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- W2912286036 abstract "A 15 year old male with a four year history of Crohn's Disease presented with unrelenting nausea, severe abdominal pain, anorexia, and a 15 lb weight loss. Despite therapy with Prevacid, azathioprine, and oral steroids, symptoms persisted. He underwent EGD and colonoscopy. During EGD, a 1.5-cm firm submucosal nodular lesion was visualized in the gastric cardia. Remainder of upper endoscopy was normal. The colon appeared diffusely erythematous with deep erosions and ulcerations present throughout. Gastric biopsies over the lesion revealed chronic active gastritis with H. pylori. Based on the appearance of the submucosal gastric mass, the differential diagnosis included enteric duplication cyst, stromal tumor, leiomyoma/leiomyosarcoma, pancreatic rest, and splenic cyst. To further classify this lesion, MRI of the abdomen was performed. The MRI revealed a 1–1.5 cm exophytic splenic cyst in the left upper quadrant which appeared to impress on the posterolateral aspect of the gastric fundus. No abnormality of the gastric wall was identified. The patient was subsequently admitted and treated with IV steroids and Infliximab for the diagnosis of Crohn's flare. The patient was also started on therapy to treat H. pylori. Symptoms improved and the patient was discharged. Given the small size of the splenic cyst and improvement in symptoms, the lesion was not surgically removed. Splenic cysts are an unusual finding in the pediatric population; however, they should be considered in the differential of a gastric submucosal mass. There are no previous reports of a splenic cyst in a pediatric patient mimicking a gastric mass at the time of upper endoscopy. These lesions may be congenital or secondary. Secondary causes include chronic parasitic infection and abdominal trauma. It is important to recognize these lesions due risk of spontaneous rupture or abdominal pain caused by impingement on other intra-abdominal structures. The definitive treatment of these lesions involves partial or total splenectomy. Decision about surgical intervention is based upon the location and size of the cyst. In this case, the decision was made the monitor the patient closely with serial imaging studies as abdominal pain improved significantly with treatment of underlying Crohn's disease and H. pylori. Should this splenic lesion grow rapidly, surgical consultation may be advised." @default.
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- W2912286036 date "2007-09-01" @default.
- W2912286036 modified "2023-09-26" @default.
- W2912286036 title "Exophytic Splenic Cyst Mimicking a Gastric Mass" @default.
- W2912286036 doi "https://doi.org/10.14309/00000434-200709002-00756" @default.
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