Recently, the Endoscopy Room of Hainan Chengmei Hospital successfully performed a highly challenging outpatient minimally invasive endoscopic surgery, precisely removing a rare submucosal cyst blocking the pylorus in a 9-year-old girl, effectively alleviating her abdominal pain, vomiting, and other discomforts that had lasted for two months.
After two months of struggling with a stubborn illness without results, a gastroscopy revealed the "culprit"
Xiaoqi (pseudonym), a 9-year-old child patient, has been experiencing persistent upper abdominal pain for nearly two months, with frequent vomiting after eating, accompanied by decreased appetite and lethargy. Her daily routine and growth and development have been significantly affected.
The child's family members took the child to undergo multiple imaging examinations, including abdominal CT and ultrasound, but the causes of abdominal pain and vomiting were not identified. Symptomatic interventions did not provide any relief to the symptoms.
"Seeing our child unable to keep food down, vomiting every time he eats, and getting thinner by the day, we were extremely anxious." Xiaoqi's father recalled his child's condition at that time, his words filled with anxiety and helplessness.
To thoroughly investigate the cause of the illness, Xiaoqi's father took her for a detailed gastroscopy.
In the endoscopy room, as the gastroscope lens penetrated deep into Xiaoqi's stomach, the "culprit" that had been bothering the child for a long time finally revealed itself. Under the gastroscope, it was clearly visible that there was a submucosal cyst with a diameter of about 2 centimeters in the pylorus area of the child, which was blocking the pylorus.
The doctor suspected that it was a pyloric cyst that was causing the gastric contents to fail to empty normally, leading to a series of obstructive symptoms such as persistent abdominal pain and vomiting after eating.
Rare diseases are prone to missed diagnosis, and minimally invasive surgical techniques can precisely break the deadlock
Professor Zhao Xinkai, the Vice President of the hospital and an expert in gastroenterology, explained that pyloric cyst is a benign cystic lesion occurring in the pylorus of the stomach. Its occurrence is often related to abnormal embryonic development, retention of gastric mucosal glandular secretion, and local chronic inflammatory stimulation. The clinical incidence rate is extremely low, and it is even rarer in children.
Moreover, early pyloric cysts have no specific symptoms, and their clinical manifestations highly overlap with common diseases such as pediatric gastritis, functional dyspepsia, and gastrointestinal spasm, making them extremely prone to missed and incorrect diagnoses. This is also the reason why Xiaoqi's previous examinations yielded no results.
Although pyloric cysts are benign lesions with a very low risk of malignant transformation, continuous enlargement of the cyst can aggravate pyloric obstruction, induce complications such as gastric ponding and gastric mucosal erosion, and long-term delay can lead to malnutrition and developmental delay in children.
Taking into account the age of the child, the location of the lesion, and the size of the cyst, and after obtaining the consent of the patient's family, under the guidance of Professor Zhao Xinkai, Dr. Chen Zhaowei, a Deputy Chief Physician in the Gastroenterology Department and Endoscopy Room, performed an endoscopic submucosal dissection (ESD) on the gastric antral tumor in the child.
(Zhao Xinkai guiding Dr. Chen Zhaowei to perform gastroscopy for the patient)
During the surgery, Dr. Chen Zhaowei precisely avoided the blood vessels and tissues surrounding the pylorus and carefully and completely peeled off the cyst from beneath the mucosa. The entire process went smoothly with minimal bleeding.
According to Dr. Chen Zhaowei, endoscopic minimally invasive treatment eliminates the need for laparotomy or laparoscopic puncture, and can completely remove lesions through the gastroscopy channel alone. It offers advantages such as minimal trauma, less bleeding, rapid recovery, no surface scarring, and preservation of normal physiological functions of the stomach, making it more suitable for pediatric patients.
After the surgery, Xiaoqi's abdominal pain and vomiting symptoms quickly alleviated, and her appetite gradually returned. She has now recovered smoothly and been discharged from the hospital.
Experts remind us to be vigilant against concealed lesions in children's digestive tract
Professor Zhao Xinkai emphasized that children's digestive tract health is directly related to their growth and development, and parents need to be vigilant and pay more attention to it.
When a child experiences recurrent abdominal pain, abdominal distension, vomiting, loss of appetite, and other symptoms of unknown causes, and these symptoms do not improve significantly after routine examinations or medication, one should not simply attribute them to "indigestion" or "gastrointestinal discomfort". Instead, consideration should be given to undergoing gastroscopy in a timely manner, so as to detect early submucosal lesions and other hidden conditions. This approach ensures early detection, diagnosis, and treatment, avoiding delays in treatment and safeguarding the healthy growth of children.
Expert Introduction
Zhao Xinkai, Chief Physician
Vice President
Director of the Endoscopy Integrated Diagnosis and Treatment Center
Medical expertise
Proficient in various complex and challenging techniques of digestive endoscopy, including ERCP and its related techniques, ESD and its related techniques, endoscopic ultrasonography, PEG, capsule endoscopy, small intestinal endoscopy, and other endoscopic diagnostic and therapeutic techniques.
Chen Zhaowei
Endoscopy Integrated Diagnosis and Treatment Center Deputy Chief Physician
Medical expertise
Proficient in endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), endoscopic full-thickness resection (EFTR), endoscopic radial incision for gastrointestinal stenosis, endoscopic stent placement for gastrointestinal stenosis, endoscopic dilation for gastrointestinal stenosis, endoscopic gastrostomy, endoscopic pyloromyotomy (POME), endoscopic pyloroplasty (PECC), endoscopic sclerotherapy for internal hemorrhoids, endoscopic ligation for internal hemorrhoids, endoscopic precise devascularization for esophagogastric varices (ESVD), and endoscopic variceal ligation.