From Chronic Anemia to Total Gastrectomy: A Case Report on a Challenging Form of Ménétrier's Disease.

Ménétrier's disease (MD) is a rare hypertrophic gastropathy marked by enlarged gastric folds, excessive mucus secretion, and protein-losing enteropathy. We present the case of a 25-year-old man initially hospitalized with severe chronic anemia, which revealed a rare and challenging form of MD. The patient reported persistent epigastric pain, vomiting, and recurrent hematemesis. Biological workup showed profound hypoalbuminemia (20 g/L) and microcytic anemia (Hb 5.8 g/dL, ferritin 3 ng/mL). Abdominal CT and upper endoscopy revealed massive polypoid thickening of the gastric fundus with cerebral-like folds and friable polypoid lesions. Histology confirmed foveolar hyperplasia with glandular atrophy, consistent with MD, in the absence of Helicobacter pylori infection. Despite supportive care, the patient experienced recurrent gastrointestinal bleeding and transfusion-dependent anemia, ultimately requiring total gastrectomy. Surgery led to a significant improvement in symptoms and nutritional status. The case report emphasizes the diagnostic complexity and challenges of managing MD, particularly in patients with severe presentations. The successful outcome following total gastrectomy underscores the importance of considering surgical options in selected cases.