Single port Billroth I gastrectomy
A 62-year-old lady presented with right upper quadrant and epigastric pain radiating round to her back. This was her fourth episode of symptoms and her pain was precipitated by fatty foods. She was investigated with an ultrasound and upper gastrointestinal endoscopy. Ultrasound imaging demonstrated a single large 2 cm gallstone in the gallbladder and was otherwise normal. However, on endoscopy a sub-mucosal swelling was found on the inferior wall of the stomach antrum []. In view of these findings, we performed an endoscopic ultrasound evaluation of the stomach and this evaluated the mass as being 56 mm at maximum diameter, slightly heterogenous and hyperechoic. No other abnormalities were found. Computer tomography confirmed a well-defined fat density submucosal lesion related to the gastric antrum []. Incorporating the clinical and radiological findings the differential diagnosis was either a gastric lipoma or gastrointestinal stromal tumour. The patient was discussed at the regional multi-disciplinary team meeting with the consensus that a distal gastrectomy and cholecystectomy should be performed with a Billroth I reconstruction in order to maintain gastrointestinal continuity should she require further management of her gallstone disease through an endoscopic route. This was performed by a single port technique.