Clinical significance of numerous irregular polypoidal lesions in the duodenum

Abstract

The patient, a 20-year-old obese male, complained of epigastric pain of two years duration with no associated nausea or vomiting. He underwent upper gastrointestinal endoscopy in a local hospital and received treatment for H. pylori infection, with no significant improvement. He was referred to King Faisal Specialist Hospital and Research Centre (KFSHRC) for further evaluation. Laboratory investigations showed: WBCs: 7.3×109/L. Hb: 133 g/L. MCV: 69.6 fL. Platelets: 500×109/L. ESR: 45 mm/hour. CRP: 10.8 mg/L. Urea: 4.0 mmol/L. Creatinine: 72 umol/L. K+: 3.9 mmol/L. Na+: 140 mmol/L. Cl-:103 mmol/L. CO2: 22 mmol/L. Albumin: 44 g/L. Bilirubin: 8 umol/L. LD: 177 U/L. ALT: 108 U/L. AST: 61 U/L. ALP: 64 U/L. GGT: 161 IU/L. Negative antinuclear antibody screen as well as celiac disease serology. Follow-up endoscopy after six months showed normal esophageal mucosa, nodular congested gastric mucosa and nodular duodenal mucosa with variable-sized polypoid lesions [Figures ​[Figures1a1a and ​andb],b], which were biopsied and sent for pathological examination [Figure 2 a–c]. Figure 1 (a, b) Figure 2 (a, b, c)