Gastric diverticulum simulating a left adrenal tumor

A 42-YEAR-OLD MAN was admitted to our hospital with a 2-month history of left lumbar pain, asthenia, and frequent headaches. Laboratory examinations produced normal findings except for moderately elevated levels of urinary catecholamines (urinary vanillylmandelic acid/24 h:12.8 mg/24 h, urinary homovanillic acid/24 h:10.5 mg/24 h). An upper abdominal CT scan showed the appearance of a 4.5-cm necrotic mass in the area of the left adrenal gland (Fig 1). A bone isotopic scan, chest radiography, and metaiodobenzylguanidine isotopic scan produced normal findings. The decision for surgical exploration was taken through a left thoracoabdominal incision. No mass could be found in the vicinity of the kidney, adrenal gland, or tail of the pancreas. The patient developed acute pancreatitis in the postoperative period and was transferred to our unit for treatment. He was treated with intravenous somatostatin, prolonged drainage, and total parenteral nutrition. Later, another CT scan showed a “mass” adjacent to the left adrenal gland containing fluid and circular hyperdense images consistent with tablets. An upper gastrointestinal barium series revealed a gastric diverticulum arising from the proximal part of the greater curvature of the stomach (Fig 2).