A 47-year-old woman with mental retardation followed up 4 years for juvenile gastric polyposis (JGP) was repeatedly admitted for tarry vomiting requiring endoscopic hemostasis. Her mother, followed up 7 years for JGP, died of upper gastrointestinal bleeding from gastric polyps without surgery. Laboratory data showed anemia and hypoproteinemia and endoscopic findings clots of the stomach, bleeding-prone edematous pedunculated polyps of the lesser curvature of the gastric angle, and numerous small polypoid lesions from the gastric body to the pylorus. Given JGP resistance to treatment, laparoscopic total gastrectomy was conducted based on the diagnosis of JGP to reduce the risk of upper gastrointestinal bleeding. Resected specimen showed multiple pedunculated polypoid lesions of the gastric angle and numerous small polypoid lesions from the gastric body to the pylorus. Histological findings showed microcystic dilation of the glands and edematous, widened stroma with inflammatory cell infiltration in polyps, together with hyperplastic epithelium. Postoperatively, laboratory data on anemia and hypoproteinemia showed improvement. Juvenile polyposis (JP) is generally considered benign, but JGP has recently been reported to have malignant potential leading to gastric remnant cancer after distal gastrectomy. This suggests that total gastrectomy is recommended even for polyposis localized in lower gastric lesions.
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