Résumé
Une halitose a conduit à réaliser une endoscopie digestive haute chez une adolescente de 13 ans. L’examen a révélé la présence d’un orifice prépylorique, d’aspect diverticulaire. Les examens d’imagerie qui ont suivi (TOGD, scanner et IRM) n’ont pas permis d’orienter le diagnostic, seule l’échographie a confirmé l’existence d’une masse antropylorique intramurale, au sein de laquelle il existait de la muqueuse gastrique, et qui communiquait avec l’estomac par un petit pertuis. Une nouvelle endoscopie a retrouvé un orifice prépylorique permettant le passage de l’endoscope mais avec une butée rapide dans un cul-de-sac polylobé. Après concertation médicochirurgicale, une intervention par coelioscopie a permis l’exérèse de la lésion. L’examen anatomopathologique a confirmé l’existence d’une duplication gastrique, avec quelques îlots pancréatiques. Les suites opératoires ont été simples et la symptomatologie initiale a disparu.
Le diagnostic de duplication gastrique est habituellement obtenu à l’aide des examens d’imagerie classique que sont l’échographie et le scanner. Dans cette observation, c’est l’endoscopie qui a permis d’identifier la lésion, confirmée ensuite après exérèse chirurgicale.
Abstract
A digestive endoscopy was performed in a 13-year-old teenager with halitosis. This examination revealed the presence of a prepyloric orifice with a diverticular aspect. The following radiological exams (OGDT, scanner and RMI) did not guide the diagnosis. Only the ultrasound confirmed the existence of an intramural antropyloric mass, in which there were mucosal gastric, and who communicated with the stomach by one small pertuis. A new endoscopy found prepyloric orifice for the passage of the endoscope but with a quick stop in a multilobed cul-de-sac. After medico-surgical consultation, an intervention by laparoscopy allowed the removal of the lesion. The anatomopathology confirmed the existence of a gastric duplication, with a few pancreatic islets. The postoperative was uneventful and the initial symptoms disappeared.
Diagnosis of gastric duplication is usually made by using radiological examinations. In this observation, the endoscopy identified the lesion, confirmed afterwards by the surgical resection.
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Carré, E., Azzis, O., Bruneau, B. et al. Diagnostic endoscopique d’une duplication gastrique communicante. Acta Endosc 42, 186–189 (2012). https://doi.org/10.1007/s10190-012-0256-2
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DOI: https://doi.org/10.1007/s10190-012-0256-2