P4229 - It's All in the Rib: A Rare Cause of Early Satiety and Weight Loss

Ryan M. Kozloski, MD¹, Caleb Hudspath, DO^2
1Womack Army Medical Center, Fort Bragg, NC; ²Womack Army Medical Center, Fort Liberty, NC

Introduction: Early satiety and weight loss can be a concerning symptom complex. The immediate concern is for a malignant process within the abdomen, causing compression of the stomach and thus reduced gastric size and early satiety.¹ Though compression by neoplasia is one cause of this symptom complex, it is important to maintain a broad differential, as heart failure and anatomic abnormalities can also cause stomach compression. Further, there are also conditions that can cause early satiety without stomach compression, such as dysmotility and vascular insufficiency. Various structural abnormalities have been described as leading to both early satiety and weight loss,² though there are few case reports describing bony abnormalities leading to this symptom complex. We present a rare case of anterior rib malformation causing extrinsic compression of the gastric body causing early satiety and weight loss.

Case Description/Methods: A 47 year old male with recent military deployment presented to the gastroenterology clinic with a three month history of early satiety and weight loss of 15 pounds. Given the patients symptoms a diagnostic esophagogastroduodenoscopy (EGD) was done for further evaluation. During the endoscopy, an area of extrinsic compression was noted along the lesser curvature of the gastric wall. The area was probed using a closed forceps and was hard. The overlying mucosa was grossly normal. The EGD was otherwise normal. Given the appearance of the extrinsic compression, cross-sectional imaging was obtained which showed displacement of the anterior portion of the left tenth rib with compression to the gastric body and heart. A gastric emptying study was normal. Given the persistent symptoms and weight loss, the patient was referred to thoracic surgery with plan for anterior rib fixation. Patient denied blunt force trauma during the recent military deployment.

Discussion: Endoscopically identified extrinsic compression of the stomach is sometimes seen during endoscopy. Subsequent work up can include cross-sectional imaging, review of previous cross- sectional imaging, or endoscopic ultrasound. Extrinsic compression of the stomach may suggest malignancy and should prompt further work up. Our case shows a rare presentation of anterior rib displacement that was initially seen on endoscopy and confirmed with cross-sectional imaging.



Disclosures:


Ryan M. Kozloski, MD¹, Caleb Hudspath, DO². P4229 - It's All in the Rib: A Rare Cause of Early Satiety and Weight Loss, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.