Completely laparoscopic resection of a rare pyloric tumor with laparoscopically sutured gastroduodenostomy

We report the case of a 31-year-old woman who presented with epigastric pai n and weight loss. Esophagogastroduodenoscopy revealed a submucosal mass in the distal antrum and pylorus. Endoscopic biopsy of the mass was nondiagno stic. A CT scan confirmed a 3.0-cm mass in the posterior wall of the distal antrum. She underwent laparoscopic resection of the distal antrum and pylo rus with end-to-end gastroduodenostomy. Pathologic examination showed an ad enomyoma of the antrum and pylorus. Her postoperative course was uncomplica ted, and she continues to do well 38 months postoperatively. Gastric adenom yoma is a rare, benign intramural tumor of the antrum and pylorus. Fewer th an 40 cases have been described in the literature. The lesions are generall y within 4 cm of the pylorus. Histologically, they are characterized by duc tal structures lined by cuboidal to columnar epithelium surrounded by smoot h muscle bundles and, occasionally, Brunner's-type glands and heterotopic p ancreas. Treatment is by resection, and recurrence has not been reported. L aparoscopic resection of portions of the stomach has been reported. Side-to -side gastrojejunostomies (Billroth II) performed laparoscopically have bee n reported. This is the first report in the English-language literature of a completely laparoscopically performed sutured gastroduodenostomy. Technic al details of the procedure and adenomyomas are discussed.