Clinical Presentation

An 18-year-old man presents to the gastroenterology clinic with a history of chronic postprandial nausea, intermittent abdominal pain, and vomiting.

(A) Barium study shows multiple, multilobulated, polypoid filling defects (arrows) in the first and second portions of the duodenum. (B) Contrast-enhanced computed tomography (CT) shows expansion of the duodenum (arrows) with soft- tissue masses. (C) More caudal image shows marked soft tissue (arrows) obliterating the duodenal lumen.

Differential Diagnosis

• Peutz-Jeghers syndrome (PJS; hamartomas): This is the most likely diagnosis, given the multiple soft-tissue masses filling the duodenum.

• Familial adenomatous polyposis (adenomas): This is a second choice that also may involve the stomach, small bowel, and colon.

• Juvenile polyposis (hamartomas): This can occur in the stomach, small bowel, and colon.

Essential Facts