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Background: Management of duodenal or ampullary adenomas in patients with familial adenomatous polyposis (FAP) is a major challenge for clinicians. Insufficient data are available to evaluate the clinical manifestations and distribution of adenomatous polyposis coli (APC) variants in these patients. Methods: We enrolled 451 patients with data regarding duodenal or ampullary polyps from 632 patients with FAP retrospectively registered in a nationwide Japanese multicenter study. Clinicopathological features and distribution of APC variants were compared between patients with and without duodenal or ampullary polyps. Results: Duodenal and ampullary polyps were found in 59% and 18% of patients with FAP, respectively. The incidence of duodenal cancer was 4.7% in patients with duodenal polyps, and that of ampullary cancer was 18% in patients with ampullary polyps. Duodenal polyps were significantly associated with the presence of ampullary polyps and jejunal/ileal polyps. Duodenal polyps progressed in 35% of patients with a median follow-up of 776 days, mostly in those with early Spigelman stage lesions. Ampullary polyps progressed in 50% of patients with a follow-up of 1484 days. However, only one patient developed a malignancy. The proportion of patients with duodenal polyps was significantly higher among those with intermediate- or profuse-type APC variants than attenuated-type APC variants. The presence of duodenal polyps was significantly associated with ampullary and jejunal/ileal polyps in patients with intermediate- or profuse-type APC variants. Conclusions: Periodic endoscopic surveillance of the papilla of Vater and small intestine should be planned for patients with FAP with duodenal polyps. [ABSTRACT FROM AUTHOR]

Adult intestinal intussusception accounts for 1 to 5 percent of mechanical bowel obstructions and is relatively rare. Its presentation, aetiology and treatment varies greatly from childhood intussesception. Duodenoduodenal intussusception (DDI) is unusual due to fixed position of the duodenum within the retroperitoneum with only a few cases of adult DDI reported in literature. In adults, a pathologic lead point within the bowel typically leads to intussusception, and this may be malignant in up to 77 percent of cases. DDI is a challenging condition due to its rarity and nonspecific presentation. Here, we present a case of DDI secondary to a duodenal polyp.

Duodenal polyps have been reported in

Introduction Brunner's gland hamartomas (BGH) are rare benign lesions with an incidence of

Duodenal polyps are uncommon. They are usually syndromic seen commonly with Familial adenomatosis polyposis or Peutz-Jegher's syndrome, but maybe seen as a solitary non-syndromic polyp presenting with gastrointestinal symptoms. Few cases of Solitary duodenal hamartomatous polyps have been seen in adults, but to the best of our knowledge never in an infant. We hereby report a case of a 6week old infant who presented with bilious vomiting, weight loss and dehydration. Radiological investigations revealed an obstructive duodenal polyp. Duodenotomy and excision proved curative.

A 71-year-old woman was given a barium meal examination as part of a workup for recurring melena and iron deficiency anemia (IDA), and it revealed a large duodenal polyp measuring 60 mm in diameter. Subsequent upper gastrointestinal endoscopy showed a large pedunculated polyp in the duodenal bulb. Magnifying endoscopy with narrow-band imaging (NBI) showed that the lesion consisted of a regular enlarged intervening part between crypts of the epithelium that resembled gastric mucosa. Although the lesion was suspected of being benign, it was resected by endoscopic submucosal dissection (ESD) to prevent the progression of the IDA. The pathology examination revealed the proliferation of mildly irregular-shaped or dilated glands lined by cuboidal cells and low columnar cells in the submucosa. The gastric glands were immunohistochemically positive for MUC6, suggesting pyloric gland differentiation. The lesion was covered by a foveolar-type epithelium, and we made a diagnosis of pyloric gland adenoma (PGA). PGAs are most common in the stomach, and they are rare in the duodenum, where endoscopic treatment is technically challenging. Here we report a case of large duodenal PGA successfully resected by ESD. Since part of PGAs has been reported to be associated with adenocarcinoma, minimally invasive treatment strategies are desirable to reduce the risk of progression to carcinoma. [ABSTRACT FROM AUTHOR]

