S1347 © 2017 by the American College of Gastroenterology The American Journal of GASTROENTEROLOGY Abstracts lymphoid aggregates. No mitoses or necrosis was present. ere was no other histologic evidence of malignancy. e histopathologic features, as well as the immunoperoxidase stains, were consistent with a benign, non-neoplastic tumor-like mass, consistent with a Giant Inflammatory Fibroid Polyp-Tumor Like (Vanek Tumor). Discussion: e present lesion is the largest inflammatory fibroid polyp reported to date. e ileal loca- tion is rare. Even if inflammatory fibroid polyps are benign lesions, surgical treatment is the only option when they present with intestinal intussusception. Preoperative diagnosis of inflammatory fibroid pol- yps is oſten difficult, and confirmation can only be obtained by histological and immunohistochemical examination. 2472 Isolated Collagenous Duodenitis: A Rare Cause of Malabsorption Andrew MacMillan, DO, Gena Han, DO. OhioHealth Riverside Methodist Hospital, Columbus, OH Collagenous gastroenteritides are uncommon disorders with distinct histopathology, characterized by subepithelial collagen deposition. We describe collagenous duodenitis in an adult male with six months of weight loss. Collagenous duodenitis in the absence of collagenous colitis is rare, with less than 120 reported cases, and can lead to malnutrition and death if untreated. A 49 year old Caucasian male with hypertension and history of stage I testicular seminoma presented with a 70lb weight loss over 6 months, and intermittent melena and hematochezia for 2 months. His hemoglobin was 12g/dL with Hct of 36.5; AST was 118 U/L, ALT 27 U/L, and alkaline phosphatase 241 U/L. Prealbumin was 11.9 mg/dL. Exami- nation revealed active bowel sounds but nontender, nondistended abdomen. Stool was heme positive. Computed tomography demonstrated asymmetric nodular thickening of the rectal wall 7cm above the anal verge concerning for possible mass. No adenopathy or retroperitoneal mass was identified. Pan- toprazole twice daily was started. Esophagogastroduodenoscopy found diffuse, moderately scalloped mucosa at the 2 nd and 3 rd portions of the duodenum. Tissue transglutaminase IgA was normal, with ele- vated total serum IgA. Duodenal histopathology revealed a sub-epithelial collagen band 25μm in thick- ness with preserved villous architecture consistent with collagenous duodenitis. Colonoscopy showed sigmoid diverticulosis and colonic polyps, which were resected. Surrounding non-adenomatous tissue showed no features of collagenous colitis. e patient’s hemoglobin remained stable; he was discharged on daily pantoprazole with plans for outpatient follow up. Collagenous duodenitis is oſten described as sharing histopathologic features of collagenous sprue. However, our patient had collagen banding with preserved duodenal villous architecture in the absence of celiac disease. Pathogenesis is thought to be secondary to immune/autoimmune inflammation from unknown luminal antigens, and collagenous duodenitis has been associated with T cell lymphoma. Leſt untreated, patients oſten have progressive malnutrition, which can lead to death. Various therapies have been trialed, including corticosteroids, H2 blockers, PPI therapy, hypoallergenic diets, and tumor necrosis factor inhibitors with varying results. Physicians should consider collagenous gastroenteritides in the differential in a patient presenting with malabsorption. 