Laparoscopic Resection of a Jejunal Inflammatory Fibroid Polyp that Caused Occult Gastrointestinal Bleeding, Diagnosed via Capsule Endoscopy and Double-Balloon Enteroscopy: A Case Report

Abstract

An inflammatory fibroid polyp (IFP) is a mesenchymal tumor of the gastrointestinal tract. IFPs in the small intestine are the most frequently detected with symptoms, such as abdominal pain and tarry stool due to intussusception. Accordingly, few studies have reported jejunal IFP as a cause of occult gastrointestinal bleeding (OGIB) diagnosed via both of capsule endoscopy (CE) and double-balloon enteroscopy (DBE). A 68-year-old woman presented with a progression of anemia and a positive fecal occult blood test result. Esophagogastroduodenoscopy and total colonoscopy findings were unremarkable. CE revealed a tumor with bleeding in the jejunum. DBE also revealed a jejunal polypoid tumor. Bleeding from the tumor seemed to have caused anemia. The patient underwent partial laparoscopic resection of the jejunum, including resection of the tumor. The tumor was histopathologically diagnosed as IFP. To our knowledge, this is the first reported case of laparoscopic resection of jejunal IFP with OGIB diagnosed via CE and DBE preoperatively.

Keywords: Capsule endoscopy; Double balloon enteroscopy; Laparoscopic surgery; Inflammatory fibroid polyp.

Fig. 1.

(A, B) Video capsule endoscopic image showing the tumor with bleeding in the distal jejunum.

Fig. 2.

Double balloon enteroscopy showing a polypoid mass in the distal jejunum.

Fig. 3.

(A) A 12-mm initial access site established at the umbilicus by using the Hasson open technique. A 12-mm trocar and two 5-mm trocars are inserted as indicated. (B) Laparoscopic image confirming the preoperative tattooing of the tumor in the jejunum.

Fig. 4.

Macroscopic and histopathological examinations of the surgical specimen. (A) The macroscopic findings show a partially dark-red polypoid mass in the jejunal wall. The histopathological examination result shows that the tumor consisted of fibrous granulation tissue (hematoxylin and eosin [H&E] staining, original magnification ×40) (B) with mild infiltration of eosinophils and lymphocytes. (H&E, original magnification ×100) (C).