The liberal use of upper endoscopy has led to an increased detection of gastric and duodenal polyps, which are identified in as many as 6 and 4.6% of patient examinations, respectively. Gastroduodenal polyps are a heterogeneous group of lesions that can be neoplastic or non‐neoplastic (e.g. hyperplastic or heterotopical). Most polyps present characteristic topographical features, as well as endoscopic appearance and size. Evaluation of the surrounding mucosa is essential in assessing the underlying pathology (e.g. Helicobacter pylori, autoimmune gastritis or inherited polyposis syndromes). Phylogenetically, gastric and duodenal polyps can be classified according to the epithelial compartment from which they derive. Polyps that arise from the surface epithelium can either be of foveolar or intestinal type, and they can develop from either the native mucosa or the metaplastic epithelium (gastric intestinal metaplasia or duodenal foveolar metaplasia). Other polyps develop from the deeper glandular component, such as pyloric/oxyntic gland derived subtypes. In this review we focus upon epithelial polyps, with an emphasis on the most common and clinically relevant lesions, and present recently described entities. [ABSTRACT FROM AUTHOR]

Duodenal polyps have been reported in <1.5% of individuals who undergo esophagogastroduodenoscopy (EGD). We present a case of a 76-year-old male with recurrent hematemesis who was found to have an intestinal-type, pedunculated tubulovillous adenoma in the descending duodenum. An isolated occurrence of nonampullary sporadic duodenal adenoma is a rare finding. Presentation as an upper gastrointestinal hemorrhage is also extremely uncommon. Our patient's polyp was pedunculated, which is atypical, because most sporadic duodenal adenomas are morphologically flat or sessile. The purpose of this case is to present a rare cause of upper gastrointestinal bleeding and to depict characteristics of an isolated duodenal tubulovillous adenoma and its treatment options. [ABSTRACT FROM AUTHOR]

Duodenal gangliocytic paragangliomas are rare neoplasms often arising in the duodenum in close proximity to the ampulla of Vater. These neoplasms are considered to have a benign behavior with lymph node metastases being a rare phenomenon and distant metastases even more so. Although a standardized treatment has not been determined, a margin-free tumor resection seems to be the best treatment modality. We report herein the case of a 36-year-old female who presented with abdominal pain and was found to have a polyp in the second part of duodenum which was excised endoscopically. Histopathology and immunohistochemistry revealed characteristic features of this rare tumor.

Portal hypertension can affect the entire gastrointestinal tract, including the duodenum. Portal hypertensive duodenopathy may occur relatively rare in patients with portal hypertension secondary to cirrhosis or extrahepatic portal venous obstruction. We report the case of a 63-years-old female patient with cirrhosis who underwent an esophagogastroduodenoscopy. Multiple small duodenal polyps (2-3 mm) were found. The histopathologic examination of the duodenal biopsy specimen revealed a polypoid duodenal mucosa, with preserved villous architecture, with focal gastric foveolar metaplasia and numerous ectatic capillaries in lamina propria. The polypoid lesions found in the duodenum are a consequence of portal hypertension. The presence of one or several polyps in the duodenum of a patient with portal hypertension, with specific histological findings (dilated mucosal capillaries, no dysplasia) is diagnostic of duodenal polyp/polyposis in the context of portal hypertension. [ABSTRACT FROM AUTHOR]

