A CASE OF CARDIAC STENOSIS DUE TO A SCAR OF GASATRIC ULCER

A 78-year-old woman was seen at the hospital because of poor appetite, nausea, and vomiting which developed around December 1991. Upper gastrointestinal series indicated a stenosis in the lower esophagus and a tumor shadow at the cardiac part of the stomach. The patient was admitted for close examination and treatment. Upper gastrointestinal endoscopy revealed a pinhole-like esophageal cardiac junction (ECJ) and the endoscope was impossible to enter the stomach side. Biopsy of the ECJ resulted in group II. Abdominal echography and CT revealed a cyst about 4cm in diameter in the left lobe of the liver. Echoguided puncture aspiration of the cyst content resulted in almost complete disappearance of the tumor shadow at the cardiac part. The patient was diagnosed as having benign stenosis at the ECJ and extramural opression of the stomach due to the hepatic cyst. On March 11, 1992 proximal gastrectomy was performed. Gross appearances included kissing ulcer at the cardiac part and white hypertrophy in the oral side region. Histopathologically extended fiber change in the submucosa was observed and it was diagnosed as fibrous stenosis due to ulcer scar. Post-operative course was uneventful and the patient was discharged from the hospital on 46th hospital day. This paper describes a rare case of cardiac stenosis probably caused by gastric ulcer scar at the ECJ.