Left upper quadrant mass with hematemesis and melena
Introduction
Introduction Left upper abdominal mass with hematemesis and melena is one of the clinical manifestations of gastric teratoma. It often occurs in infants. Infant stomach teratoma is a rare disease, which causes gastric mucosal ulcer due to tumor growth to the stomach. Hematemesis and melena can occur. The etiology of gastric teratoma has not been elucidated, but it is generally considered to be different from teratomas from any part of the body because it is not related to the body axis and chest and abdomen of the back body axis, but from the visceral wall. This may be about 1/4 of the malignancy of other parts of the teratoma, and gastric teratoma is usually a benign cause.
Cause
Cause
(1) Causes of the disease
The etiology of gastric teratoma has not been elucidated, but it is generally considered to be different from teratomas from any part of the body because it is not related to the body axis and chest and abdomen of the back body axis, but from the visceral wall. This may be because other parts of the teratoma are about 1/4 of the malignant and the teratoma is usually benign.
(two) pathogenesis
Like other teratomas, gastric teratoma contains three germ layer components, most of which are mainly mature tissues, but some of the neural tissues show the original immature structure, the difference is that the disease is generally considered benign, and from the discovery Development to malignancy Although immature neuronal tissue is usually seen, a few cases are pathologically reported as immature teratoma, but clinically confirmed to be benign and simple tumor resection without good chemotherapy effect, age, gender and gross morphological obstruction Symptoms Gastrointestinal bleeding and X-ray findings are not reliable signs of malignancy. Moriuchi has a total of 40 cases, gastric teratoma 70%, gastric teratoma grows 16% to the stomach, 14% inside and outside the stomach, intragastric growth All tumors from the anterior wall grow out of the stomach, and tumors that grow into the stomach can cause hematemesis and melena symptoms due to mucosal ulcers.
Examine
an examination
Related inspection
Fiber endoscopy, abdominal plain film, fecal blood
X-ray diagnosis: Gastric teratoma showed various changes in various X-ray examinations due to the size, shape and internal structure of the lesion:
(1) Abdominal plain film: In the middle upper abdomen or the whole abdomen, the uneven shadow of density unevenness can be seen, the boundary can be unclear and the intestine can be squeezed to the right front lower mass, and the strip-shaped bone-like or spot-like sand-like calcification shadow can be seen in the shadow;
(2) Barium meal perspective: it shows that the small intestine of the stomach is deformed and displaced downward; the filling defect in the stomach can also expand and the gas-liquid level and a large amount of fluid can be expanded; or the contrast agent in the stomach can also accumulate in the mass along the mass. Leaflet
(3) tincture enema: visible transverse colon descending colon and sigmoid colon pressure down the upper abdomen showed a huge shadow.
Diagnosis
Differential diagnosis
There is tenderness in the cystic mass of the left upper abdomen: the cystic inflammatory mass in the left upper abdomen has obvious tenderness, such as the tumor in the middle of the abdomen, which is often a tumor or cyst of the stomach or pancreas, or an intragastric stone.
Lower abdomen mass: The lower abdomen mass refers to a mass in the lower abdomen. The touch has a hard feeling. It may be benign or malignant, mostly gynecological disease symptoms or intestinal and peritoneal diseases. A soft sausage-like mass can be seen in the right lower quadrant: cecal granuloma with cecal amoebic granuloma and schistosomiasis granuloma in the ileocecal area. The cecal amoebic granuloma is a complication of chronic colitis caused by Entamaeba Histolytica. The ileocecal schistosomiasis granuloma is a late stage disease of intestinal schistosomiasis. The schistosomiasis egg deposition site is mainly the terminal ileum except the colon. The clinical symptoms are localized abdominal pain and intermittent diarrhea. The right lower abdomen can be touched with soft sausage-like mass. In addition, chronic low intestinal obstruction is often accompanied by acute intestinal obstruction.
Mass in the midline of the abdomen: The mass in the midline of the abdomen is a clinical feature of the white line. The bilateral rectus abdominis sheaths are interwoven in the midline of the abdomen to form a belly white line. The abdominal visceral vaginal white line is called the hernia of white line. Abdominal wall mass, fixed tenderness: the outer wall of the abdominal wall, fixed tenderness is the main clinical signs of the semilunar hernia. The anterior and posterior layers of the rectus abdominis sheath heal at the lateral edge of the rectus abdominis, forming a semi-moon-shaped, convex-laterally curved, sacral structure, ie the meniscus. The peritoneal or intra-abdominal organs protrude through the meniscus of the lateral abdominis, called the spigelian hernia, also known as the lateral abdomen. Spige (1617) first described the anatomy of the meniscus, so it is also known as spiglian.