Carcinoma cervix is one of the most common malignancies seen in women worldwide and more so in the Indian subcontinent. Carcinoma cervix is known for its orderly lymphatic spread. Skip metastasis or intraluminal metastasis is not a frequent occurrence. A 50-year-old diabetic and hypertensive female patient who was diagnosed to have carcinoma cervix (stage II A 2) Grade II to III and post radiotherapy (3 years back) presented to the surgical outpatient with dyspeptic symptoms and vague abdominal pain. On examination she was found to have a 1x1cm hard, fixed, left supraclavicular node and a palpable liver. Ultrasound abdomen revealed multiple retro peritoneal lymphadenopathy and Contrast Enhanced Computerised Tomography (CECT) abdomen revealed secondary deposits in the pancreatico-duodenal groove infiltrating the duodenal C-loop and pancreatic head, with multiple retroperitoneal nodes with necrosis. Fine needle Aspiration Cytology (FNAC) from left supraclavicular node revealed metastatic squamous cell carcinoma. Oesophagogastroduodenoscopy showed 2 sessile lesions in the anterior wall of duodenum with mucosa stretched and central umbilication with almost complete luminal obstruction. Biopsy from the duodenal lesion also turned out positive for metastatic squamous cell carcinoma. Gynaecological examination was negative for any local recurrence. Patient was managed symptomatically for dyspepsia and is currently undergoing chemotherapy. She is at present on regular follow-up and is asymptomatic for the bowel metastasis. Given the frequency of cancer cervix and the rarity of intra luminal metastasis, this case report serves to reiterate the fact that the abdomen is truly a pandora’s box.

Familial adenomatous polyposis (FAP) is a genetic disorder in which multiple colorectal polyps and cancers develop. However, the prevalence of small intestinal tumors in patients with FAP remains unclear. We elucidated the prevalence of polyps in the small intestine and duodenum using capsule endoscopy (CE). Patients with FAP receiving a periodic screening colonoscopy at Kyoundo Hospital were encouraged to participate in the study. All study participants underwent esophagogastroduodenoscopy (EGD) within 2 weeks before CE. Outcome measurements were the prevalence of duodenal polyps (DP) and small intestinal polyp (SIP), detectability of the ampulla of Vater, and concordance of the duodenal findings between CE and EGD. Twenty-three patients (mean age, 47 years; 15 males) were enrolled in the study. CE showed DPs in 11 patients (52 %) and SIPs in nine patients (43 %). The mean numbers of DPs and SIPs was 11.5 ± 6.2 and 11.9 ± 10.9, respectively. SIPs were more often detected in patients with DPs versus those without (62 vs. 13 %, P = 0.07). The ampulla of Vater was observed by CE in four patients (21 %). EGD showed DPs in 13 patients (62 %). EGD missed DPs in two of 11 patients with DPs detected by CE. EGD found DPs in four of 10 patients without DPs using CE. The kappa index was 0.422. Patients with FAP have a high prevalence of polyps in the small intestine. Although the clinical significance of small intestinal polyps remains unclear, patients with FAP seem to be good candidates for CE. [ABSTRACT FROM AUTHOR]

Polypoid vascular and lymphatic malformation of the small intestine is rare. We report the case of a polypoid vascular and lymphatic malformation of the duodenum in a 58-year-old woman presenting with post-prandial epigastric discomfort. She did not have common symptoms of intestinal vascular and lymphatic malformation, such as gastrointestinal bleeding, steatorrhea, and hypoalbuminemia. A 5.0 × 0.8-cm semipedunculated polypoid lesion was found in the duodenal bulb with protrusion into the prepyloric antrum and was successfully removed using an endoscopic snare. [ABSTRACT FROM AUTHOR]

