title: Prolapsing Gastric Polyp Causing Intermittent Gastric Outlet Obstruction.
abstract: Gastric polyps are often an incidental finding on upper gastrointestinal endoscopy, with an incidence up to 5%. The majority of gastric polyps are asymptomatic, occurring secondary to inflammation. Prior reviews discussed Helicobacter pylori (H pylori)-associated singular gastric polyposis; however, we present a rare and unusual case of recurrent multiple benign gastric polyposis post H pylori eradication resulting in intermittent gastric outlet obstruction. A 70-year-old independent male, Chinese in ethnicity, with a background of diabetes mellitus, hypertension, and a simple renal cyst presented with a combination of melena, anemia, and intermittent vomiting of partially digested food after meals. Initial gastroscopy was positive for H pylori; thus he was treated with H pylori eradication and proton pump inhibitors. Serial gastroscopy demonstrated multiple sessile gastric antral polyps, the largest measuring 4 cm. Histopathologic examination confirmed a benign hyperplastic lesion. Computed tomography identified a pyloric mass with absent surrounding infiltration or metastasis. A distal gastrectomy was performed, whereby multiple small pyloric polyps were found, the largest prolapsing into the pyloric opening, thus explaining the intermittent nature of gastric outlet obstruction. Such polyps often develop from gastric ulcers and, if left untreated, may undergo neoplasia to form malignant cells. A distal gastrectomy was an effective choice of treatment, taking into account the polyp size, quantity, and potential for malignancy as opposed to an endoscopic approach, which may not guarantee a complete removal of safer margins and depth. Therefore, surgical excision is favorable for multiple large gastric polyps with risk of malignancy.
authors.affiliation: 1 Department of Surgery and.
authors.forename: Nik Ritza
authors.initials: NR
authors.lastname: Kosai
authors.affiliation: 1 Department of Surgery and.
authors.forename: Hardip Singh
authors.initials: HS
authors.lastname: Gendeh
authors.affiliation: 1 Department of Surgery and.
authors.forename: Abdul Rashid
authors.initials: AR
authors.lastname: Norfaezan
authors.affiliation: 1 Department of Surgery and.
authors.forename: Jamin
authors.initials: J
authors.lastname: Razman
authors.affiliation: 2 Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Paul Anthony
authors.initials: PA
authors.lastname: Sutton
authors.affiliation: 3 Department of Anatomy, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Srijit
authors.initials: S
authors.lastname: Das
mesh_terms: D018256:Adenomatous Polyps / Q000150:complications* / Q000601:surgery*; D000368:Aged; D017219:Gastric Outlet Obstruction / Q000209:etiology* / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D011391:Prolapse; D013274:Stomach Neoplasms / Q000150:complications* / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: Gastric obstruction; Gastric polyp; Surgical management