A 59-year-old man with a history of renal stones presented with the
symptoms heartburn over several months. He stated that he had received an
abdominal operation for cholecystitis 30 years ago. A diverticulum
approximately 7 cm in diameter with a narrow orifice ([Fig. 1]) was found at the greater curvature of the
antrum during upper gastrointestinal endoscopy, with a polypoid mass lesion
(3 × 3 cm) ([Fig. 2])
in the diverticulum.
Fig. 1 Diverticulum with a
narrow orifice (arrow).
Fig. 2 Polypoid mass lesion in
the diverticulum.
Abdominal computed tomography showed the gastric diverticulum
(arrow) and a large stone (star) impacted in the distal common bile duct (CBD)
without intrahepatic bile duct dilatation ([Fig. 3]).
Fig. 3 Abdominal computed
tomography showing the gastric diverticulum (arrow) and a large stone (star)
impacted in the distal common bile duct (CBD) without intrahepatic bile duct
dilatation.
The stone in the CBD was removed by endoscopic retrograde
cholangiopancreatography (ERCP). The patient received two partial polypectomies
of the divertivular polyp; the histology revealed a hyperplastic polyp. At the
second endoscopy, we saw a small hole in the diverticulum. We injected contrast
medium into the hole under fluoroscopy. The contrast medium went backwards from
the cystic duct (arrow) to the CBD and showed the tip of the endoscope in the
gallbladder ([Fig. 4]).
Fig. 4 Contrast medium injected
into the diverticulum under fluoroscopy went from the cystic duct (arrow) to
the common bile duct (CBD).
Cholecystogastrostomy was performed and explained the impaction of
the huge CBD stone without biliary dilatation. Endoscopy through the
cholecystogastrostomic orifice showed no residual polyp 6 months later.
Polypoid lesions of the gallbladder can be divided into benign and
malignant lesions. Benign polypoid lesions are divided into tumors or
pseudotumors. Pseudotumors include polyps, hyperplasia, or other inflammatory
lesions. The incidence of benign tumors of resected gallbladders ranges from
0.15 % to 8.5 % [1]. Our
patient had a hyperplastic polyp. Laparoscopic cholecystrectomy is advised for
polyps larger than 10 mm or when there is rapid growth. To our
knowledge, this is first report of a gallbladder polyp treated with endoscopic
polypectomy through cholecystogastrostomy.
Cholecystoenterostomy is a rare complication in gallstone disease,
found in 3 % – 5 % of patient
with cholelithiasis. It often involves the duodenum (71 %), the
stomach (14 %), and the colon (6 %). The
cholecystogastrostomy in our case was iatrogenic.
Gastric diverticula are usually asymptomatic, with a prevalence of
0.01 % in autopsy and 0.3 % in radiologic study.
Diverticula can be divided into two groups: true (congenital) and pseudo
(acquired) [2]. True diverticula are usually located on
the posterior wall of the stomach below the gastroesophageal junction, and
false diverticula are frequently located in the gastric antrum
[3]. Because the patient presented without epigastric
distress, he is receiving regular follow-up at the outpatients’
department.
Endoscopy_UCTN_Code_TTT_1AO_2AN
