Diverticulum of the stomach. Cicatricial and tumor processes of the stomach
In contrast to the ulcerative process, uncomplicated gastric diverticula are characterized by variability in shape and size under the influence of palpation or dosed compression due to soft, elastic walls involved in gastric peristalsis. The walls of the diverticulum retain the ability to contract. Diverticula are rounded or elongated, oval in shape, usually connected to the stomach by a neck, in which mucosal folds can be traced, passing from the stomach into a protrusion. There is no infiltrative shaft at the base of the diverticulum and local pain on palpation. Clinical manifestations in the presence of a diverticulum are uncertain: sometimes there are pains in the po; spoon area, heartburn, vomiting.
Cicatricial processes of the stomach. In cicatricial processes of the stomach, most often caused by inflammatory-destructive changes (ulcer, antral gastritis, etc.), there are deformities in the form of an hourglass, shortening of the lesser curvature (cochlear and purse -like stomach), wrinkles of the lesser curvature and sagging of the greater, as well as narrowing – stenosis of the pylorus and duodenal bulb. Deformation of the stomach may also be associated with suturing of a perforated ulcer or wound.
The contours of the stomach in the area of cicatricial lesions are uneven, wavy, tortuous. Longitudinal folds are usually not traced, however, unlike cancerous deformity, there are no signs of fold breakage, and the depth of cicatricial retraction exceeds its length along the contour of the stomach. Often there are signs of an active gastric or duodenal ulcer.
The elasticity of the walls, if broken, is to a relatively small extent: a complete loss of elasticity is not observed. The contractility of the affected area is preserved, although usually weakened. If cicatricial deformity of the stomach is accompanied by a violation of its evacuation function, then usually the lumen of the stomach is significantly expanded and the manifestations of the inflammatory process are clearly expressed.
Tumors of the stomach. In malignant tumors, there is no single radiographic picture of the stomach lesion. With developed exophytic cancer, the leading radiological symptom is a filling defect, and with endophytic cancer , deformation (narrowing) of the organ caused by infiltration of the stomach wall with tumor tissue. Mixed forms have signs of both types of tumors. In all such cases, the area of the stomach affected by a malignant tumor differs from a healthy wall in uneven, straightened contours, is rigid , does not peristaltize and steadfastly retains its shape under dosed compression (palpation), tighter filling of the organ with a suspension of barium, inflation of the stomach and other influences.
In the edge -forming position, unevenness, broken outlines of the filling defect are usually visible, which is mainly due to the nature of the surface of the tumor itself (tuberosity), which is distinguished by a pronounced variety of forms. The length of the edge filling defect always exceeds its depth.
However, it must be borne in mind that with a small cancerous tumor, powerful peristaltic contractions of a healthy wall can passively displace the affected area, creating a false impression of its intactness . The relief of the inner surface of the stomach at the site of a cancerous lesion loses its normal folding. At the same time, the folds can be straightened, thickened and rigid , smoothed or not traced at all or replaced by a tumor, the bumpy surface of which creates a picture of randomly located rounded enlightenments with polycyclic contours, shapeless accumulations and barium strips between them (“malignant”, or atypical, relief) .