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Gastroduodenal intussusception resulting from large hyperplastic polyp.

Kim DJ, Lee JH, Kim W - J Gastric Cancer (2012)

Bottom Line: Benign neoplasms, gastrointestinal stromal tumors and pedunculated adenocarcinomas of less than 5 cm have been reported to cause gastroduodenal intussusception.We report a case of 76-year-old woman who was presented with a 3-day history of nausea and vomiting due to upper gastrointestinal obstruction.Computed tomography revealed gastroduodenal intussusception with the transpyloric herniation of alarge gastric hyperplastic polyp.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT
Gastroduodenal intussusception is an infrequent cause of gastrointestinal obstructive disease. Benign neoplasms, gastrointestinal stromal tumors and pedunculated adenocarcinomas of less than 5 cm have been reported to cause gastroduodenal intussusception. We report a case of 76-year-old woman who was presented with a 3-day history of nausea and vomiting due to upper gastrointestinal obstruction. Computed tomography revealed gastroduodenal intussusception with the transpyloric herniation of alarge gastric hyperplastic polyp. The patient underwent laparoscopic wedge resection with the eversion method.

No MeSH data available.


Related in: MedlinePlus

Preoperative abdominal computed tomography images. (A) A large hyperplastic polyp that has herniated into the 2nd portion of the duodenum with peripancreatic fat infiltration. (B) Gastroduodenal intussusception with transpyloric herniation of the large gastric mass.
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Figure 1: Preoperative abdominal computed tomography images. (A) A large hyperplastic polyp that has herniated into the 2nd portion of the duodenum with peripancreatic fat infiltration. (B) Gastroduodenal intussusception with transpyloric herniation of the large gastric mass.

Mentions: A 76-year-old female presented to our emergency department with a 3-day history of nausea and vomiting. She experienced a cerebral vascular stroke 30 years beforehand and has taken medication for diabetes and hypertension for 10 years. Two years beforehand a 5 cm-sized hyperplastic polyp was found with a gastrofiberscope (GFS), but she declinedpolypectomy because of the possible complications such as bleeding and perforation. Mild tenderness was found on the epigastrium during physical examination. Laboratory examination revealed a leukocytosis (white blood cell: 15,980/mm3, normal range: 4,600~10,000/mm3), elevated erythrocyte sedimentation rate (55 mm/hr, normal range: 0~20 mm/hr), elevated C-reactive protein (77.41 mg/L, normal range: 0~10 mg/L) and mild hyperamylasemia (161 IU/L, normal range: 37~160 IU/L). Computed tomography (CT) revealed gastroduodenal intussusception with herniation of a large intraluminal mass into the 1st and 2nd portions of the duodenum and peripancreatic fat infiltration without a fluid collection (Fig. 1). Endoscopic examination with a GFS showed that the intussusception had already been resolved and that the intussusceptions was due to a 10 cm-sized pedunculated masson the gastric lower body anterior wall (Fig. 2). Biopsy was performed, which confirmed the diagnosis of hyperplastic polyp. Because of the increased size of the hyperplastic polyp and the event of gastroduodenal intussusception, the patient and her family agreed to surgical treatment. With a laparoscopic approach, we made a gastrostomy at the anterior wall with the Harmonic Scalpel (Ethicon Endo-surgery, Cincinnati, OH, USA) and exposed the mass to perform secure wedge resection because of its size. We performed resection with Endo-GIA 60 mm (Ethicon Endo-surgery) (Fig. 3). Gastrotomy site was closed with Endo-GIA 60 mm (Ethicon Endo-surgery). The operation took 20 minutes, and it was a proper and safe procedure for the elderly patient with several comorbidities. The patient recovered and resumed an oral diet on the 2nd postoperative day.


Gastroduodenal intussusception resulting from large hyperplastic polyp.

Kim DJ, Lee JH, Kim W - J Gastric Cancer (2012)

Preoperative abdominal computed tomography images. (A) A large hyperplastic polyp that has herniated into the 2nd portion of the duodenum with peripancreatic fat infiltration. (B) Gastroduodenal intussusception with transpyloric herniation of the large gastric mass.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3473228&req=5

Figure 1: Preoperative abdominal computed tomography images. (A) A large hyperplastic polyp that has herniated into the 2nd portion of the duodenum with peripancreatic fat infiltration. (B) Gastroduodenal intussusception with transpyloric herniation of the large gastric mass.
Mentions: A 76-year-old female presented to our emergency department with a 3-day history of nausea and vomiting. She experienced a cerebral vascular stroke 30 years beforehand and has taken medication for diabetes and hypertension for 10 years. Two years beforehand a 5 cm-sized hyperplastic polyp was found with a gastrofiberscope (GFS), but she declinedpolypectomy because of the possible complications such as bleeding and perforation. Mild tenderness was found on the epigastrium during physical examination. Laboratory examination revealed a leukocytosis (white blood cell: 15,980/mm3, normal range: 4,600~10,000/mm3), elevated erythrocyte sedimentation rate (55 mm/hr, normal range: 0~20 mm/hr), elevated C-reactive protein (77.41 mg/L, normal range: 0~10 mg/L) and mild hyperamylasemia (161 IU/L, normal range: 37~160 IU/L). Computed tomography (CT) revealed gastroduodenal intussusception with herniation of a large intraluminal mass into the 1st and 2nd portions of the duodenum and peripancreatic fat infiltration without a fluid collection (Fig. 1). Endoscopic examination with a GFS showed that the intussusception had already been resolved and that the intussusceptions was due to a 10 cm-sized pedunculated masson the gastric lower body anterior wall (Fig. 2). Biopsy was performed, which confirmed the diagnosis of hyperplastic polyp. Because of the increased size of the hyperplastic polyp and the event of gastroduodenal intussusception, the patient and her family agreed to surgical treatment. With a laparoscopic approach, we made a gastrostomy at the anterior wall with the Harmonic Scalpel (Ethicon Endo-surgery, Cincinnati, OH, USA) and exposed the mass to perform secure wedge resection because of its size. We performed resection with Endo-GIA 60 mm (Ethicon Endo-surgery) (Fig. 3). Gastrotomy site was closed with Endo-GIA 60 mm (Ethicon Endo-surgery). The operation took 20 minutes, and it was a proper and safe procedure for the elderly patient with several comorbidities. The patient recovered and resumed an oral diet on the 2nd postoperative day.

Bottom Line: Benign neoplasms, gastrointestinal stromal tumors and pedunculated adenocarcinomas of less than 5 cm have been reported to cause gastroduodenal intussusception.We report a case of 76-year-old woman who was presented with a 3-day history of nausea and vomiting due to upper gastrointestinal obstruction.Computed tomography revealed gastroduodenal intussusception with the transpyloric herniation of alarge gastric hyperplastic polyp.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT
Gastroduodenal intussusception is an infrequent cause of gastrointestinal obstructive disease. Benign neoplasms, gastrointestinal stromal tumors and pedunculated adenocarcinomas of less than 5 cm have been reported to cause gastroduodenal intussusception. We report a case of 76-year-old woman who was presented with a 3-day history of nausea and vomiting due to upper gastrointestinal obstruction. Computed tomography revealed gastroduodenal intussusception with the transpyloric herniation of alarge gastric hyperplastic polyp. The patient underwent laparoscopic wedge resection with the eversion method.

No MeSH data available.


Related in: MedlinePlus