Hemorrhagic Gastric Diverticulum Mimics Adrenal Tumor: A Case Report
A case report published in BMC Surgery by Jia Li. and colleagues has shown that a hemorrhagic gastric diverticulum can very much resemble a left adrenal tumor on imaging studies, thus creating a diagnostic dilemma and prompting surgical exploration, which ultimately confirmed that the adrenal gland was normal. This case illustrates what is thought to be the first recorded instance of a hemorrhagic gastric diverticulum simulating an apparent adrenal mass. The observation illustrates the diagnostic pitfalls of periadrenal anatomy, where other organs, such as the gastrointestinal tract, can mimic adrenal neoplasms because of shared radiologic features.
The periadrenal space is a complex area, and it is often difficult to differentiate true adrenal masses from those that occur outside the adrenal gland. The presentation is often non-specific, and there may be overlap in the imaging characteristics of adrenal masses and masses of other organs.
A 50-year-old male patient was admitted for epigastric pain and discomfort. Upper gastrointestinal endoscopy showed gastric retention without evidence of a distinct mass lesion. Non-contrast computed tomography of the abdomen showed a left adrenal tumor. Follow-up abdominal magnetic resonance imaging studies further supported the suspicion of a left adrenal neoplasm. The differential diagnoses included adrenal adenoma and pheochromocytoma. Despite the radiographic findings, laboratory studies showed normal levels of adrenal hormones, making the possibility of a functional adrenal tumor less likely. Nevertheless, because of the continued concern for a tumor on imaging studies and the associated risk of pheochromocytoma, surgical exploration was performed.
On cross-sectional imaging, the lesion was thought to originate from the left adrenal area and showed contrast enhancement, which is typical for adrenal neoplasms. The imaging features were so suggestive that a presumptive diagnosis of a left adrenal tumor was made. The non-specific clinical presentation of epigastric pain without any endocrine changes did not favor either a gastrointestinal or an adrenal primary.
However, the operative findings did not support the imaging diagnosis. The left adrenal gland was found to be normal. A more detailed dissection revealed a mass that was posterior to the stomach. The mass was intimately adherent to the adrenal gland, which made it appear as an adrenal mass on imaging.
In this single case, imaging reports such as non-contrast CT and MRI were suggestive of a left adrenal tumor. However, the adrenal hormone work-up was 0 for abnormalities. Surgical exploration confirmed 1 normal left adrenal gland and also identified a mass arising from the posterior wall of the stomach. Macroscopic examination confirmed a hemorrhagic gastric diverticulum. The hemorrhagic part accounted for the contrast enhancement on imaging studies, leading to the initial misdiagnosis.
This is the first reported case of a hemorrhagic gastric diverticulum simulating a left adrenal mass. Despite the strong imaging suggestion of a left adrenal tumor, surgical exploration disclosed a normal adrenal gland and a hemorrhagic gastric diverticulum originating from the posterior wall of the stomach. This case illustrates the difficulties of diagnosis created by the complex periadrenal anatomy and the need to consider a gastrointestinal lesion in the differential diagnosis of an adrenal mass.
Reference:
Li, J., Wang, Y., Zheng, J. et al. The left adrenal mass is difficult to differentiate from a hemorrhagic gastric diverticula: a case report. BMC Surg (2026). https://doi.org/10.1186/s12893-026-03541-8
