1
|
Gastroduodenal intussusception as a rare cause of pancreatitis in a young female Ugandan: A case report. Int J Surg Case Rep 2021; 89:106632. [PMID: 34844196 PMCID: PMC8636807 DOI: 10.1016/j.ijscr.2021.106632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction and importance Gastroduodenal intussusceptions are rare and usually secondary to gastric lesions acting as the lead point. Gastrointestinal stromal tumors (GISTs) commonly occur in the stomach (40–60%). Other gastric tumors include; adenocarcinomas, leiomyomas, lymphomas among others. When gastric tumors act as lead points in gastroduodenal intussusception, pancreatitis may arise due to compression of the ampulla of Vater or pancreatic head. Gastroduodenal intussusception may mimic other inflammatory upper gastrointestinal conditions leading to delays in early diagnosis and timely intervention. Case presentation A twenty three year old female with gastroduodenal intussusception secondary to a gastric body GIST with associated pancreatitis. This gastroduodenal mass was initially diagnosed as a pancreatic head echo-complex mass by ultrasound. Confirmatory preoperative diagnosis was made after doing contrasted abdominal computed tomography (CT) scan and upper gastrointestinal endoscopy. Open gastric wedge resection was done. Patient had uneventful recovery and was discharged on the fifth postoperative day. Clinical discussion Gastroduodenal intussusceptions have non-specific clinical features that may lead to delays in making the correct diagnosis. CT scan is a good imaging modality for diagnosing this condition but access is limited in low resource settings. Resection of the organic cause after reducing the intussusception leads to resolution of the symptoms caused by the intussusception, the GIST and the resultant pancreatitis. Conclusion Gastroduodenal intussusception is rare and may present with nonspecific clinical features. Pancreatitis may arise due to the compression effects on the ampulla of Vater or pancreatic head. A high index of suspicion is key in making a timely diagnosis. Gastroduodenal intussusception is rare and may cause pancreatitis by it's direct pressure effects on the ampulla of vater. This condition may mimic pancreatitis leading to a delay in early surgical intervention. Abdominal ultrasound scan in experienced hands, abdominal CT scan with or without Oesophagogastroduodenoscopy is diagnostic.
Collapse
|
2
|
Zorzetti N, Lauro A, D'Andrea V, Ruffato A, Ferruzzi L, Antonacci N, Tranchino RM. Benign Blockage: Gastric Outlet Obstruction due to a Prolapsing Gastric Pedunculated Polyp-Case Report and Literature Review. Dig Dis Sci 2021; 66:1791-1795. [PMID: 33634429 DOI: 10.1007/s10620-021-06890-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 12/09/2022]
Affiliation(s)
- N Zorzetti
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy.
| | - A Lauro
- Department of Surgical Sciences, La Sapienza University, Rome, Italy
| | - V D'Andrea
- Department of Surgical Sciences, La Sapienza University, Rome, Italy
| | - A Ruffato
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy
| | - L Ferruzzi
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy
| | - N Antonacci
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy
| | - R M Tranchino
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy
| |
Collapse
|
3
|
Burud IAS, Tata MD, Tak NAB. Gastric outlet obstruction secondary to a pedunculated hyperplastic polyp with early malignant changes. J Taibah Univ Med Sci 2017; 13:305-308. [PMID: 31435339 PMCID: PMC6694954 DOI: 10.1016/j.jtumed.2017.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/03/2017] [Accepted: 10/15/2017] [Indexed: 11/25/2022] Open
Abstract
Hyperplastic polyps are the most common polypoidal lesions of the stomach showing a varied presentation. They may be asymptomatic; however, occasionally they can cause anaemia and gastric outlet obstruction. Malignant transformation is a serious complication associated with such polyps. We present the case of an elderly woman who complained of epigastric pain and intermittent vomiting. Oesophagogastroduodenoscopy (OGDS) showed a large pedunculated polyp along the lesser curvature of the stomach, 4 cm from the gastro-oesophageal junction, extending into the first part of the duodenum that caused gastric outlet obstruction. Computed tomography reported a soft-tissue mass arising from the incisura and extending through the pylorus into the duodenum (D1 and proximal D2). An endoscopic polypectomy was performed, and histopathological examination reported evidence of early gastric carcinoma. She underwent regular endoscopic follow-up with biopsies performed over 2 years, and the last follow-up showed mild-to-moderate dysplasia at the previous excision site. She underwent a planned laparoscopic wedge resection, and histopathological examination confirmed the presence of a hyperplastic polyp showing low-grade dysplasia.
