Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2009 Jul-Sep;13(3):425-9.

Esophageal leiomyomatosis combined with intrathoracic stomach and gastric volvulus

Firas W Obeidat  1 , Reinhold A Lang, Florian Löhe, Christian Graeb, Carsten Rist, Karl-Walter Jauch, Tanija K Hüttl, Thomas P Hüttl
Affiliations
Case Reports

Esophageal leiomyomatosis combined with intrathoracic stomach and gastric volvulus

Firas W Obeidat et al. JSLS. 2009 Jul-Sep.

Abstract

Case report: A 42-year-old female presented with long-standing symptoms suggestive of gastroesophageal reflux disease improved after proton pump inhibitor treatment. An upper endoscopy revealed an intrathoracic position of the stomach (type 4 hiatal hernia) with no mucosal abnormality. Barium swallow demonstrated gastric herniation with gastric volvulus without stenosis. A computed tomographic scan confirmed the intrathoracic location of the stomach associated with thickening and edema of the gastric wall due to gastric volvulus, but no evidence of malignancy. The patient was scheduled for laparoscopic gastric repositioning with anterior hemifundoplication. Due to the incidental intraoperative finding of a large distal esophageal tumor (frozen section: esophageal leiomyomatosis), the operation was converted to conventional distal esophagectomy and proximal gastrectomy with reconstruction using a Merendino procedure. Final histology revealed extensive circumferential leiomyomatosis of the distal esophagus with a diameter of 10 cm. Esophageal leiomyomatosis is an extremely rare pathological finding with <100 cases reported in the literature.

Conclusion: Any surgeon performing laparoscopic fundoplication has to be ready to deal with such unexpected findings, ie, converting the procedure and doing reconstruction with minimal morbidity. The Merendino procedure is a well-established reconstructive surgical option in cases of tumor formation at the gastroesophageal region with fewer postoperative morbidities like reflux symptoms.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Barium swallow study showing intrathoracic stomach (upside-down-stomach).
Figure 2.
Figure 2.
Barium swallow study showing intrathoracic stomach with organo-mesenteric volvulus.
Figure 3.
Figure 3.
Computed tomography of the chest: axial slices demonstrating intrathoracic stomach with thickening of the wall. Note the orally administered contrast medium located in the stomach.
Figure 4.
Figure 4.
Reconstruction of the gastroesophageal junction with interposition of jejunum according to Merendino.
Figure 5.
Figure 5.
Macroscopic preparation of the esophagus in formalin 4%. Dimensions of tumor: 10.5 cm × 2.5 cm.
Figure 6.
Figure 6.
Leiomyomatosis of the muscularis propria.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Seremetis MG, Lyons WS, deGuzman VC, et al. Leiomyoma of the esophagus. An analysis of 838 cases. Cancer. 1976;38:2166–2177 - PubMed
    1. Lonsdale RN, Roberts PF, Vaughan R, et al. Familial oesophageal leiomyomatosis and nephropathy. Histopathology. 1992;20:127–133 - PubMed
    1. Federici S, Ceccarelli P, Bernardi F, et al. Esophageal leiomyomatosis in children: report of a case and review of the literature. Eur J Pediatr Surg. 1998;8:358–363 - PubMed
    1. Bourque M, Spigland N, Bensoussan A, et al. Esophageal leiomyoma in children: two case reports and review of the literature. J Pediatr Surg. 1989;24:1103–1107 - PubMed
    1. Hall A. A case of diffuse fibromyoma of the esophagus, causing dysphagia and death. Q J Med. 1916;9:409–428

Publication types

LinkOut - more resources