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DOI: 10.1055/s-0030-1256055
© Georg Thieme Verlag KG Stuttgart · New York
Endoscopic treatment of a giant pedunculated angiolipofibroma of the distal duodenum
M. KopacovaMD, PhD
Second Department of Medicine
Charles University
Teaching Hospital
Sokolska 581
500 05 Hradec Kralove
Czech
Republic
Fax: +420-495-834785
Email: kopaemar@fnhk.cz
Publication History
Publication Date:
18 March 2011 (online)
Dual antiplatelet therapy (with clopidogrel and aspirin) may be complicated by severe gastrointestinal bleeding [1]. It may unmask an underlying pathology that has been silent so far. Small intestinal bleeding is the most frequent indication for double-balloon enteroscopy (DBE), both for diagnosis and treatment [2] [3]. DBE is feasible even for polypectomy of large small-intestinal polyps (e. g. hamartomas) [4]. We present an unusual case of successful endoscopic removal of a giant angiolipofibroma.
A 73-year-old man on dual antiaggregation therapy was investigated because of recurrent gastrointestinal bleeding requiring repeated blood transfusions (8 units over 3 months). The patient underwent gastroscopy and colonoscopy elsewhere with normal findings, and capsule enteroscopy with suspicion of small-bowel arteriovenous malformations (AVMs). He was subsequently referred to our department for DBE. However, no AVMs were revealed at DBE. Surprisingly, a finger-like giant polyp growing from the distal part of the duodenum reaching the proximal jejunum was found. The length of the polyp was 12 cm and its diameter 2 cm. Because of the patient’s serious comorbidity, we decided to remove the polyp endoscopically ([Video 1]).
Quality:
The polyp was extracted for histology ([Figs. 1] and [2]).
The final diagnosis was angiolipofibroma ([Fig. 3]).
There were no complications after the procedure ([Fig. 4]) and subsequent follow-up was uneventful.
Angiolipofibroma of the gastrointestinal tract is extremely rare. We found only one similar case in the available literature [5]. A giant pedunculated angiolipofibroma of the esophagus in a 62-year-old patient caused slowly deteriorating dysphagia but did not bleed. This was diagnosed by computed tomography and resolved by surgery [5].
Endoscopic polypectomy of giant small-intestinal polyps is a possible alternative to surgery in polymorbid patients. An experienced endoscopist, a safe design of the procedure, and preventive measures (availability of appropriate urgent surgery in case of complications) are necessary conditions.
#Acknowledgements
The work was supported by research project MZO 00179906 from the Ministry of Health, Czech Republic.
Endoscopy_UCTN_Code_CCL_1AB_2AZ_3AC
Competing interests: None
#References
- 1 Roy P, Bonello L, Torguson R et al. Impact of “nuisance” bleeding on clopidogrel compliance in patients undergoing intracoronary drug-eluting stent implantation. Am J Cardiol. 2008; 102 1614-1617
- 2 Kopacova M, Tacheci I, Rejchrt S et al. Double balloon enteroscopy and acute pancreatitis. World J Gastroenterol. 2010; 16 2331-2340
- 3 Rejchrt S, Kopacova M, Tacheci I et al. Interventional double balloon endoscopy for Crohn’s, gastrointestinal bleeding, and foreign body extraction. Tech Gastrointest Endosc. 2008; 10 101-106
- 4 Kopacova M, Bures J, Ferko A et al. Comparison of intra-operative enteroscopy and double balloon enteroscopy in the diagnosis and treatment of Peutz–Jeghers syndrome. Surg Endosc. 2010; 24 1904-1910
- 5 Koischwitz D. Computertomographische Diagnose eines monströsen gestielten Angiolipofibroms des Ösophagus. [Computed tomographic diagnosis of a monstrous pedunculated angiolipofibroma of the esophagus.] Fortschr Röntgenstr. 1988; 149 105-107
M. KopacovaMD, PhD
Second Department of Medicine
Charles University
Teaching Hospital
Sokolska 581
500 05 Hradec Kralove
Czech
Republic
Fax: +420-495-834785
Email: kopaemar@fnhk.cz
References
- 1 Roy P, Bonello L, Torguson R et al. Impact of “nuisance” bleeding on clopidogrel compliance in patients undergoing intracoronary drug-eluting stent implantation. Am J Cardiol. 2008; 102 1614-1617
- 2 Kopacova M, Tacheci I, Rejchrt S et al. Double balloon enteroscopy and acute pancreatitis. World J Gastroenterol. 2010; 16 2331-2340
- 3 Rejchrt S, Kopacova M, Tacheci I et al. Interventional double balloon endoscopy for Crohn’s, gastrointestinal bleeding, and foreign body extraction. Tech Gastrointest Endosc. 2008; 10 101-106
- 4 Kopacova M, Bures J, Ferko A et al. Comparison of intra-operative enteroscopy and double balloon enteroscopy in the diagnosis and treatment of Peutz–Jeghers syndrome. Surg Endosc. 2010; 24 1904-1910
- 5 Koischwitz D. Computertomographische Diagnose eines monströsen gestielten Angiolipofibroms des Ösophagus. [Computed tomographic diagnosis of a monstrous pedunculated angiolipofibroma of the esophagus.] Fortschr Röntgenstr. 1988; 149 105-107
M. KopacovaMD, PhD
Second Department of Medicine
Charles University
Teaching Hospital
Sokolska 581
500 05 Hradec Kralove
Czech
Republic
Fax: +420-495-834785
Email: kopaemar@fnhk.cz