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.