Hyperplastic gastric polyps are incidentally diagnosed during upper gastrointestinal endoscopy. They are known to cause gastric outlet obstruction and chronic blood loss leading to iron deficiency anemia. However, hyperplastic gastric polyp presenting as acute severe upper gastrointestinal bleeding is very rare. To the best of our knowledge, there have been two cases of hyperplastic gastric polyps presenting as acute gastrointestinal bleeding in the medical literature. We present a case of a 56-year-old African American woman who was admitted to our hospital with symptomatic anemia and sepsis. The patient developed acute upper gastrointestinal bleeding during her hospital stay. She underwent emergent endoscopy, but bleeding could not be controlled. She underwent emergent laparotomy and wedge resection to control the bleeding. Biopsy of surgical specimen was reported as hyperplastic gastric polyp. We recommend that physicians should be aware of this rare serious complication of hyperplastic gastric polyps as endoscopic polypectomy has diagnostic and therapeutic benefits in preventing future complications including bleeding. 1. Introduction Hyperplastic gastric polyps are the second most common variety of gastric polyps in the United States of America (USA) preceded by fundic gland polyps [1]. Hyperplastic polyps have been known to present clinically as gastric outlet obstruction or chronic occult blood loss leading to iron deficiency anemia [2, 3]. However, to the best of our knowledge, acute gastrointestinal bleeding in association with hyperplastic gastric polyps has been reported very rarely [3, 4]. We present a case of a 56-year-old African American woman with acute severe upper gastrointestinal bleeding which could not be controlled with endoscopic measures and finally underwent surgical intervention to control the bleeding. 2. Case Presentation A 56-year-old African American woman was brought to the emergency room (ER) by her family members with generalized weakness of 3 weeks duration. She also reported generalized body aches, subjective fever, stiffness of joints in the morning, skin rash, and loss of appetite. She denied any abdominal pain, nausea, vomiting, diarrhea, constipation, or urinary symptoms. She has known medical history of rheumatoid arthritis and pernicious anemia. She denied any major surgical procedures in the past or allergies to any medications. Her current medications included methotrexate, celecoxib, and folic acid. She never used tobacco, alcohol, or recreational drugs. As per family, the patient has been depressed, not
References
[1]
S. W. Carmack, R. M. Genta, C. M. Schuler, and M. H. Saboorian, “The current spectrum of gastric polyps: a 1-year national study of over 120,000 patients,” American Journal of Gastroenterology, vol. 104, no. 6, pp. 1524–1532, 2009.
[2]
M. Al-Haddad, E. M. Ward, E. P. Bouras, and M. Raimondo, “Hyperplastic polyps of the gastric antrum in patients with gastrointestinal blood loss,” Digestive Diseases and Sciences, vol. 52, no. 1, pp. 105–109, 2007.
[3]
G. S. Brooks, E. S. Frost, and C. Wesselhoeft, “Prolapsed hyperplastic gastric polyp causing gastric outlet obstruction, hypergastrinemia, and hematemesis in an infant,” Journal of Pediatric Surgery, vol. 27, no. 12, pp. 1537–1538, 1992.
[4]
H. Okano, T. Saitou, and T. Sase, “Bleeding from a gastric hyperplastic polyp during anticoagulation therapy,” Internal Medicine, vol. 50, no. 12, p. 1349, 2011.
[5]
D. J. Morais, A. Yamanaka, J. M. R. Zeitune, and N. A. Andreollo, “Gastric polyps: a retrospective analysis of 26,000 digestive endoscopies,” Arquivos de Gastroenterologia, vol. 44, no. 1, pp. 14–17, 2007.
[6]
K. Haruma, T. Kamada, K. Sugiu, A. Tanaka, and K. Honda, “Gastric hyperplastic polyp is one of the diseases for which H. pylori eradication is recommended,” Nippon Rinsho, vol. 63, supplement 11, pp. 285–287, 2005.
[7]
H. Tanabe, H. Hara, C. Ohtubo, N. Miyokawa, and H. Sano, “Disappearance of gastric adenocarcinoma in hyperplastic polyp after eradication of Helicobacter pylori. Report of a case,” Japanese Journal of Gastroenterology, vol. 102, no. 5, pp. 559–563, 2005.