Collapse
Affiliation(s)
- Ismail A S Burud
- Department of Surgery, International Medical University Clinical Campus, Seremban, Malaysia
| | - Mahadevan D Tata
- Department of Surgery, Hospital Tuanku Ja'afar, Jalan Rasah, Seremban, Malaysia
| | - Nor Akmar B Tak
- Department of Pathology, Hospital Tuanku Ja'afar, Jalan Rasah, Seremban, Malaysia
| |
Collapse
|
4
|
Yildiz MS, Doğan A, Koparan IH, Adin ME. Acute Pancreatitis and Gastroduodenal Intussusception Induced by an Underlying Gastric Gastrointestinal Stromal Tumor: A Case Report. J Gastric Cancer 2016; 16:54-7. [PMID: 27104028 PMCID: PMC4834622 DOI: 10.5230/jgc.2016.16.1.54] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/27/2016] [Accepted: 02/28/2016] [Indexed: 01/08/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal system and comprise only 1% to 3% of all gastrointestinal tract tumors, with the majority of them arising in the stomach. In this report, we present the unique findings of a case of gastroduodenal intussusception caused by an underlying gastric GIST and complicated with severe acute pancreatitis.
Collapse
Affiliation(s)
| | - Ahmet Doğan
- Department of General Surgery, Dunya Hospital, Batman, Turkey
| | | | - Mehmet Emin Adin
- Department of Radiology, Silvan Dr. Yusuf Azizoğlu Hospital, Diyarbakır, Turkey
| |
Collapse
|
5
|
Antral hyperplastic polyp: A rare cause of gastric outlet obstruction. Int J Surg Case Rep 2014; 5:287-9. [PMID: 24747755 PMCID: PMC4066575 DOI: 10.1016/j.ijscr.2014.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 02/14/2014] [Accepted: 03/17/2014] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Gastric polyps are usually found incidentally during upper gastrointestinal endoscopic examinations. These polyps are generally benign, with hyperplasia being the most common. While gastric polyps are often asymptomatic, they can cause gastric outlet obstruction. PRESENTATION OF CASE A 64 years-old female patient presented to our polyclinic with a history of approximately 2 months of weakness, occasional early nausea, vomiting after meals and epigastric pain. A polypoid lesion of approximately 25mm in diameter was detected in the antral area of the stomach, which prolapsed through the pylorus into the duodenal bulbus, and subsequently caused gastric outlet obstruction, as revealed by upper gastrointestinal endoscopy of the patient. The polyp was retrieved from the pyloric canal into the stomach with the aid of a tripod, and snare polypectomy was performed. DISCUSSION Currently, widespread use of endoscopy has led to an increase in the frequency of detecting hyperplastic polyps. While most gastric polyps are asymptomatic, they can cause iron deficiency anemia, acute pancreatitis and more commonly, gastric outlet obstruction because of their antral location. Although there are no precise principles in the treatment of asymptomatic polyps, polyps >5mm should be removed due to the possibility of malignant transformation. CONCLUSION According to the medical evidence, polypectomy is required for gastric hyperplastic polyps because of the risks of complication and malignancy. These cases can be successfully treated endoscopically.
Collapse
|
6
|
Jones O, Monk D, Balling T, Wright A. Acute pancreatitis secondary to a prolapsed gastric fundal GIST. Int J Surg Case Rep 2011; 3:82-5. [PMID: 22288053 DOI: 10.1016/j.ijscr.2011.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 10/24/2011] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Gastrointestinal stromal tumours (GISTs) account for less than 3% of all gastrointestinal tract tumours and 5.7% of all sarcomas, and the majority of these tumours are gastric in origin. Patients commonly present with gastrointestinal bleeding or abdominal pain with 10-30% of patients presenting with symptoms of gastrointestinal obstruction. PRESENTATION OF A CASE We present a case of a 65-year-old gentleman who presented with symptomatic iron deficiency anaemia. Gastroscopy revealed a large submucosal lesion originating from the gastric fundus, consistent with a GIST. The patient developed acute epigastric pain, vomiting with raised inflammatory markers. A CT of the abdomen revealed the GIST to be causing gastric outlet obstruction as result of a prolapse of the tumour through the pylorus into the duodenum. This also resulted in compression of the distal common bile duct and was associated with the radiological appearance of acute pancreatitis. This responded to conservative management. The GIST was resected subsequently using a laparoscopic technique. DISCUSSION Only one similar case has previously been reported in the literature. Several surgical approached have been described in the management of gastric GISTs including open, laparoscopic, hand assisted, ultrasound assisted and a combined endoscopic and laparoscopic approach. A laparosopic 'eversion' techinque was preferred in our case due to the close proximity of the tumour to the gastro-oesophageal junction. CONCLUSION Pancreatitis secondary to a prolapsed gastric GIST is a rare entity. Laparoscopic wedge resection of these tumours can be safely performed with a satisfactory oncological outcome.
