Figure it out fridays 

A 52-year-old woman with a BMI of 40.7 kg/m2, with no significant past history, was referred for LSG. Two weeks prior to the operation, UGI endoscopy revealed mild GERD and H. Pylori. The patient received appropriate treatments for these problems. LSG was performed, followed by normal post-operation recovery and routine nutritional consult at discharge

At one-month post-operation, she experienced nausea, vomiting, and early satiety. She also had attempts for self-induced vomiting. Non-operative management was attempted unsuccessfully for several months and therefore a more thorough investigation was carried out.

Figure A. Barium swallow and meal: incisura stricture

Figure B. Upper GI endoscopy: showing soft mass like structure and hiatal hernia

Figure C. Upper GI endoscopic intervention: extraction of mass

 

HINT: Upon follow-up questioning, the patient reported routine consumption of raisins, seeds, and plums in her dietary habits.

 

What diagnosis would most likely explain the above symptoms and findings?

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A. Peptic ulcer

B. Malignant Tumor

C. Phytobezoar

D. Tuberculosis 

E. Hiatus hernia 

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