Case report
A 20-year-old man, with a 4-year history of dyspeptic symptoms successfully treated with pharmacological therapy (low dose PPI), presented to a local hospital in January 2019 for recurrence of dyspepsia, vomiting and abdominal pain.
EGD revealed a submucosal polypoid lesion of about 2 cm, with a short peduncle, in the third duodenal portion. Endoscopic ultrasound confirmed the presence of polypoid neoformation of the third duodenal portion, with subepithelial development and apparently confined to the mucosa, while magnetic resonance of the abdomen with contrast did not identify the lesion.
Physical examination and laboratory investigations were unremarkable.
The patient presented to our endoscopic unit and, after repetition of EGD, that showed the duodenal lesion unchanged compared to the previous procedure (Figure 1), he was hospitalized to remove the lesion endoscopically, under laparoscopic vision. The laparoscopic procedure began with pneumoperitoneum and placement of three ports, then an enterostat was placed at the first jejunal loop for the scopic control of the polypectomy. An endoscope with a front-view was used to reach the lesion located between the third and fourth duodenal portions. Saline solution and methylene blue was injected into the peduncle of the lesion, and the neoformation was resected en bloc using a snare cautery; hemoclips were placed at the base for additional hemostasis (Figure 1). The resected lesion measured approximately 2,6 x 1,5 cm and histopathological examination revealed heterotopic gastric mucosa in the duodenum (Figure 2). There were no complications related to the procedure. No residual tissue was observed on repeat endoscopic examination after 1 year and the patient remained asymptomatic.