Badipatla Kanthi Rekha, Nayudu Suresh K, Dominguez Michelle Frances, Wong Jeremey, Louie Kevin, Chaudhri Ali A, Karpinos Robert, Dmitry Karev
Division of Gastroenterology and Hepatology, SBH Health System, Affiliated With Albert Einstein College of Medicine, Bronx, NY 10457, USA.
Department of Medicine, SBH Health System, Affiliated with Albert Einstein College of Medicine, Bronx, NY 10457, USA.
J Med Cases. 2022 Jun;13(6):269-273. doi: 10.14740/jmc3899. Epub 2022 Jun 11.
Gastroduodenal intussusception (GDI) is a very rare clinical entity in adults. GDI can present acutely or chronically in adults with varying spectrum of symptoms and signs. GDI can present acutely with abdominal pain, vomiting and palpable mass. In rare instances it can lead to anemia and cachexia. Computed tomography (CT) of the abdomen can demonstrate GDI in majority of cases. However, endoscopy findings could lead to identifying etiological factor and tissue diagnosis. In majority of the cases endoscopy may show mucosal or submucosal lesion leading to GDI. We bring forward a case of GDI wherein patient presented with cachexia, intermittent vomiting along with anemia. Further workup including imaging has resulted in the rare diagnosis of GDI. Interestingly we encountered a rare of its kind, endoscopic presentation where there was total absence of stomach due to its complete invagination through the pylorus into the duodenum arising from a giant gastric hyperplastic polyp. We have successfully managed this patient with surgical intervention leading to positive clinical outcomes. On review of literature, we found that it is extremely rare to have a completely absent stomach on endoscopy in a patient with no previous surgical intervention. We would like to share our experience so that endoscopists are aware of such uncommon and interesting presentations. To the best of our knowledge, such a case has not been reported so far in literature.
胃十二指肠套叠（GDI）在成人中是一种非常罕见的临床病症。GDI在成人中可急性或慢性出现，症状和体征表现多样。GDI急性发作时可出现腹痛、呕吐及可触及的肿块。在罕见情况下，它可导致贫血和恶病质。腹部计算机断层扫描（CT）在大多数病例中可显示GDI。然而，内镜检查结果有助于确定病因和进行组织诊断。在大多数病例中，内镜检查可能显示导致GDI的黏膜或黏膜下病变。我们报告一例GDI病例，该患者表现为恶病质、间歇性呕吐及贫血。包括影像学检查在内的进一步检查确诊了这一罕见的GDI病例。有趣的是，我们遇到了一种罕见的内镜表现，由于一个巨大的胃增生性息肉通过幽门完全内陷进入十二指肠，导致胃完全缺失。我们通过手术干预成功治疗了该患者，取得了良好的临床效果。查阅文献时，我们发现既往无手术史的患者在内镜检查中出现胃完全缺失的情况极为罕见。我们希望分享我们的经验，以便内镜医师了解这种不常见且有趣的表现。据我们所知，迄今为止文献中尚未报道过此类病例。