Introduction Management and outcomes for duodenal adenomas may vary based on etiology, familial versus sporadic. We reviewed the records of patients managed at our institution for duodenal adenomatous polyps for the 20-year period ending July 2006. Discussion Methods of polyp resection (endoscopic, local surgical resection, or definitive surgical resection) within both sporadic and familial patient groups were compared. Patients with known cancer were excluded. Two hundred seventy-eight patients with duodenal polyps were followed during this time period: 110 patients (39.6%) with sporadic polyps and 168 (60.4%) with familial adenomatous polyposis (FAP). Sporadic patients presented at a mean age of 66.5 years. Endoscopic resection was attempted in 44 patients (40%) with morbidity in 9% and local recurrence rate of 52% with a mean follow-up of 43 months. Surgical resection was performed in 46 patients (42%): 27 by definitive resection and local resection in 19. At a mean follow-up of 41 months, there were no local recurrences in the patients treated by definitive resection and six recurrences (32%) after local resection. Morbidity was 39%. There was a significant difference in local recurrence when comparing definitive resection to both endoscopic and local resection (p<0.001, p=0.002, respectively), but no significant difference between endoscopic and local excision (p=0.13). Cancer was discovered in the surgical specimens of 11 patients (24%) with benign preoperative biopsies. FAP patients began surveillance at a mean age of 39.5 years, and mean surveillance duration was 100 months. Endoscopic resection/ablation was attempted in 40 patients (24%) with a morbidity of 7.5%. With a mean follow-up of 77.5 months, the local recurrence rate was 72.5%. Surgical resection was performed in 50 patients (30%) with a mean follow-up of 44 months. Definitive resection was performed in 47 and local excision in three with local recurrence rates of 9% and 100%, respectively. Surgical morbidity was 48%. Local recurrence was significantly lower following definitive resection compared to endoscopic or local resection (p<0.001), but there was no difference in local recurrence between the latter two groups (p=0.29). Four patients (8%) undergoing surgery were discovered to have invasive cancer despite benign endoscopic biopsies. In summary, endoscopic and local surgical management for both sporadic and familial duodenal polyps are associated with a high rate of local recurrence. Definitive resection in the form of pancreaticoduodenectomy, pancreas-sparing duodenectomy, or segmental duodenectomy offers the best chance for polyp eradication and prevention of carcinoma, regardless of polyp etiology. [ABSTRACT FROM AUTHOR]

Carcinoma cervix is one of the most common malignancies seen in women worldwide and more so in the Indian subcontinent. Carcinoma cervix is known for its orderly lymphatic spread. Skip metastasis or intraluminal metastasis is not a frequent occurrence. A 50-year-old diabetic and hypertensive female patient who was diagnosed to have carcinoma cervix (stage II A 2) Grade II to III and post radiotherapy (3 years back) presented to the surgical outpatient with dyspeptic symptoms and vague abdominal pain. On examination she was found to have a 1x1cm hard, fixed, left supraclavicular node and a palpable liver. Ultrasound abdomen revealed multiple retro peritoneal lymphadenopathy and Contrast Enhanced Computerised Tomography (CECT) abdomen revealed secondary deposits in the pancreatico-duodenal groove infiltrating the duodenal C-loop and pancreatic head, with multiple retroperitoneal nodes with necrosis. Fine needle Aspiration Cytology (FNAC) from left supraclavicular node revealed metastatic squamous cell carcinoma. Oesophagogastroduodenoscopy showed 2 sessile lesions in the anterior wall of duodenum with mucosa stretched and central umbilication with almost complete luminal obstruction. Biopsy from the duodenal lesion also turned out positive for metastatic squamous cell carcinoma. Gynaecological examination was negative for any local recurrence. Patient was managed symptomatically for dyspepsia and is currently undergoing chemotherapy. She is at present on regular follow-up and is asymptomatic for the bowel metastasis. Given the frequency of cancer cervix and the rarity of intra luminal metastasis, this case report serves to reiterate the fact that the abdomen is truly a pandora's box. [ABSTRACT FROM AUTHOR]

