Isolated Duodenal Adenoma Presenting as Gastrointestinal Bleed - A Case Report

Abstract

A 60-year-old male patient presented with history of passing black coloured stool for 15 days. Clinically, there was pallor with documented haemoglobin of 5.9 gm%. Patient was resuscitated with intravenous fluids and two units of packed red blood cells. Other routine blood investigations were normal. Once the patient was haemodynamically stable, EGD was performed which revealed normal esophagus and stomach, and a 1cm sessile polyp in the first part of the duodenum [Table/ Fig-1]. Endoscopic polypectomy was performed and specimen was subjected to the histopathological examination (HPE). Colonoscopy didnot reveal any significant pathology. Upper gastrointestinal endoscopic re-assesment was done three hours after polypectomy to confirm haemostasis at the polypectomy site. Postprocedure pneumoperitoneum was ruled out by abdominal imaging.HPE of excised specimen showed tubular adenomatous polyp with mildly distorted villous structure and tubular hyperplasia of the glands, focal mild dysplasia of the glandular epithelium and mild inflammatory cell infiltration in the lamina propria [ DIsCUssIoNDuodenal polyps are rare lesions with different pathological manifestations. Varieties include adenomas, submucosal tumours (lipomas, endocrine tumours and gastrointestinal tumours), Brunner's gland hyperplasia and hamartomas. The prevalence of duodenal polyps, as detected during EGD performed for other reasons, ranges from 0.3-4.6% [1]. Around 20% of small bowel adenomas occur in the duodenum. The malignant potential of these lesions is reportedly between 35% and 55%. These adenomas may produce symptoms mimicking those of ulcer disease, although majority of the patients are asymptomatic at the time of diagnosis.Adenomas can occur sporadically or as part of a polyposis syndrome with FAP or Gardner's syndrome. Both groups carry malignant potential but polyposis syndrome scores higher among the two. The majority of the sporadic duodenal adenomas are flat and sessile and occur in the 2 nd part of the duodenum. Patients with sporadic duodenal adenomas carry an increased risk of colonic neoplasia and should be offered colonoscopy [2]. Sporadic duodenal adenomas are found in only 0.3% of upper GI endoscopies performed, usually for other reasons [3]. The peak incidence of duodenal adenoma is between 6 th and 8 th decades of life.Surgery Section aBstRaCt Duodenal polyps are rare lesions in patients undergoing Esophago gastro duodenoscopy (EGD), and the prevalence varies widely with range of 0.3-4.6% of cases. Duodenal adenomas most commonly occur in association with familial adenomatous polyposis. Isolated occurrence of such adenomas is very rare and presentation as upper gastrointestinal (GI) haemorrhage is even rarer. We herein report a case of elderly male patient presenting to emergency department with features of upper GI bleeding. Patient was resuscitated followed by EGD was done. On EGD bleeding duodenal polyp was found and endoscopic polypectomy was done to control the bleeding. Subsequent colonoscopy was done and was normal. T...

Histopathological spectrum of duodenal polyps in a retrospective ten-year study

“…Duodenal polyps are not very common lesions in patients undergoing upper gastrointestinal (UGI) endoscopy, and the prevalence varies widely from 0.3-4.6% of cases 1,2 . Recent advances in endoscopic procedure and techniques have made precise excision of diminutive polyps (less than 2 cm in diameter) possible 3 ( Figure 1 ).…”

Intussuscepting Ampullary Adenoma: An Unusual Cause of Gastric Outlet Obstruction Leading to Cavitating Lung Lesions

“…Clinically, they are usually asymptomatic and found incidentally at endoscopy; however, some patients may present with symptoms caused by obstruction of the main gastrointestinal tract and/or the distal biliary/pancreatic ducts. The most common presenting symptoms are gastric outlet obstruction or gastrointestinal bleeding [8, 9]. However, rarer presenting complaints may include acute pancreatitis, biliary obstruction or, as in this case, intussusception.…”

The flat and immobile villi sign: a novel approach in identifying duodenal adenomas

“…The finding of duodenal polyps is rare, representing only 0.3% to 4.6% of all patients undergoing EGD 1 . The prevalence of duodenal adenomas has been increasing because of the increased use of diagnostic endoscopic procedures.…”