Collapse
Affiliation(s)
- Owain Jones
- Countess of Chester NHS Foundation Trust, United Kingdom
| | | | | | | |
Collapse
|
7
|
Sun CK, Yang KC, Liao CS. Endoscopic Management of Gastric Polyp with Outlet Obstruction without Polypectomy. Case Rep Gastroenterol 2011; 5:267-71. [PMID: 21887127 PMCID: PMC3153338 DOI: 10.1159/000328443] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Although gastric polyp is usually an incidental endoscopic finding, large-sized polyps can cause symptoms ranging from epigastralgia to bleeding from ulcerated polyps and gastric outlet obstruction. Although the gold standard of treatment is removal of the polyp either through endoscopic polypectomy or surgical excision, complications associated with these procedures cannot be ignored. The risk becomes a major concern for patients at high risk for surgery when complications arise. We describe a debilitated 74-year-old woman who presented with early satiety, intermittent postprandial nausea and vomiting for three months. Upper endoscopy revealed a 2.5 cm pedunculated polyp over the gastric antrum causing intermittent obstruction. Considering her high risk for polypectomy, detachable snaring was performed without polypectomy in an outpatient setting. The patient was complication-free with complete relief of obstructive symptoms one week after the procedure. Subsequent follow-ups showed satisfactory healing without signs of mucosal disruption or recurrence. The results suggest that detachable snaring without polypectomy may be a therapeutic option for high-risk patients with benign symptomatic gastric polyps.
Collapse
Affiliation(s)
- Cheuk-Kay Sun
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | | | | |
Collapse
|
8
|
Parikh M, Kelley B, Rendon G, Abraham B. Intermittent gastric outlet obstruction caused by a prolapsing antral gastric polyp. World J Gastrointest Oncol 2010; 2:242-6. [PMID: 21160624 PMCID: PMC2998838 DOI: 10.4251/wjgo.v2.i5.242] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 11/30/2009] [Accepted: 12/07/2009] [Indexed: 02/05/2023] Open
Abstract
Most gastric polyps have an asymptomatic presentation and are an incidental finding on upper endoscopy. Symptomatic presentations can range from an ulcerated polyp leading to anemia and occult bleed to complete gastric outlet obstruction. We report a case of an 89-year-old woman who presented with postprandial nausea and early satiety. Her upper endoscopy revealed a 2 cm pedunculated hyperplastic polyp arising from the antrum of the stomach which was seen prolapsing into the pylorus causing intermittent gastric outlet obstruction. In the present report, we statistically analyzed 39 prolapsing gastric polyps previously reported in the English literature and demonstrate the current utility of monopolar snare polypectomy in establishing a histological diagnosis while offering simultaneous treatment. Additionally, we review the literature for the management of all hyperplastic gastric polyps in relation to advancements in digestive endoscopy.
Collapse
Affiliation(s)
- Mehul Parikh
- Mehul Parikh, Brian Kelley, Gabriel Rendon, Bincy Abraham, Department of Internal Medicine, Baylor College of Medicine, Houston, TX 77030, United States
| | | | | | | |
Collapse
|
9
|
Park DY, Lauwers GY. Gastric polyps: classification and management. Arch Pathol Lab Med 2008; 132:633-40. [PMID: 18384215 DOI: 10.5858/2008-132-633-gpcam] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2007] [Indexed: 11/06/2022]
Abstract
Gastric polyps can be broadly defined as luminal lesions projecting above the plane of the mucosal surface. They are relatively frequent in routine pathology practice, where the main goal is to rule out the possibility of malignancy. Various subtypes of gastric polyps are recognized and generally divided into nonneoplastic and neoplastic. We will review herein only a limited subset of gastric polyps representing the most common or, sometimes, challenging.
