Duodenal and Jejunal Polyps in Extra-hepatic Portal Hypertension

Dr Ira Shah

doi:https://10.7199/ped.oncall.2017.11

Duodenal and Jejunal Polyps in Extra-hepatic Portal Hypertension

Dr 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.

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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.

What could be the cause of polyps in this child_?

Discussion
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.

Compliance with ethical standards

Funding: None

Conflict of Interest: None

References

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. [CrossRef] [PMC free article]
Misra V, Misra SP, Dwivedi M, Gupta SC. Histomorphometric study of portal hypertensive enteropathy. Am J Clin Pathol. 1997; 108:652-7. [CrossRef] [PubMed]
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. [CrossRef] [PubMed]
Pillai SB, Ram Ganesh VR, Mohanakrishnan A, Nirmala V. Portal duodenopathy presenting as polyposis. Indian J Pathol Microbiol. 2010;53:558-9. [CrossRef] [PubMed]

DOI: https://doi.org/10.7199/ped.oncall.2017.11

Cite this article as:
Shah I. Duodenal and Jejunal Polyps in Extra-hepatic Portal Hypertension. Pediatr Oncall J. 2017;14: 76-77. doi: 10.7199/ped.oncall.2017.11