Gastroduodenal Intussusception and Biochemical Pancreatitis Due to a Gastric Hyperplastic Polyp: A Case Report

Abstract

Introduction: Gastroduodenal intussusceptions represent less than 10% of intussusceptions. Common etiologies include benign and malignant intestinal neoplasms. We present a rare case of a gastroduodenal intussusception caused by a hyperplastic gastric polyp. Case Report: A 76-year-old man with history of coronary artery disease presented to the emergency room with a 1-day history of abdominal pain and emesis. His medications included ticlopidine and aspirin for a bare metal stent that was placed 6 months ago. Laboratory studies were notable for mildly elevated liver tests and lipase, which peaked at 3,663. Computed tomography (CT) of the abdomen demonstrated gastric antral wall thickening without evidence of pancreatitis. Esophagogastroduodenoscopy (EGD) revealed a large, fungating, and multi-lobulated gastric polyp that was at least 10 cm in width. Endoscopic ultrasound demonstrated a polyp involving the superficial and deep mucosal layers of the gastric wall. Stack biopsies confirmed the presence of a hyperplastic gastric polyp without dysplasia. Further resection could not be performed due to the patient’s current use of ticlopidine and aspirin. Endoscopic resection was recommended 5 days after stopping anticoagulation and the patient was discharged home. The following day, he returned with worsening symptoms, and a repeat CT of the abdomen showed a gastroduodenal intussusception with gastric outlet obstruction secondary to the gastric mass acting as lead point. The lipase continued to be elevated without radiographic evidence of pancreatitis. The intussusception was endoscopically reduced by pulling the polyp back into the stomach using a through-the-scope 15-mm controlled radial expansion (CRE) balloon inflated beyond the lead point. Because of the high likelihood of recurrence, we attempted endoscopic resection of the polyp. Due to the broad-base and size of the lesion, we were only able to complete partial resection. We used an endoloop prior to resecting each of multiple pieces with a hot snare. The polyp was reduced in size by greater than 50% with the longest protruding piece being less than 3 cm in length. The patient has had no recurrence of symptoms or intussusception for over 6 months. Discussion: There are few documented cases of gastroduodenal intussusception in adults. We present a unique case of intermittent gastroduodenal intussusception and biochemical pancreatitis due to a large gastric polyp that was managed endoscopically with complete resolution of symptoms. To our knowledge, this is the first reported case of a large hyperplastic gastric polyp causing gastroduodenal intussusception and biochemical pancreatitis treated with endoscopic management alone.