Cachexia and Invisible Stomach on Endoscopy: An Endoscopist's Enigma and a Surgeon's Axiom.

Area of Science:

• Gastroenterology and Surgical Pathology

Background:

• Gastroduodenal intussusception (GDI) is an exceedingly rare condition in adults, often presenting with nonspecific symptoms like abdominal pain, vomiting, anemia, and cachexia.
• Computed tomography (CT) aids in diagnosis, but endoscopy is crucial for identifying the etiological factor and obtaining tissue diagnosis, frequently revealing a mucosal or submucosal lesion.

Observation:

• This report details a rare GDI case in an adult presenting with cachexia, intermittent vomiting, and anemia.
• A striking endoscopic finding was the complete absence of the stomach, caused by its invagination into the duodenum via the pylorus, originating from a giant gastric hyperplastic polyp.

Findings:

• The patient was diagnosed with GDI through imaging and endoscopic evaluation.
• The endoscopic view revealed an unprecedented scenario: a completely invaginated stomach due to a giant gastric hyperplastic polyp.

Implications:

• This case underscores the importance of considering GDI in adults with relevant symptoms, even with unusual endoscopic presentations.
• Surgical intervention led to positive clinical outcomes, demonstrating its efficacy in managing this rare condition.
• The unique endoscopic finding of a completely absent stomach, without prior surgery, is a novel observation with significant implications for endoscopists' awareness.