Prolapsed fundic gastric polyp causing gastroduodenal intussusception and acute pancreatitis

Jetha, Zishan; Lisi, Michael

doi:10.1093/jscr/rjy139

Cited by 7 publications

(8 citation statements)

References 8 publications

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“…7 Extensive literature search to date only yielded reports of 11 cases of such exceptional circumstances, and only 5 cases of acute pancreatitis secondary to gastroduodenal intussusception of gastric GIST (Table 1). [8][9][10][11][12][13][14][15][16][17][18] The mean age of these five patients was 71 years, with a slight female predilection. Three patients had pedunculated GISTs dangling from the fundus, causing intussusception, while the remaining two patients had GIST located in the antrum.…”

Section: Discussionmentioning

confidence: 99%

Gastroduodenal intussusception of a gastrointestinal stromal tumor: a rare cause of acute pancreatitis

et al. 2022

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Gastrointestinal stromal tumor (GIST) accounts for approximately 1% of all gastrointestinal tract neoplasms. 1 GIST usually presents as an incidental gastric subepithelial lesion during upper endoscopy or abdominal radiologic studies. In symptomatic cases, abdominal pain and gastrointestinal bleeding are common manifestations. Gastrointestinal obstruction is a less frequent presentation, occurring in only 10-30% of patients, 2 while gastroduodenal intussusception and acute pancreatitis are extremely unusual presentations of gastric GIST. This report presents the case of a patient diagnosed with gastric GIST complicated by gastroduodenal intussusception, resulting in acute pancreatitis. CASE REPORTA 55-year-old man presented with worsening epigastric pain and vomiting for 10 days. He reported intermittent abdominal pain for 10 months prior to presentation. Abdominal examination revealed tenderness at the epigastrium. His serum amylase level was 320 U/L, compatible with acute pancreatitis. Abdominal computed tomography (CT) revealed a 4 × 4.7 cm well-defined hyperdense mass in the 2 nd part of the duodenum, compressing the pancreatic head, edematous pancreatic parenchyma, peripancreatic fat stranding, and pancreatic duct dilatation (Fig. 1A, B). Esophagogastroduodenoscopy was significant for abnormal torsion of gastric folds that originated from the gastric fundus, coursed along the lesser curvature, and invaginated into the pyloric canal, thereby blocking the passage of the scope into the duodenal bulb (Fig.

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Section: Discussionmentioning

confidence: 99%

Gastroduodenal intussusception of a gastrointestinal stromal tumor: a rare cause of acute pancreatitis

et al. 2022

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“…Progressive gastric outlet obstruction is the most common symptom [26][27][28][29][30][31][32] even if, in some cases, it can be intermittent with vomiting and recurrent epigastric pain, often eluding ready diagnosis [33][34][35][36][37][38][39][40]. Rarely, polyps protrude distally, obstructing the ampulla of Vater, with subsequent dilatation of the common bile and main pancreatic ducts, another rare presentation that can include acute pancreatitis and biliary obstruction [41,42].…”

Section: Discussionmentioning

confidence: 99%

“…• Appropriate management of gastric polyps depends on their histology, symptomatology, malignant potential, and comorbidities. [23] 6 cm Well-differentiated adenocarcinoma ESD Sone et al [24] 3.8 × 3.6 × 2.1 cm Hyperplastic polyp Snare polypectomy Sooklal et al [25] 10 cm Adenoma with low grade of dysplasia ESD with the clip-snare method Cerwenka et al [26] n.a Hyperplastic polyp Snare polypectomy Yriberry Urena et al [27] n.a Hyperplastic polyp Endoscopic resection and argon plasma coagulation Chen et al [28] 6 cm Hyperplastic polyp Total removal Dean et al [29] 10 × 7 × 4.5 cm Hyperplastic polyp Laparotomic surgical resection Aydin et al [30] 2.5 cm Hyperplastic polyp Snare polypectomy Burus et al [31] 4 cm Hyperplastic polyp with early gastric cancer foci Endoscopic polypectomy + endoscopic followup Lei et al [32] 3 cm Hyperplastic polyp Endoloop-assisted electrosurgical polypectomy Kumar et al [33] I) 8 cm I) Adenoma I) Endoscopic polypectomy II) 9 × 8 cm II) Leiomyoma II) Laparotomic surgical resection III) 2 cm III) Hyperplastic polyp III) Endoscopic polypectomy IV) 3.5 cm IV) Hyperplastic polyp IV) Endoscopic polypectomy Pontone et al [34] n.a Hyperplastic polyp Endoscopic polypectomy with hydroxypropylmethylcellulose Kosai et al [35] 4 cm plus multiple smaller satellite polyps Hyperplastic polyp Distal gastrectomy with Billroth 2 reconstruction Parikh et al [36] 2 cm Hyperplastic polyp Snare polypectomy Sun et al [37] 2.5 cm Granulation tissue Detachable snaring without polypectomy Gencosmanoglu et al [38] 3 cm Hyperplastic polyp Snare polypectomy with submucosal injection of diluted adrenaline Freeman [39] n.a Adenoma complicated by adenocarcinoma Endoscopic excision Gashi et al [40] 3 cm Hyperplastic polyp Endoscopic excision De La Cruz et al [41] 13 cm Hyperplastic polyp Laparotomic surgical resection Jetha et al [42] 8.8 × 4 × 3.7 cm Adenoma plus foci of high-grade dysplasia Laparotomic surgical resection…”

