Menetrier's Disease: Case Report

Abstract

A 25 year old man presented with epigastric pain , postprandial vomiting which was non projectile and non bilous, progressive weight loss, and body swelling for 2 years. The only remarkable findings were wasting and epigastric tenedreness and positive succussion splash. A gastroduodenoscopy revealed polypoid gastric mucosa involving the fundus and body of the stomach but sparing the antrum; there was no ulceration. Histology os endoscopic biopsy specimen showed features suggestive of Menetrier's disease. Treatment with oral cimetidine was continued along with high protein and calorie diet but the symptoms persisted . Subsequently, an exploratory laparotomy was done and the findings at surgery were a hypertrophied stomach with polypoid mucosa involving the fundus and body. The antroduodenal region was grossly normalTotal gastrectomy with direct esophagoduodenostomy was done The second histology report confirmed Menetrier's disease. Menetrier's disease is a rare form of hypertrophic gastropathy. It is a premalignant disorder of the stomach. Cytomegalovirus and Helicobacter pylori infections, and transforming growth factor alpha , have been implicated in the aetiopathogenesis of the disease. Conservative treatment by aggressive eradication of H.pylori improves patients' symptoms, and abrogates the protein losing enteropathy characteristic of the disease. Surgery by total gastrectomy offers the best definitive treatment as it removes the risk of gastric cancer in a gastric remnant. (Nig J Surg Res 2001; 3: 165 – 169) KEY WORDS: Menetrier's Disease, Helicobacter Pylori, Total Gastrectomy