[Juvenile gastric polyposis: differential diagnosis for recurrent nausea, vomiting, upper abdominal pain and diarrhoea].

METHODS

A 46-year-old woman presented with nausea and vomiting, colics and localized pain in the upper abdomen. There was a family history of juvenile polyposis (3 of 4 siblings). Twelve years ago a colectomy had been performed in the patient for a gastric mucosal polyps.

METHODS

The physical examination showed a nearly normal BMI of 20,9 kg/m2. Gastroscopy showed polyps prolapsed into the duodenum, some of them incarcerated causing the listed symptoms.

METHODS

Because of progressing symptoms a total gastrectomy of a huge stomach was performed. Antral polyps were found to have prolapsed through the pylorus, causing gastric outlet obstruction. Histology confirmed juvenile polyposis. There was no evidence of a malignant process.

CONCLUSIONS

Juvenile polyposis is a rare inherited disease. Polyps can affect the entire gastrointestinal tract but predominantive in the colon. The clinic course of the juvenile polyposis is highly variable, but generally benign. Although malignant degeneration has been reported. A cumulative risk of malignant degeneration for the entire gastrointestinal tract has been estimated as being between 10 and 50 %, but it is very rare in the upper gastrointestinal tract. People with juvenile polyposis should have regular endoscopic controls. But if endoscopic control are impossible, total gastrectomy with lymphadenectomy may sometimes be necessary. Even after such extensive resection the patient may remain without symptoms.