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Abstracts: STOMACH

Anterograde and Retrograde Ball-Valve Syndrome: A Report of Four Cases


Rafiq, Ehsan MD1; Bawany, Muhammad MD1; De Las Casas, Luis MD1; Sood, Vinay DO, FACG2; McPhee, Michael MD3; Nawras, Ali MD, FACG1

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American Journal of Gastroenterology: October 2012 - Volume 107 - Issue - p S42
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Purpose: Ball-valve syndrome (BVS) is a rare condition in which a gastric tumor herniates into duodenum and might cause intermittent and/or partial gastric outlet obstruction. A variant of this condition is retrograde BVS, which is even a rarer entity in which a duodenal polypoid mass prolapses into stomach and might give rise to partial obstruction. Various diverse pathological conditions can give rise to both anterograde and retrograde BVS. Mechanical complications of gastric and duodenal bulb polyps are rare, most frequently reported with inflammatory fibroid polyps. We are presenting 4 cases of BVS (2 anterograde and 2 retrograde). Interestingly, all were pseudotumors (inflamed hyperplastic polyps) involving the stomach and duodenal bulb.

Results: Among the 4 cases that we encountered, there were 3 females and 1 male. Mean age of patients was 73 years (range 65-80). Mean size of the tumors was 35 mm (range 30-44). Most common presenting symptom was overt gastrointestinal bleeding (3 cases) while 1 patient presented with anemia. Three cases were managed endoscopically and one surgically. Resection of the largest endoscopically removed polyp (case 3) was challenging due to size and location of the polyp (in the duodenal bulb). The technique of snare polypectomy was facilitated by pulling the polyp into the stomach with an endo-loop. Using double channel therapeutic gastroscope successful resection of this very large polyp was performed without any complications. Histologically, all our cases were inflamed hyperplastic polyps.

Conclusion: Most of the polyps causing BVS are benign but yet symptomatic due to mechanical complications. Symptomatic patients should be treated either endoscopically or surgically. Although technically challenging in some cases (very large polyps), most of these polyps can be managed safely with endoscopic resection.

[96] Case #4. EGD picture (left) showing duodenal bulb polyp prolapsing into the gastric antrum (retrograde ball-valve syndrome). EUS picture (right) showing heterogenous duodenal bulb polyp.
[96] Four cases of ball-valve syndrome
© The American College of Gastroenterology 2012. All Rights Reserved.