Prophylactic colectomy is generally recommended for patients with familial adenomatous polyposis (FAP) who are inevitably affected with large bowel cancer. After prophylactic colectomy has been performed, gastrointestinal malignancy is the leading cause of death. Duodenal adenomas are found in patients with FAP and the adenoma–carcinoma sequence exists in the FAP duodenum, suggesting that treatment of duodenal polyps might be beneficial. Several methods of treatment for duodenal lesions in patients with FAP have been reported, but the current treatment options are not ideal. The nonsteroid anti-inflammatory drugs, sulindac and aspirin, are used for chemoprevention, while recently developed cyclooxygenase-2 inhibitors may be of some use in the future. Endoscopic polypectomy has been attempted for duodenal polyps and open surgical polypectomy has proven to be effective for selected patients. Photodynamic therapy and Argon plasma coagulation may be suitable to treat carpeted polyposis. New methods of duodenal resection, such as pancreas-preserving duodenectomy and pylorus-preserving pancreaticoduodenectomy, might be considered for severe duodenal polyposis; however, because prophylactic duodenal surgery has been considered too aggressive, surveillance duodenoscopy is usually performed to detect duodenal cancer at an early stage. [ABSTRACT FROM AUTHOR]

Introduction  Brunner's gland hamartomas (BGH) are rare benign lesions with an incidence of <0.01%, accounting for 5 to 10% of all benign tumors of the duodenum. It requires expeditious management by a multidisciplinary team. The aim of the study is to report our experience with surgery for BGH. Methodology  Data of all patients who underwent surgical intervention for duodenal polypoidal mass between August 2007 and March 2020 were retrieved from our prospectively maintained gastrointestinal (GI) surgery database. All patients whose histopathology report of the resected specimen confirmed BGH ( n  = 9) were included in the present study. Other pathological diagnosis like duodenal lipoma ( n  = 2), ganglioneuroma ( n  = 1), adenoma ( n  = 10), and adenocarcinoma ( n  = 4) were excluded. Results  Nine patients had confirmatory histopathological diagnosis of BGH and met our inclusion criteria. Three (33.3%) of them were men with a median age of 45 (range: 24-61) years. The median interval between onset of symptoms and diagnosis of duodenal polyp was 14 (range: 4-180) days. Five patients (55.5%) presented with upper GI hemorrhage. Three (33.3%) patients presented with abdominal pain, and one (11.1%) patient presented with episodes of bilious vomiting. Diagnostic endoscopy could detect the lesion in all (100%) patients. Contrast-enhanced computed tomography detected duodenal polypoidal lesion in five (55.5%) patients. The mean size of tumor was 4.78 ± 1.36 cm. These lesions were symptomatic in all the patients and warranted intervention. In view of failed endoscopic intervention ( n  = 7, 77.7%), or extramural extension of the tumor ( n  = 2, 22.2%), surgical intervention was considered. Most commonly performed operation was duodenal polypectomy ( n  = 6, 66.6%). Three postoperative complications developed in two (22.2%) patients. There was no surgery-related mortality. After a median follow-up of 60 (12 -78) months, no patient developed GI bleed or intestinal obstruction. Conclusion  In this study, the clinical profile of BGH was explored from the surgeon's point of view. Although endoscopic management is the first-line treatment, surgery plays an important role, particularly, if this fails or is not feasible. In experienced hand, surgery can be performed with acceptable perioperative morbidity and mortality and long-term satisfactory outcomes., Competing Interests: Conflict of Interest None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).)

A polypoid tumor was surgically removed from the second part of the duodenum of a 56-year-old male. The main body consisted of large epithelioid cells arranged in an adenoma like pattern of strands and nests. These cells were argyrophil and had marked nonspecific esterase activity. Unmyelinated nerves with proliferated Schwann cells accompanied these epithelioid cells together with scattered gangliocyte like elements. Ultramicroscopically, the epithelioid cells were seen to contain round electron dense granules, 150 nm in diameter on average. The tumor is considered to be a nonchromaffin paraganglioma, as it probably developed from paraganglion cells associated with small arteries or branches of the vagus nerve, or from the undifferentiated pluripotent APUD cells of the duodenum. [ABSTRACT FROM AUTHOR]

