Karan Midha

Jawaharlal Institute of Post Graduate Medical Education and Research

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Biju Pottakkat

Jawaharlal Institute of Post Graduate Medical Education and Research

Senthil Gnanasekaran

Jawaharlal Institute of Post Graduate Medical Education and Research

Raja Kalayarasan

Jawaharlal Institute of Post Graduate Medical Education and Research

Ram Prakash Gurram

Jawaharlal Institute of Post Graduate Medical Education and Research

Shahana Gupta

All India Institute of Medical Sciences

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Jawaharlal Institute of Post Graduate Medical Education and Research

Medical College and Hospital, Kolkata

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Kerala Institute of Medical Sciences

Sanjay Gandhi Post Graduate Institute of Medical Sciences

Lourdes Hospital

Cochin University of Science and Technology

Gastroenterology Medical Center and Hospital

The Royal Melbourne Hospital

Laboratoire des Sciences de l'Ingénieur, de l'Informatique et de l'Imagerie

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Atypical Presentation of Gastrointestinal Stromal Tumor as Multiple Intra-Abdominal Cysts: A Case Report

Cureus (2020)

Ram Prakash Gurram Senthil Gnanasekaran Karan Midha Biju Pottakkat Raja Kalayarasan

Gastrointestinal stromal tumors (GISTs) are the most common nonepithelial solid neoplasms involving the alimentary tract. We report a case of cystic GIST with multiple cystic metastases. A 61-year-old man presented with upper abdominal pain for two months. Further evaluation revealed a large intra-abdominal cyst in the lesser sac and another cyst over the segment VII of the liver on imaging. Multiple intra-abdominal hydatidoses were suspected based on the imaging and its endemic nature in the geographical area. However, the hydatid serology was normal. In view of hemorrhagic cyst fluid, an intraoperative frozen biopsy of the cyst wall was done, which revealed features suspicious of a mesenchymal tumor. Sleeve gastrectomy with en-bloc excision of the gastric cyst, excision of the hepatic cyst, and complete excision of multiple other intra-abdominal cysts were performed considering GIST as a possibility. Histology revealed a clear cell variant of GIST. Gastric GISTs primarily presenting as multiple intra-abdominal cysts and of clear cell histological variants had never been reported in the literature. The patient was started on imatinib, and he has shown no evidence of recurrence after 12 months of follow-up. A high index of suspicion, intraoperative frozen section, meticulous surgery, and immunohistochemistry are all crucial for the effective management of atypical cases. GIST may be considered as a part of differential diagnosis in clinical scenarios with multiple intra-abdominal cysts, especially in the equivocal setting.

Imatinib Mesylate

Stromal tumor

CD117

Abdominal mass

10.7759/cureus.7999

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Proximal Splenorenal Shunt in a Rare Renal Vein Anomaly: A Case Report

Cureus (2019)

Biju Pottakkat Karan Midha Shahana Gupta Raja Kalayarasan Senthil Gnanasekaran

Left renal vein (LRV) has been considered as the most suitable vein for proximal splenorenal shunt (PSRS), a commonly performed shunt for non-cirrhotic portal hypertension. Anatomical anomalies in LRV that can pose technical difficulty during shunt procedure are reported in 10% cases. We report a rare anomaly of LRV which precluded performance of standard end-to-side proximal splenorenal shunt and describe its management by performing an interposition end-to-end proximal splenorenal shunt. A 50-year-old female presented with recurrent episodes of upper gastrointestinal bleed for five years. She was pale and had a massive splenomegaly. There were no signs of encephalopathy. Upper gastrointestinal (UGI) endoscopy revealed three columns of grade 3 esophageal varices, large fundal varices and mild portal hypertensive gastropathy. Duplex ultrasound and contrast-enhanced computed tomography (CECT) of the abdomen was suggestive of non-cirrhotic portal fibrosis. She underwent an interposition end-to-end proximal splenorenal shunt with inferior branch of left renal vein. She developed partial shunt thrombosis at follow-up of 18 months and underwent balloon angioplasty and metallic stenting of shunt. She is doing well at 24 months follow-up with no recurrence of symptoms and a patent shunt. In conclusion, the presence of renal vein abnormalities does not preclude performance of PSRS with suitable modifications. A high index of suspicion is required to detect them preoperatively to avoid technical difficulties and to plan modifications of PSRS. Interposition end-to-end graft proximal splenorenal shunt is a valid option with good primary-assisted patency rate and clinical outcome.

Portosystemic shunt

10.7759/cureus.4754

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Citations (2)