A rare cause of upper gastrointestinal bleeding; giant lesion in esophagus!

Year 2022, , 854 - 858, 01.10.2022

Mehmet İbiş , Mustafa Ergin , Ali Çelik , Güner Kılıç Kaan Talay

https://doi.org/10.31362/patd.1037286

Abstract

Fibrovascular polyps are one of the benign esophageal tumors and rare gastrointestinal bleeding reasons. They are mostly located in the proximal esophagus. Swallowing and breathing problems, mass feelings, discomfort when swallowing, nausea, weight loss, and a persistent cough are the most common symptoms. Endoscopic resection or esophagectomy are the two main options for treatment. A 60-year-old male patient was admitted for epigastric pain and melena. Endoscopy showed a 15-centimeter-long pedunculated polyp originating from the proximal esophagus and extending to the cardia, narrowing the lumen. The lesion was excised with multiple incisions using surgical ligature and an endoscopic knife after endoscopic ultrasonography and computed tomography examinations. The lesion was too big to be endoscopically removed from the esophageal lumen. Therefore, nearly a 3-4 cm incision was made on the abdomen skin. Under the guidance of the endoscope, the polyp was removed from the incision region using a clamp. Following hemostasis, the stomach was reconstructed and the procedure ended. No problems occurred. The patient is protected from major surgical and operational risks with endoscopic removal of large polyps. Patients who are candidates for endoscopic resection should consider it.

Keywords

Gastrointestinal bleeding, fibrovascular polyp, endoscopic treatment

Nadir bir üst gastrointestinal kanama nedeni; özofagusta dev lezyon!

Abstract

Gastrointestinal kanamanın nadir nedenleri arasında yer alan ve benign özofagus tümörleri arasında bulunan fibrovasküler polipler çoğunlukla proksimal özofagustan köken alır. Yutma ve nefes almada zorluk, yutma sırasında hissedilen kitle hissi ve ağrı, bulantı hissi, kilo kaybı, inatçı öksürük ve kanama gibi şikâyetlere neden olan kitlelerdir. Tedavi endoskopik rezeksiyon veya özofajektomidir. 60 yaşında erkek hasta melena şikâyeti ile başvurdu. Endoskopide ön kesici dişlerden itibaren 17. cm'den başlayarak kardiaya uzanan ve lümeni daraltan 15 cm uzunluğunda pedinküle polip görüldü. Endoskopik ultrasonografi ve bilgisayarlı tomografi incelemelerinin ardından lezyon, cerrahi ligasyon ve endoskopik knife ile çoklu kesi yapılarak rezeke edildi. Lezyon büyük olduğu için özofagus lümeninden çıkarılamadı, kardiadan 3-4 cm'lik bir kesi yapıldı. Polip endoskop eşliğinde klemp ile kesi alanından çıkarıldı. Daha sonra mide onarıldı ve hemostazın ardından operasyon sonlandırıldı. Herhangi bir komplikasyon olmadı. Dev poliplerde endoskopik rezeksiyon, hastayı majör cerrahi ve operatif risklerden korur. Uygun hastalarda endoskopik rezeksiyon düşünülmelidir.

Keywords

Gastrointestinal kanama, fibrovasküler polip, endoskopik tedavi

References

• Zhang, Wei, Eliakim Manda, and Ming Qiu. "Unusual causes of upper gastrointestinal bleeding: Review of Chinese literature." Intractable & rare diseases research 1.1 (2012): 18-22.
• Drenth, Joost PH, et al. "CASE REPORT: Recurrent Esophageal Fibrovascular Polyps: Case History and Review of the Literature." Digestive diseases and sciences 47.11 (2002): 2598-2604.
• Lee, Ser Yee, et al. "Recurrent giant fibrovascular polyp of the esophagus." World journal of gastroenterology: WJG 15.29 (2009): 3697.
• Jose, Paul, Nigel Scott, and Abeezar I. Sarela. "Two-stage removal of giant fibrovascular polyp of the oesophagus." Case Reports 2010 (2010): bcr0520103011.
• Trakál, Juan José, et al. "Giant fibrovascular polyp of the esophagus: a novel technical approach." Case reports in gastrointestinal medicine 2012 (2012).
• Blacha, Marielle MJ, et al. "Dysphagia caused by a fibrovascular polyp: a case report." Cases Journal 1.1 (2008): 1-3.
• Jun, W. A. N. G., et al. "Fibrovascular polyp of the hypopharynx and esophagus." Chinese Medical Journal 124.19 (2011): 3182-3184.
• Kim, Jin Sun, and Young Mog Shim. "Giant fibrovascular polyp of the hypopharynx: surgical treatment with the biappoach." Journal of Korean medical science 21.4 (2006): 749-751.
• Zhang, Hao, and Rong-Hua Nie. "A rare case of giant fibrovascular polyp of the esophagus." Saudi Medical Journal 36.11 (2015): 1348.
• Chourmouzi, Danai, and Antonios Drevelegas. "Giant fibrovascular polyp of the oesophagus: a case report and review of the literature." Journal of Medical Case Reports 2.1 (2008): 1-4.
• Topal, Yunus, Doğan Gönüllü, and Ferda Nihat Köksoy. "Bir Özofageal Fibro-Vasküler Polip Olgusu." Journal of Academic Research in Medicine 3.3 (2013).