Section: Key Messagesmentioning

confidence: 99%

Benign Blockage: Gastric Outlet Obstruction due to a Prolapsing Gastric Pedunculated Polyp—Case Report and Literature Review

et al. 2021

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An 89-year-old woman was admitted to the emergency department at "Ospedale Civile Umberto I" in Lugo (Ravenna) for 1 month of vomiting, mild epigastric pain, and postprandial diarrhea without fever. Main comorbidities included chronic atrial fibrillation treated with a direct-acting oral anticoagulant, previous MI, hypertension, diabetes, and hypercholesterolemia, though despite her age the patient was autonomous in her daily activities. On admission, laboratory tests included normal WBC count, Hgb, and CRP. Abdominal X-ray demonstrated a stomach filled by ingested food (Fig. 1a

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“…Adult intussusception is an unusual condition in clinical practice and gastroduodenal involvement remains an even more uncommon presentation [ 1 , 2 ]. While there are many different etiologies for gastroduodenal intussusception (GDI), gastrointestinal stromal tumor (GIST) has been reported in literature as the most common cause of GDI [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Cachexia and Invisible Stomach on Endoscopy: An Endoscopist’s Enigma and a Surgeon’s Axiom

et al. 2022

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Gastroduodenal intussusception (GDI) is a very rare clinical entity in adults. GDI can present acutely or chronically in adults with varying spectrum of symptoms and signs. GDI can present acutely with abdominal pain, vomiting and palpable mass. In rare instances it can lead to anemia and cachexia. Computed tomography (CT) of the abdomen can demonstrate GDI in majority of cases. However, endoscopy findings could lead to identifying etiological factor and tissue diagnosis. In majority of the cases endoscopy may show mucosal or submucosal lesion leading to GDI. We bring forward a case of GDI wherein patient presented with cachexia, intermittent vomiting along with anemia. Further workup including imaging has resulted in the rare diagnosis of GDI. Interestingly we encountered a rare of its kind, endoscopic presentation where there was total absence of stomach due to its complete invagination through the pylorus into the duodenum arising from a giant gastric hyperplastic polyp. We have successfully managed this patient with surgical intervention leading to positive clinical outcomes. On review of literature, we found that it is extremely rare to have a completely absent stomach on endoscopy in a patient with no previous surgical intervention. We would like to share our experience so that endoscopists are aware of such uncommon and interesting presentations. To the best of our knowledge, such a case has not been reported so far in literature.

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Prolapsed fundic gastric polyp causing gastroduodenal intussusception and acute pancreatitis

Cited by 7 publications

References 8 publications

Gastroduodenal intussusception of a gastrointestinal stromal tumor: a rare cause of acute pancreatitis

Gastroduodenal intussusception of a gastrointestinal stromal tumor: a rare cause of acute pancreatitis

Benign Blockage: Gastric Outlet Obstruction due to a Prolapsing Gastric Pedunculated Polyp—Case Report and Literature Review

Cachexia and Invisible Stomach on Endoscopy: An Endoscopist’s Enigma and a Surgeon’s Axiom

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