A 48-year-old woman presented with a 1-day history of acute abdominal pain after a
bout of drinking-related vomiting. She had no significant medical history or family
history and was not taking any medications. There were no abnormal findings on careful
physical examination, and the standard laboratory results were also within normal
ranges. Upper gastrointestinal endoscopy revealed a long stalk arising from the duodenal
bulb that had prolapsed into the distal portion of the duodenum (Figure [1 a] ). The scope could not be advanced more distally because the stalk was impacted
in the duodenal lumen. A small-bowel series showed a large polypoid mass with a long
stalk (Figure [1 b] ).
Figure 1 a Endoscopic view of a long stalk that was prolapsing into the distal portion of the
duodenum. b Small-bowel series showing a large pedunculated polyp in the second portion of the
duodenum (arrow).
On day 3 the abdominal pain disappeared spontaneously. Follow-up upper gastrointestinal
endoscopy revealed only an edematous cut-off stalk with ulceration at its tip in the
duodenal bulb (Figure [2 a]). Follow-up small-bowel series also showed no evidence of the previously noted mass
(Figure [2 b]). Histopathologic evaluation of the biopsy specimen taken from the remnant of the
stalk revealed inflammatory exudates with granulation tissue. The patient is still
being followed up and has not complained of any unusual symptoms to date. There have
been previous case reports describing compression and obstruction due to a prolapsed
polyp as a cause of acute abdominal pain [1]
[2].
Figure 2 a Endoscopic view of an edematous and ulcerated stalk stump at the duodenal bulb. b The follow-up small-bowel series showed no evidence of the previously noted polypoid
mass.
Endoscopy_UCTN_Code_CCL_1AB_2AZ_3AB
