Antral inflammatory polyp causing intermittent gastric outlet obstruction: Case report

We report a case of a 45-year-old woman who presented with vomiting & severe fatigue. On routine examination show iron deficiency anemia Gastroscopy revealed a large polyp in the antral region causing intermittent gastric outlet obstruction. Histopathologic examination revealed an inflammatory fibroid polyp (known also as Vanek’s tumour). 1 Background: Gastric polyps are usually found incidentally on upper gastrointestinal endoscopy performed for an unrelated indication and only in rare cases do they cause symptoms. Nevertheless, the diagnosis and appropriate management of gastric polyps are important, as some polyps have malignant potential . In 1949, Vanek described inflammatory fibroid polyp as ‘‘gastric submucosal granuloma with eosinophilic infiltration.’’ 2 These polyps are characterized by the proliferation of spindle cells, small blood vessels, and inflammatory cells, often dominated by eosinophils. 3 These uncommon polyps of unknown etiology may be found throughout the gastrointestinal tract, but they are most common in the antropyloric region (80%). They are diagnosed in male and female adults of all ages and are associated in some cases with hypochlorhydria or achlorhydria. 4,5 Gastric outlet obstruction (GOO) presents with nausea and vomiting and usually develops over weeks to months. 6 It may be complete or incomplete with intermittent symptoms. In the past, peptic ulcer disease was considered as the most common cause of GOO; more recently, gastric malignancy has become a more frequent entity 7. The rare causes are bezoars, foreign bodies, Bouveret's syndrome, hypertrophic pyloric stenosis, and large polyps of the antrum or pyloric channel 8,9,10,11 . Inflammatory fibroid polyps are extremely rare lesions that represent less than 0.1 percent of all gastric polyps. Following resection, inflammatory fibroid polyps typically do not recur, and surveillance is not recommended.