2473 Lymphoma in the Mist: A “Misty Mesentery” Mystery Sam Davis, DO, Shamyal Khan, DO, John Alvarez, MD, MPH, Jonathan Ramirez, MD. Baylor Scott & White Health, Temple, TX Primary intestinal follicular lymphoma (FL) accounts for less than 1% of gastrointestinal malignan- cies.Nonspecific symptoms such as epigastric pain, anorexia, nausea, and vomiting along with vari- able imaging can make the diagnosis elusive. A 54 year-old Hispanic female with a history of type II diabetes and mild CAD presented with epigastric pain and vomiting. CT abdomen/pelvis at an outside hospital reported retroperitoneal mesenteric lymphadenopathy. Labs and other studies including EGD and KUB were unremarkable. Biopsy was pursued; however her lymphadenopathy was too small for biopsy. Surveillance CT Abdomen/Pelvis noted “stable findings of misty mesentery within the cen- tral midabdomen with multiple associated enlarged mesenteric and periarotic lymph nodes.” Gastric emptying study was normal. CT abdominal angiogram showed no evidence of mesenteric ischemia. Symptoms of brief melena prompted a pill cam revealing strictures in the small bowel with ulcerations transhepatic cholangioscopy with internal and external stent placement with clinical improvement of her coagulopathy and bleeding. Aſter discharge, due to a drop in her hemoglobin without any overt bleeding, EGD was requested by hematology. Due to the patient's age and comorbidiites, however, the test was deferred. VCE was performed with the CapsoCam©. e GIST was visualized with a large ulceration but no active bleeding. Appropriate stent placement was also noted. VCE has become the gold standard for primary SB evaluation. VCE is indicated for the evaluation of obscure GI bleeding, Crohn's disease and evaluation of SB tumors.A new small bowel capsule, capsule, CapsoCam© provides the ability for 360° imaging (panoramic view) with a larger number of images captured per second than standard VCE. is technology allows for better visualization of the duodenum and duodenal papilla making it ideal for diagnosing difficult-to-visualize areas, like the duodenal sweep is case highlights the use of the CapsoCam© capsule for a SLE in a patient with a GIST tumor of the duodenum, a drop in hemeglobin and a potential overt bleed. Due to its ability to provide a 360° view, the capsule enabled us to visualize the second portion of the duodenum, rule out active tumor bleeding and avoid tradi- tional endoscopy in a high-risk patient. Further studies will be needed to determine if the CapsoCam© capsule can consistently provide a reliable alternative to endoscopy for “second-look” evaluation of duodenal lesions. 2471 Small Bowel Intussusception Secondary to Inflammatory Fibroid Polyp of the Ileum Nataliya K. Sostin, MD, Saad Baqai, MD, Amarpreet Bhalla, MD, Jeraldine Orlina, MD, Hani El-Fanek, MD. Danbury Hospital, Danbury, CT Introduction: Inflammatory fibroid polyps (IFP) are rare, benign, tumor-like lesions that can develop anywhere in the gastrointestinal tract. Most frequently, they are localized in the gastric antrum. Ileum is the most common site where these polyps cause small bowel obstruction. Most IFPs are polypoid masses smaller than 5 cm, although sizes up to 20 cm have been reported. Case report: We report a case of a 56-year-old man presented with progressive abdominal pain for 7 days. He denied any nausea and vomiting but did have foul smelling bloody diarrhea. His abdomen was soſt, slightly distended, tympanic to percussion, and tender in leſt lower quadrant. Bowel sounds were hyperactive. CT scan revealed a tubular, elongated, both intraluminal and extraluminal ileal mass caus- ing mild partial obstruction and short segment intussusception. e patient underwent resection; gross examination showed a large solid tan-white elongated mass protruding into the small bowel lumen on one side and pushing the serosal surface on the other side. e large luminal portion of the protruding tumor measured 15.0 x 5.5 x 4.0 cm, and the extraluminal portion measured 5.5 x 4.0 cm. e total length was 20.5 cm. Multiple sections showed a well demarcated, non-encapsulated, polypoid, fibro- histiocytic mass, composed of hypocellular stroma with proliferation of widely spaced bland spindled and stellate-shaped cells emdedded in a collagenous fibromyxoid stroma. e intervening stroma dem- onstrated prominent vascularity, diffuse eosinophils, and few scattered plasma cells with foci of benign [2470C] Capsule endoscopy image GIST. [2473A] CT Abdomen/Pelvis demonstrating mesenteric lymphadenopathy measuring up to 1.1 cm. [2471]