Collapse
Affiliation(s)
- Do Youn Park
- Department of Pathology Massachusetts General Hospital , Boston, MA 02114, USA
| | | |
Collapse
|
10
|
Vikram R, McCulloch AS, Zealley IA. True gastrogastric intussusception: a rare radiologic diagnosis with surgical correlation. AJR Am J Roentgenol 2006; 186:585-6. [PMID: 16423980 DOI: 10.2214/ajr.05.0115] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Raghunandan Vikram
- Ninewells Hospital and Medical School Dundee, Scotland, DD1 9SY United Kingdom
| | | | | |
Collapse
|
11
|
Karl T, Langwara H, Bähr R. [Prolapsed malignant polyp of the stomach causing acute pancreatitis]. Chirurg 2004; 75:75-9. [PMID: 14740132 DOI: 10.1007/s00104-003-0707-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Polyps of the stomach are rare lesions with an incidence between 1.7% and 3.9%. Until now, most cases were asymptomatic and found during endoscopic examination. Only three cases of prolapsing gastric polyps causing acute pancreatitis have been reported. Prolapsed polyps of the stomach should be included in the differential diagnosis of secondary pancreatitis. If endoscopic polypectomy is impossible, surgical treatment is necessary. In case early gastric cancer of the mucosa is detected in a polyp, limited surgery is possible. Otherwise, gastrectomy with lymphadenectomy of the D2 compartment is required
Collapse
Affiliation(s)
- T Karl
- Chirurgische Klinik der Städtischen Kliniken Karlsruhe, Akademisches Lehrkrankenhaus der Universität Freiburg, Karlsruhe.
| | | | | |
Collapse
|
12
|
Ishikawa K, Arita T, Shimoda K, Hagino Y, Kitano S. Carbohydrate antigen 19-9-producing early protruded gastric carcinoma prolapsing into the duodenal bulb. Dig Endosc 2003. [DOI: 10.1046/j.1443-1661.2003.00265.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
|
13
|
Gencosmanoglu R, Sen-Oran E, Kurtkaya-Yapicier O, Tozun N. Antral hyperplastic polyp causing intermittent gastric outlet obstruction: case report. BMC Gastroenterol 2003; 3:16. [PMID: 12831404 PMCID: PMC166166 DOI: 10.1186/1471-230x-3-16] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2003] [Accepted: 06/27/2003] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Hyperplastic polyps are the most common polypoid lesions of the stomach. Rarely, they cause gastric outlet obstruction by prolapsing through the pyloric channel, when they arise in the prepyloric antrum. CASE PRESENTATION A 62-year-old woman presented with intermittent nausea and vomiting of 4 months duration. Upper gastrointestinal endoscopy revealed a 30 mm prepyloric sessile polyp causing intermittent gastric outlet obstruction. Following submucosal injection of diluted adrenaline solution, the polyp was removed with a snare. Multiple biopsies were taken from the greater curvature of the antrum and the corpus. Rapid urease test for Helicobacter pylori yielded a negative result. Histopathologic examination showed a hyperplastic polyp without any evidence of malignancy. Biopsies of the antrum and the corpus revealed gastritis with neither atrophic changes nor Helicobacter pylori infection. Follow-up endoscopy after a 12-week course of proton pomp inhibitor therapy showed a complete healing without any remnant tissue at the polypectomy site. The patient has been symptom-free during 8 months of follow-up. CONCLUSIONS Symptomatic gastric polyps should be removed preferentially when they are detected at the initial diagnostic endoscopy. Polypectomy not only provides tissue to determine the exact histopathologic type of the polyp, but also achieves radical treatment.
Collapse
Affiliation(s)
- Rasim Gencosmanoglu
- Department of Gastrointestinal Surgery, Marmara University Institute of Gastroenterology, Istanbul, Turkey
| | - Ebru Sen-Oran
- Department of Gastrointestinal Surgery, Marmara University Institute of Gastroenterology, Istanbul, Turkey
| | | | - Nurdan Tozun
- Department of Gastroenterology, Marmara University Institute of Gastroenterology, Istanbul, Turkey
| |
Collapse
|