2653 Solitary Peutz-Jeghers Polyp Presenting as Iron Deficiency Anemia

Abstract

INTRODUCTION: A sporadic hamartomatous polyp in the duodenum is an uncommon finding, with occurrence of solitary Peutz-Jeghers polyps only reported in singular or small case series. Typical presentation of Peutz-Jeghers type polyps occurs in patients with Peutz-Jeghers syndrome (PJS), which is a rare, autosomal-dominant disorder consisting of the simultaneous presentation of multiple hamartomatous polyps in any part of the alimentary tract and mucocutaneous pigmentation deposits [1]. We present a case of a solitary Peutz-Jeghers type polyp causing anemia found in the duodenum of a patient without any other characteristic findings of PJS. CASE DESCRIPTION/METHODS: Our patient was a 37 yo female with h/o pulmonary embolus on anticoagulation who had undergone workup of iron deficiency anemia by an outside gastroenterologist. After negative EGD and colonoscopy, a capsule enteroscopy showed a polypoid lesion in the small bowel, and she was referred for push enteroscopy. Anticoagulation had been held for the procedure. The push confirmed a 2.5 cm pedunculated polyp in the third portion of the duodenum, which was resected with snare cautery, and removed using a Roth net. No bleeding was seen, but as the patient was to resume anticoagulation, 2 hemoclips were applied to the resection site. Pathology showed Peutz-Jeghers type polyp. On follow-up the patient’s hemoglobin had returned to normal levels, confirming the polyp as the cause of anemia. DISCUSSION: Solitary PJ polyps are extremely rare and are typically found in case reports with presentation on the spectrum from asymptomatic finding to dyspepsia, abdominal pain, intussusception and melena. To our knowledge, our patient’s case consists of the first reported case of a solitary PJ-type polyp presenting solely as iron deficiency anemia.