Vorkommen einer Hiatushernie und eines transpylorischen Schleimhautprolapses.

During the past 5 years we operated 13 cases of combination of a hiatal hernia and a transpyloric prolapse of the gastric mucosa. These represent ca. 7% of all operated hiatal herniae. In addition we treated 9 cases conservatively, at that the combination of a loose cardia and a labile pylorus was diagnosed through endoscope. Results of these both treatments are satisfactory. 12% of operated hiatal herniae are combined with duodenal ulcer but only 4% with gastric ulcer. It may be concluded that gastric entrance (cardia) and exit (pylorus) have a close connection.

Retrograde gastric mucosal prolapse as a cause of haematemesis.

Three cases of haematemesis associated with alcohol abuse are described. Early fibreoptic endoscopical examination in each showed a focal, well demarcated area of gastric mucosal haemorrhage, close to the oesophagogastric junction. Two patients showed prolapse of the lesion into the lower part of the oesophagus, and the third had coexistent Mallory-Weiss tears. Our observations suggest that forceful vomiting is responsible for this lesion, by causing abrupt retrograde gastrooesophageal prolapse. The prognosis of the lesion appears good.

[Rare causes of acute gastric hemorrhage]. / Redkie prichiny ostrykh zheludochnykh krovotechenii

According to the author's findings rare causes of acute gastric hemorrhages (the Mallory-Weiss syndrome, cancerous lesions of the gastrointestinal organs, excluding the stomach, esophageal and duodenal diverticulum, prolapse of gastric mucosa into the duodenum, necrosis of the gastric wall, its traumatic rupture, the Rendu-Osler disease, rupture of the renal artery aneurysm) made 3.2% of other causes. Profuse hemorrhage was noted in 12 of 32 patients under consideration. In 8 of 32 patients (25%) the diagnosis was established only at autopsy. In other more frequent causes of acute gastric hemorrhage the diagnosis proved to be feasible in 90-95% of cases.

Haematemesis: a new syndrome?

Three patients presented with symptoms suggesting a Mallory-Weiss tear. Endoscopy showed a localized, clearly demarcated area of bright red mucosa near the gastro-oesophageal junction; this was thought to have arisen by retrograde intussusception of the stomach during vomiting or retching and may have caused the haemorrhage.