Giant pseudopolyposis and antegrade colonic obstruction: report of a case

Obstructing giant post-inflammatory polyposis in ulcerative colitis: Case report and review of the literature

BACKGROUND

Post-inflammatory polyps >15 mm in diameter or length are termed "giant". This benign and rare sequel of ulcerative colitis or colonic Crohn's disease can mimic colorectal carcinoma.

OBJECTIVE

To illustrate this rare complication of inflammatory bowel disease and outline the characteristic radiological, endoscopic and histopathological features, by reviewing all previously published cases of giant post-inflammatory polyps in the English literature.

RESULTS

Reports of 81 giant post-inflammatory polyps in 78 patients were identified by systematic review of the literature. The incidence of giant post-inflammatory polyps is related to the extent of ulcerative colitis (incidence: 0%, 30%, and 70%, in proctitis, left-sided, and extensive disease, respectively). These lesions are typically located in the transverse or descending colon. Giant post-inflammatory polyps are as common in Crohn's disease (n=36) as in ulcerative colitis (n=42, 54%). Clinical presentations varies, including pain (n=29), rectal bleeding (n=20), diarrhoea (n=19), luminal obstruction (n=15), or a palpable mass (n=11). Symptomatic presentation results in surgical resection. Clinical details and outcomes are comprehensively tabulated.

CONCLUSION

Recognition of this rare entity will prevent unnecessary radical surgical resection for presumed carcinoma. It highlights the need for clinical, radiological, endoscopic and histopathological correlation.

Colonoscopic management of polypoid lesions

Virtually all colonic polyps may be removed endoscopically and with great safety provided the endoscopist is experienced with diagnostic colonoscopy as well as electrosurgical principles and hazards. Many polypoid protrusions will not require total removal or even sampling. Those lesions thought to need formal surgical management will require not only adequate tissue sampling but also accurate localization for the surgeon.

Localized giant pseudopolyposis of the colon in ulcerative colitis. Report of a case

Localized giant pseudopolyposis of the colon is a rare complication of both ulcerative colitis and Crohn's disease. It is not regarded as being premalignant, but it may masquerade clinically as a malignancy. This report presents a case and reviews others reported in the literature.

Giant pseudopolyps in granulomatous colitis. Report of a case

A case of giant localized pseudopolyp causing partial large-bowel obstruction and occurring in granulomatous colitis is reported. This represented the first manifestation of the patient's disease. The role of surgery in certain patients is discussed.