Electronic Clinical Challenges and Images in GI
Article Outline
- Image 3
- Answer to the Clinical Challenges and Images in GI Question: Image 3: Giant Gastric Polyp Prolapsing Into the Duodenum
- References
- Copyright
Image 3
Question: A 65-year-old man, without a significant past medical history, presented after a week of epigastric pain, nausea, and vomiting. On physical examination, no abnormalities were found and abdominal palpation was normal. On admission, his hemoglobin was 6.4 g/dL; other laboratory values were within normal limits. Urgent endoscopy revealed a complete pyloric obstruction and the endoscope was unable to cross the pylorus. Abdominal computed tomography showed a well-defined intraluminal defect in the duodenum (Figure A) with a “ring enhancement” in the venous phase (Figure B).
What is the diagnosis in this patient?
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Answer to the Clinical Challenges and Images in GI Question: Image 3: Giant Gastric Polyp Prolapsing Into the Duodenum
The diagnosis was made at surgery: The polyp was easily reduced into the stomach and the patient underwent a distal gastric resection with Roux-en-Y reconstruction. Macroscopic analysis of the surgical specimen showed an ulcerated giant polyp, sliding on the gastric wall (Figure C).
Histologic examination revealed a benign hyperplastic polyp without any evidence of malignancy. Hyperplastic gastric polyps (HGPs) represent the majority of gastric polyps. They are small and asymptomatic, and are usually discovered during upper digestive endoscopies. Rarely, HGPs can be responsible of gastrointestinal blood loss and iron-deficiency anemia. HGPs are benign lesions; nevertheless, a very low risk of malignant degeneration has been recognized.1
Sporadic cases of giant benign or malignant polyps prolapsing through the pylorus and determining an intermittent gastric outlet obstruction were reported in the literature.2, 3 In our case, the prolapse of a giant polyp determined a complete pyloric obstruction requiring urgent surgery for diagnosis and treatment.
References
- Gastric polyps: a retrospective analysis of 26,000 digestive endoscopies. Arq Gastroenterol. 2007;44:14–17
- Hyperplastic gastric polyp causing progressive gastric outlet obstruction. Mayo Clin Proc. 1998;73:964–967
- . Endoscopic excision of a prolapsing malignant polyp which caused intermittent gastric outlet obstruction. World J Gastroenterol. 2005;11:5245–5247
For submission instructions, please see the Gastroenterology web site (www.gastrojournal.org).
PII: S0016-5085(08)01870-2
doi:10.1053/j.gastro.2008.10.035
© 2009 AGA Institute. Published by Elsevier Inc. All rights reserved.
