Title : Menetrier's disease presenting as gastric outlet obstruction mimicking linitis plastica: A case report
Abstract:
Menetrier’s disease is a rare, acquired premalignant disorder of the stomach with thickened gastric folds associated with protein-losing enteropathy and H Pylori infection. The clinical presentation of Menetrier’s disease might cause diagnostic difficulty and can be mistaken for malignancy, hence tissue acquisition technique is very crucial for diagnosis. We describe a case of Menetrier’s disease in a 59-year-old, Filipino Female presenting as gastric outlet obstruction secondary to thickened gastric folds mimicking Linitis Plastica without overt symptoms of protein-losing enteropathy and negative for H. Pylori infection. Esophagogastroduodenoscopy revealed a poorly distensible stomach with poor contractility with multiple nodular masses seen from the proximal stomach to the antrum with multiple mucosal breaks with narrowing at the pre pyloric area. Endoscopic ultrasonography showed thickened gastric wall (16 mm) with intact five-wall layers. Endoscopic mucosal resection with band ligation biopsy of giant gastric folds observed along the greater gastric curvature revealed foveolar hyperplasia and significant parietal cell loss. Menetrier’s disease was diagnosed and patient underwent near total gastrectomy, gastro-jejunostomy secondary to the obstructive symptoms. MD should be considered in the differential diagnosis of patients presenting as gastric outlet obstruction and tissue sampling technique is very crucial in ruling out other mimics of MD.
Key Words: Menetrier’s disease, Thickened Gastric Folds, Linitis Plastica
Audiences Take Away:
- Menetrier’s disease should be considered in patients coming with gastric outlet obstruction symptoms and endoscopic findings of thickened gastric folds even in the absence of H. pylori infection and no peripheral edema
- MD can mimic other causes of thickened gastric folds like infections, inflammatory and most importantly malignancy, hence tissue sampling technique is very crucial in ruling out other mimics of MD
- Diffuse gastric wall thickening diagnosis is very challenging hence we compare the accuracy of each diagnostic technique for gastric mucosal sampling
- Audience will be able to learn the approach, differential diagnosis, different diagnostic modalities for TGF, and treatment for Menetrier’s Disease