[8]
K. Dirschmid, C. Platz-Baudin, and M. Stolte, “Why is the hyperplastic polyp a marker for the precancerous condition of the gastric mucosa?” Virchows Archiv, vol. 448, no. 1, pp. 80–84, 2006.
[9]
V. Russin, B. Krevsky, and D. F. Caroline, “Mixed hyperplastic and adenomatous polyp arising from ectopic gastric mucosa of the duodenum,” Archives of Pathology and Laboratory Medicine, vol. 110, no. 6, pp. 556–558, 1986.
[10]
W. Remmele, W. Hartmann, U. Von der Laden et al., “Three other types of duodenal polyps: mucosal cysts, focal foveolar hyperplasia, and hyperplastic polyp originating from islands of gastric mucosa,” Digestive Diseases and Sciences, vol. 34, no. 9, pp. 1468–1472, 1989.
[11]
D. Chatelain and J. F. Flejou, “Hyperplastic polyp in heterotopic gastric mucosa, a rare lesion of the upper esophagus,” Annales de Pathologie, vol. 18, no. 5, pp. 415–417, 1998.
[12]
N. Schmulewitz, J. Tobias, and P. Singh, “Hyperplastic polyp arising from heterotopic gastric epithelium in the esophagus,” Gastrointestinal Endoscopy, vol. 66, no. 6, pp. 1221–1222, 2007.
[13]
E. Gonzalez-Obeso, H. Fujita, V. Deshpande et al., “Gastric hyperplastic polyps: a heterogeneous clinicopathologic group including a distinct subset best categorized as mucosal prolapse polyp,” American Journal of Surgical Pathology, vol. 35, no. 5, pp. 670–677, 2011.
[14]
N. Bassullu, I. Turkmen, S. Uraz, et al., “Xanthomatous hyperplastic polyps of the stomach: clinicopathologic study of 5 patients with polypoid gastric lesions showing combined features of gastric xanthelasma and hyperplastic polyp,” Annals of Diagnostic Pathology, vol. 17, no. 1, pp. 72–74, 2012.
[15]
P. G. Dean, P. Michael Davis, A. G. Nascimento, and D. R. Parley, “Hyperplastic gastric polyp causing progressive gastric outlet obstruction,” Mayo Clinic Proceedings, vol. 73, no. 10, pp. 964–967, 1998.
[16]
R. Gencosmanoglu, E. Sen-Oran, O. Kurtkaya-Yapicier, and N. Tozun, “Antral hyperplastic polyp causing intermittent gastric outlet obstruction: case report,” BMC Gastroenterology, vol. 3, article 16, 2003.
[17]
M. Alper, Y. Akcan, and O. Belenli, “Large pedinculated antral hyperplastic gastric polyp traversed the bulbus causing outlet obstruction and iron deficiency anemia: endoscopic removal,” World Journal of Gastroenterology, vol. 9, no. 3, pp. 633–634, 2003.
[18]
H. Cerwenka, H. Bacher, and H. J. Mischinger, “Pyloric obstruction caused by prolapse of a hyperplastic gastric polyp,” Hepato-Gastroenterology, vol. 49, no. 46, pp. 958–960, 2002.
[19]
T. Kono, Y. Imai, T. Ichihara et al., “Adenocarcinoma arising in gastric inverted hyperplastic polyp: a case report and review of the literature,” Pathology Research and Practice, vol. 203, no. 1, pp. 53–56, 2007.
[20]
S. Brozzetti, A. Gialloreti, C. Cicchini, A. Stazi, and M. Indinnimeo, “Transpyloric prolapse of a gastric carcinoma arising from a pedunculated hyperplastic polyp,” Il Giornale di Chirurgia, vol. 19, no. 1-2, pp. 19–21, 1998.
[21]
K. Hizawa, T. Fuchigami, M. Iida et al., “Possible neoplastic transformation within gastric hyperplastic polyp—application of endoscopic polypectomy,” Surgical Endoscopy, vol. 9, no. 6, pp. 714–718, 1995.
[22]
S. Dang, D. P. McElreath, S. Kumar et al., “Giant gastric hyperplastic polyp: not always a benign lesion,” The Journal of the Arkansas Medical Society, vol. 107, no. 5, pp. 89–92, 2010.
