Duodenal and Jejunal Polyps in Extra-hepatic Portal Hypertension
 
print
Ira Shah
Consultant in Pediatric Infectious Diseases and Pediatric Hepatology, Nanavati Hospital and Incharge Pediatric HIV, TB and Liver Clinics, B J Wadia Hospital for Children, Mumbai, India.

Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056.


Clinical Problem :
A 7 years old boy suffering from extrahepatic portal hypertension had an episode of malena. An upper GI endoscopy was done. There was presence of Grade 1-2 esophageal varices without any bleeding stigmata. Stomach showed changes of portal gastropathy. There were multiple polyps in the duodenum and jejunum. One of the jejunal polyp was actively bleeding which was controlled by saline-adrenaline injection and bipolar heater probe coagulation. A duodenal polyp was resected and sent for histopathological evaluation.


Question :
What could be the cause of polyps in this child_?

Expert Opinion :
Histopathological evaluation of the polyp showed numerous thick-walled capillaries in its subepithelial portion, and a few vascular ectasias suggestive of portal hypertensive duodenopathy. The most common manifestations of portal hypertension are esophageal and gastric varices. Gastric mucosal changes such as presence of mosaic pattern, cherry red spots and scarlatina rash on endoscopy are called as portal hypertensive gastropathy which are also not uncommon. {1} Duodenum can also be involved and apart from duodenal varices, there may be presence of erythema, scattered petechiae, friable mucosa, erosion, ulcer and edema. {2} This is known as portal duodenopathy. On histopathology, they may present as subepithelial edema and increase of diameter and wall thickness of the capillaries. {3} Polyp can also occur due to portal hypertension duodenopathy which on histology may show presence of multiple thick walled capillaries {1} as was seen in our patient. It is postulated that multiple polyps can occur due to angiogenesis {neovascularization} due to high portal pressure {4}. Thus not all bleeding in portal hypertension is due to varices but can also be due to portal hypertensive polyps.

References
1. Zeitoun J-D, Chryssostalis A, Terris B, Prat F, Gaudric M, Chaussade S. Portal hypertensive duodenal polyp: A case report. World J Gastroenterol. 2007`13:1451-1452.
2. Misra V, Misra SP, Dwivedi M, Gupta SC. Histomorphometric study of portal hypertensive enteropathy. Am J Clin Pathol. 1997` 108:652-7.
3. Devadason D, Murphy MS, Brown R, Wilson D, McKiernan PJ. Duodenal capillary hemangiomatous polyps: a novel manifestation of extra hepatic portal hypertension_? J Pediatr Gastroenterol Nutr. 2007`45:114-6.
4. Pillai SB, Ram Ganesh VR, Mohanakrishnan A, Nirmala V. Portal duodenopathy presenting as polyposis. Indian J Pathol Microbiol. 2010`53:558-9.


Correct Answers :  yes 100%
CIP 2017
Ask a Doctor
Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.