Schwannomas are usually benign, slow growing tumors, that originate from any nerve that has a Schwann cell sheath. Here, we report the case of a 40 year-old female patient with an incidentally noted submucosal gastric tumor while being evaluated for cervical lymphadenopathy as a part of workup for lymphoma. She underwent sleeve resection of the stomach under suspicion of a gastrointestinal stromal tumor, but postoperative histopathological and immunohistochemical findings confirmed the diagnosis of shwannoma. Although schwannomas are mostly benign, they are often indistinguishable preoperatively from malignant tumors such as gastrointestinal stromal tumors. Therefore, resection is the treatment of choice for all such tumors.Keywords Gastric schwannoma . GIST . Immunohistochemistry . Sleeve resection Case ReportA 48 year old lady with cervical lymphadenopathy was subjected to ultrasound of the abdomen for ruling out splenomegaly as a part of work up for lymphoma. Ultrasound of the abdomen (Fig. 1) revealed a well defined lobulated hypoechoic mass lesion in the epigastric region located between the left lobe of liver and gastric wall. It was 4.2 × 4.1 cm in size. Computed tomography scan showed well defined uniformly enhancing gastric fundal wall mass, (Fig. 2) most likely to be GIST (gastrointestinal stromal tumour) with celiac axis and periportal nodal enlargement. The mass was partly exophytic and partly projecting into the lumen causing smooth indentation. The patient then underwent upper GI endoscopy which showed a sub mucosal bulge on the anterior wall of the fundus of the stomach. An endosonography was done using a linear scope which showed a large submucosal mixed echoic mass with few areas of necrosis in body of stomach mainly on greater curvature measurng 5 × 4 cm arising from muscularis propria. Two celiac nodes, hypoechoic round with uniform echotexture were also seen. FDG pet scan showed metabolically active tumor mostly representing GIST (Gastrointestinal stromal tumour) from body of the stomach (Fig. 3).A provisional diagnosis of submucosal mass, which could be most likely GIST, was made and fine needle aspiration cytology was done from both the lesion and the nodes with endosonoguidance. The FNA from gastric submucosal lesion showed features suggestive of spindle cell tumor while the celiac nodes showed reactive hyperplasia. A preoperative diagnosis of GIST arising from anterior wall of proximal stomach was made. The patient was subjected to laparoscopic examination which revealed an exophytic solid tumor measuring 6 × 7 cm arising from the anterior wall of the junction of body and fundus. The medial margin was at the lesser curvature and lateral margin was just short of greater curvature. In order to get a good tumor negative margin laparoscopy was converted to minilaparotomy and sleeve resection of the tumor was done using linear staplers. Histopathology revealed a submucosal tumor with features suggestive of spindle cell tumor (Fig. 4). IHC done showed positivity

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HighlightsThe most common cause of gas under diaphragm is hollow viscous perforation.This is a case report of a rare cause of gas under diaphragm on a plain chest radiograph.A case of pancreatic abscess presenting as gas under diaphragm is discussed and literature is reviewed.

Meckel's diverticulitis (MD) may occur de novo or may result from a foreign body in the diverticulum. A case is reported where MD was caused by incarceration of a roundworm. There do not appear to be previous documented reports of this condition.

Pneumoperitoneum indicates the need for urgent laparotomy. But under certain clinical situations like, patient on ventilatory support should arouse the suspicion of supradiaphragmatic source of pneumoperitoneum. Supradiaphragmatic causes account for 10%. This article describes two patients, both on ventilatory support in the intensive care unit. Failure to recognize spontaneous aseptic-pneumoperitoneum can result in unnecessary laparotomy with its risks. Hence under relevant circumstances, non-surgical causes of pneumopreitoneum should be excluded.