A 73-year-old woman was admitted to the hospital for a gastric polypectomy. Nine months
earlier, she had visited the hospital because of abdominal discomfort. At that time,
upper endoscopy showed a 1.8-cm pedunculated polyp on the lesser curvature of the
prepyloric antrum (A). A biopsy specimen was obtained, and it was diagnosed as a hyperplastic polyp. The
patient was recommended for endoscopic polypectomy, but she decided to defer the procedure
to a later date. Before revisiting the hospital for the polypectomy, the patient experienced
melena and abdominal pain for several days. Additionally, before experiencing melena,
she had a history of using nonsteroidal anti-inflammatory drugs (NSAIDs) for back
pain. Upon revisit, upper endoscopy revealed that the pedunculated polyp previously
located on the prepyloric antrum had disappeared, and a small active ulcer had formed
at the same site (B). The ulcer was confirmed as benign, both endoscopically and histologically. For
treatment of the ulcer, the patient was prescribed a proton-pump inhibitor for 2 months.
In this case, owing to the location and morphology of the polyp, the pedunculated
polyp on the antrum was likely to undergo traction mechanically and torsion by peristalsis.
Additionally, ulcerogenic medications such as NSAIDs may also play a role in autoamputation.
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Publication history
Published online: November 01, 2017
Massimo Raimondo, MD, Associate Editor for Focal PointsIdentification
Copyright
© 2017 by the American Society for Gastrointestinal Endoscopy
