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BMJ Case Reports 2017; doi:10.1136/bcr-2016-214998
  • Rare disease
  • CASE REPORT

The vanishing duodenal polyp: mesenteric invagination presenting as duodenal pseudopolyp

  1. Thomas M van Gulik6
  1. 1Division of Anatomy, Embryology and Physiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  2. 2Division of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  3. 3Department of Gastroenterology, MC Zuiderzee, Lelystad, The Netherlands
  4. 4Division of Gastroenterology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  5. 5Department of Radiology, Groene Hart Hospital, Gouda, The Netherlands
  6. 6Division of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Professor Thomas M van Gulik, t.m.vangulik{at}amc.nl
  • Accepted 27 April 2017
  • Published 13 May 2017

Summary

Duodenal polypoid masses are an uncommon finding mainly diagnosed incidentally at endoscopy or surgery. We report a 39-year-old female patient with symptoms of intermittent stabbing pain in the upper right abdominal quadrant and an iron deficiency anaemia, without complaints of weight loss, haematemesis or melaena. A duodenal polyp and acute duodenitis have been described during endoscopic examinations and CT and ultrasound. Surgical excision of the polyp was advised. Intraoperatively, an elongated duodenum was remarkable; however, at duodenotomy, no polyp was found, nor during intraoperative endoscopy. Looking back at the endoscopy and imaging results, it was noted that the polyp varied in size and location. It was therefore concluded that we dealt with the pseudopolyp phenomenon, caused by invagination of the duodenal wall and its mesentery into the duodenum, presenting as a lipomatous pseudopolyp. Telescopic invagination of the duodenal wall was facilitated by the elongated hypermobile duodenum.

Footnotes

  • Contributors BSdeB, Medical student, present during surgery, did the conception and study design, data collection, thorough analysis and interpretation of data, literature search, figure preparation (figures 1 and 2), manuscript writing and final approval. SSKSP, MD, responsible radiologist, did the reporting of clinical findings, data collection, figure preparation (figure 2a), manuscript writing and final approval. MK, MD, responsible gastroenterologist in first hospital, did the reporting of clinical findings, interpretation of data, critical revision of the manuscript and final approval. SAE, MD, responsible gastroenterologist in first hospital, did the reporting of clinical findings, figure preparation (figure 1), critical revision of the manuscript and final approval. MEG, MD, responsible gastroenterologist in second hospital, did the reporting of clinical findings, interpretation of duodenoscopy data, critical revision of the manuscript and final approval. CIJP, MD PhD, responsible gastroenterologist in second hospital, did the reporting of clinical findings, interpretation of duodenoscopy data, critical revision of the manuscript and final approval. HMdeB, MD, second opinion radiologist, did the interpretation of radiological data, critical revision of the manuscript and final approval. Professor TMvG, responsible surgeon in second hospital, did the reporting of clinical findings, conception and study design, manuscript writing and final approval.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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