We report herein a case of a 43 year old female who was found to have developed ampullary carcinoma seven years following a subtotal colectomy for familial polyposis coli. She presented to us with only a light fever and early stage ampullary carcinoma was subsequently diagnosed by endoscopic examination of the upper gastrointestinal tract, including an endoscopic retrograde choledochopancreatography. The patient is presently alive and well without any evidence of recurrence 33 months after undergoing a pancreaticoduodenectomy. [ABSTRACT FROM AUTHOR]

A 62-year-old woman with a precancerous duodenal polyp in the suprapapillary region of the second portion of the duodenum was surgically treated by pancreato-duodenectomy. The postoperative course and follow-up was uneventful. A statistical analysis of primary duodenal tumor cases (excluding tumors of the duodenal papilla) reported in Japan during the period from 1962 to 1977 was also reported. [ABSTRACT FROM AUTHOR]

Duodenal polyps are uncommon. They are usually syndromic seen commonly with Familial adenomatosis polyposis or Peutz-Jegher's syndrome, but maybe seen as a solitary non-syndromic polyp presenting with gastrointestinal symptoms. Few cases of Solitary duodenal hamartomatous polyps have been seen in adults, but to the best of our knowledge never in an infant. We hereby report a case of a 6week old infant who presented with bilious vomiting, weight loss and dehydration. Radiological investigations revealed an obstructive duodenal polyp. Duodenotomy and excision proved curative. [ABSTRACT FROM AUTHOR]

A 59-year-old patient underwent the duodenal endoscopic mucosal resection of a hyperplastic polyp. Four hours after the procedure she developed severe epigastric pain. Laboratory and imaging results were consistent with mild acute edematous pancreatitis. After several days of dietary therapy and intravenous crystalloid fluids the patient recovered, and 1 month later was asymptomatic and had no signs of pancreatic inflammation. This case illustrates a rare but clinically important complication of therapeutic upper endoscopy, which may be attributable to thermal injury of the duodenal wall and the adjacent pancreas. It also underscores the importance of the close follow up of patients who undergo invasive endoscopic procedures and the need for additional preventive measures to be taken when resecting duodenal lesions.

It has recently been shown that duodenal foveolar gastric metaplasia (FGM) sometimes presents as a polyp. The mechanism by which FGM develops into a polypoid lesion is unknown and it is unclear whether this form of FGM is indistinguishable from other polypoid lesions or whether endoscopists do not recognize it because they are unfamiliar with it. We identified and retrieved archival cases of FGM endoscopically suspicious for adenomatous polyp and examined their pathological, clinical and endoscopic features. Endoscopic features of the 13 identified FGMs presenting as polyps were heterogeneous and overlapping with those of adenomatous polyps. FGM was frequently associated with mucosal and submucosal Brunner's glands, but defining and recognizing hyperplasia of these glands remains difficult. Other pathological features could not explain the development of a polypoid lesion. The endoscopic features of FGM polyps are non-specific, overlapping with those of adenomatous polyps. FGM polyps probably acquire their polypoid aspect due to association with Brunner's gland hyperplasia (BGH), which also arises due to chronic inflammation and damage. Because BGH is ill-defined and difficult to recognize, while FGM is diagnosed easily, this type of polypoid lesions has until now only been recognized based on the presence of FGM, although FGM is most likely a secondary phenomenon and not the primary cause of the polyp., Competing Interests: The authors declare that they have no conflict of interest, (© Acta Gastro-Enterologica Belgica.)

Duodenal gangliocytic paragangliomas are rare neoplasms often arising in the duodenum in close proximity to the ampulla of Vater. These neoplasms are considered to have a benign behavior with lymph node metastases being a rare phenomenon and distant metastases even more so. Although a standardized treatment has not been determined, a margin-free tumor resection seems to be the best treatment modality. We report herein the case of a 36-year-old female who presented with abdominal pain and was found to have a polyp in the second part of duodenum which was excised endoscopically. Histopathology and immunohistochemistry revealed characteristic features of this rare tumor., Competing Interests: There is no conflict of interest