معرفي يك مورد جالب پوليپوز معده گزارش يك مورد و مروري بر منابع پزشكي

Report of a Rare Case of Gastric Polyposis Case Report and Review of Literature

ﭘﻮﻟﻴﭗ ﻫﺎﻱ ﻫﺎﻳﭙﺮ ﭘﻼﺳﺘﻴﮏ ﻣﻌﺪﻩ ﺑﺴﻴﺎﺭ ﻧﺎﺩﺭ ﺑﻮﺩﻩ ﻭ ﺍﻏﻠﺐ ﻣﻨﻔﺮﺩ ﻣﻲ ﺑﺎﺷﻨﺪ. ﻋﻤـﻮﻣﺎﹰ ﺑﺪﻭﻥ ﻋﻼﻣﺖ ﻫﺴﺘﻨﺪ، ﺩﺭ ﺻﻮﺭﺕ ﻋﻼﻣﺖ ﺩﺍﺭ ﺷﺪﻥ، ﺑﻪ ﺻﻮﺭﺕ ﺧﻮﻧﺮﻳﺰﻱ ﮔﻮﺍﺭﺷﻲ، ﺩﺭﺩ ﺷﮑﻢ، ﺍﺣﺴﺎﺱ ﭘﺮﻱ ﺯﻭﺩﺭﺱ ﻳﺎ ﻋﻼﺋﻢ ﺍﻧﺴﺪﺍﺩﻱ ﺷﮑـﻢ ﺑﻪ ﻃﻮﺭ ﻣﺘﻨﺎﻭﺏ ﻇﺎﻫﺮ ﻣﻲ ﺷﻮﻧﺪ. ﺑﻴﻤـﺎﺭ ﺧﺎﻧﻢ 45 ﺳﺎﻟـﻪ ﺍﻱ ﺑﻮﺩ ﮐﻪ ﺍﻭﻟﻴـﻦ ﺑﺎﺭ ﺑﺎ ﺷﮑﺎﻳﺖ ﺿﻌـﻒ، ﺑﻲ ﺣﺎﻟﻲ، ﺳﺮﮔﻴـﺠﻪ ﻭ ﺁﻧﻤـﻲ ﺷﺪﻳﺪ )ﻫﻤـﻮﮔﻠﻮﺑﻴﻦ: 3/9 gr/dl( ﻣـﺮﺍﺟﻌﻪ ﻧﻤـﻮﺩ. ﺩﺭﺩ ﺷﮑـﻢ ﻭ ﻧﻔـﺦ ﺑﻌﺪ ﺍﺯ ﻏـﺬﺍ ﺧﻮﺭﺩﻥ ﺭﺍ ﺫﮐﺮ ﻣﻲ ﮐﺮﺩ. ﺩﺭ ﺁﻧﺪﻭﺳﮑـﻮﭘﻲ ﭘﻮﻟﻴﭗ ﻫﺎﻱ ﻣﺘﻌـﺪﺩ ﺑﻪ ﺷﮑﻞ ﺧﻮﺷﺔ ﺍﻧﮕـﻮﺭ ﺩﺭ ﻣﻌـﺪﻩ ﺑﻪ ﻫﻤـﺮﺍﻩ ﭘﻮﻟﻴﭗ ﻫﺎﻱ ﭘﺮﺍﮐﻨﺪﻩ ﺩﺭ ﺳﺎﻳـﺮ ﻧﻮﺍﺣﻲ ﺩﺳﺘﮕﺎﻩ ﮔـﻮﺍﺭﺵ ﺩﻳﺪﻩ ﺷﺪ، ﮐﻪ ﻫﻴﭻ ﮐـﺪﺍﻡ ﺑﺪﺧﻴﻢ ﻧﺒـﻮﺩﻧﺪ. ﺑﻴﻤﺎﺭ ﺗﺤﺖ ﻋﻤﻞ Near Total ﮔﺎﺳﺘﺮﮐﺘـﻮﻣﻲ ﻭﮔﺎﺳﺘﺮﻭﮊﮊﻧﻮﺳﺘـﻮﻣﻲ ﻗـﺮﺍﺭ ﮔﺮﻓﺖ ﻭ ﺑﺎ ﺣﺎﻝ ﻋﻤـﻮﻣﻲ ﺧﻮﺏ ﻣﺮﺧﺺ ﺷﺪ. ﭼﻨﺪﻳﻦ ﻧﻮﺑﺖ ﺑﻪ ﻋﻠﺖ ﻧﺎﺭﺳﺎﻳﻲ ﻗﻠﺐ ﺑﺴﺘﺮﻱ ﮔﺮﺩﻳﺪ ﻭ 10 ﺳﺎﻝ ﺑﻌﺪ ﺑﻪ ﻋﻠﺖ ﻫﻤﻴﻦ ﻋﺎﺭﺿﻪ ﻓـﻮﺕ ﺷﺪ. ﺍﻳﻦ ﻣﻮﺭﺩ ﺍﺯ ﻧﻈﺮ ﺗﻌـﺪﺍﺩ ﺑﺴﻴﺎﺭ ﺯﻳﺎﺩ ﭘﻮﻟﻴﭗ ﮐﻪ ﺗﻤﺎﻡ ﻣﻌﺪﻩ ﺭﺍ ﻓﺮﺍ ﮔﺮﻓﺘﻪ، ﻫﻤـﺮﺍﻫﻲ ﺁﻥ ﺑﺎ ﭘﻮﻟﻴﭗ ﺩﺭ ﺳﺎﻳﺮ ﻣﻨﺎﻃﻖ ﺩﺳﺘﮕﺎﻩ ﮔﻮﺍﺭﺵ، ﻋـﺪﻡ ﻭﺟﻮﺩ ﻋﻼﺋﻢ ﮔـﻮﺍﺭﺷﻲ ﻭﺍﺿﺢ ﻭ ﺑﺮﻭﺯ ﺁﻧﻤﻲ ﺷﺪﻳﺪ ﺑﺪﻭﻥ ﻭﺟﻮﺩ ﺧﻮﻧﺮﻳﺰﻱ ﺷﺪﻳﺪ )ﻋﻠﻴـﺮﻏﻢ ﭘﺎﺗﻮﻟﻮﮊﻱ ﻭﺳﻴﻊ ﺩﺭ ﻣﻌﺪﻩ( ﻳﺎ ﺑﺪﺧﻴﻤﻲ ﻗﺎﺑﻞ ﺗﻮﺟﻪ مي باشد

Hyperplastic polyps are very rare and often solitary. Usually they have no symptoms, if they were symptomatic, they would have gastro intestinal (GI) bleeding, abdominal pain, early fullness of stomach, intermittent obstructive pattern. The patient was a 45 year old woman that complained about fatigue, malaise, dizziness and had severe anemia (Hb: 3.9 gr/dl). She didn’t mention abdominal pain, bloating and, other GI disorders. In endoscopy, many grape like polyps were seen in the stomach; also scattered ones in other parts of GI were observed which none of them were malignant. The patient was operated (Billirot II) and discharged with good general condition. She was hospitalized 4 times during 11 years after surgery because of cardiac decompensation and died finally due to Congestive Heart Failure. The case is interesting and considerable because of the large amount of polyps in the stomach, a few polyps in other parts of GI, absence of obvious alimentary signs or symptoms, severe anemia without active GI bleeding (in spite of extensive pathology in the stomach) or malignancy.