Grand Rounds

Hyperplastic duodenal and jejunal polyps in a child with portal cavernoma


Amit Dashputra1, Ira Shah2
1Seth G S Medical College, Mumbai, India, 2Pediatric Gastroenterology, V Care Polyclinic, Mumbai, India

Address for Correspondence: Amit Dashputra, Seth G S Medical College, Mumbai, India. Email: amitdashputra@outlook.com


Keywords: Hyperplastic duodenal, jejunal polyps, portal cavernoma

Clinical Problem:
A 7-year-old boy presented with abdominal pain for 2 days. He was diagnosed to have extrahepatic portal hypertension with portal cavernoma at the age of 1 year. At that time, he had hematemesis and malena. However, colonoscopy and esophagogastroscopy (OGDscopy) showed no varices. Ultrasound abdomen at that time showed multiple channels at porta with hepatopetal flow suggestive of portal cavernoma. There was no history of umbilical sepsis, jaundice or umbilical catheterization. Subsequently he had no further bleeding episodes. On presentation to us, height was 116 cm and weight was 18.3 kg. He had a 10 cm splenomegaly. Other systems were normal. Investigations showed hemoglobin of 8.8 gm/dL, white cell count 2600 cells/cumm (56% polymorphs, 31% lymphocytes) and platelets of 50,000 cells/cumm. Liver function tests were normal. Ultrasound abdomen showed normal liver with portal cavernoma with periportal, pericholecystic, peripancreatic, retroperitoneal and rectal collaterals. Spleen measured 17.3 cm and splenic vein was normal. He was started on propranolol (1 mg/kg), folic acid and iron supplements and advised OGDscopy which showed grade 3 varices for which band ligation was done. One month later, he had malena and again OGDscopy was done. Presence of duodenal polyps was noted. Five months later, he again had malena and OGDscopy was done that showed grade I-II esophageal varices, portal gastropathy and multiple duodenal and proximal jejunal polyp. One jejunal polyp was actively oozing which was controlled with saline adrenaline injection and bipolar probe coagulation. Biopsy of duodenal polyp was done which on histopathology was suggestive of hyperplastic polyps. He was advised colonoscopy to rule out colonic polyps, which has not been done yet due to financial constraints. He is on regular follow up.

What is the cause of duodenal and jejunal polyps?


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