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Evaluation of Gastrointestinal Mass in a 48-Year-Old Female with Post-Cholecystectomy Symptoms

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A 48-year-old female presented to the ER with abdominal pain. CT scan revealed intra- and extrahepatic biliary ductal dilation, more prominent than expected post-cholecystectomy. Notably, a heterogeneous mass measuring 3.1x2.2 cm was found in the pancreatic head/duodenum region, with differential diagnoses including a duodenal or pancreatic head mass or inflammation. Additionally, two 6mm soft tissue nodules within the omentum were observed, suggesting a possible gastrointestinal stromal tumor (GIST) with early omental implants. GI consult and ERCP recommended.

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Evaluation of Gastrointestinal Mass in a 48-Year-Old Female with Post-Cholecystectomy Symptoms

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Presentation Transcript

  1. SYB case 2

  2. 48 year old female presented to the ER with abdominal pain • CT without contrast done to evaluate

  3. Findings • Intra-and extrahepaticbiliaryductal dilation more prominent than expected post cholecystectomy

  4. More Findings • In the region of the pancreatic head/duodenum there is a heterogenous mass like area measuring 3.1x 2.2 cm • Differential includes duodenal or pancreatic head mass or inflammation, but  no inflammatory stranding is seen

  5. Additional Findings • Two 6mm soft tissue nodules within the omentum, one anterior to the liver other one lateral to the greater curvature of stomach.  

  6. These soft tissue densities together with the duodenal mass may represent a gastrointestinal stromal tumor with early omental implants.   • Recommend GI consult and ERCP for further evaluation

  7. Discussion • GIST are tumors of connective tissue • They are the most common form of sarcoma, but still are rare • One out of every 3-4 is malignant • Found in stomach, small bowel, esophagus • Present as abdominal pain, GI bleeding, trouble swallowing • Most common site of spread is to liver, but can spread to peritoneum

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