Recto-sigmoid polyposis revealing rectal prolapse in two young patients

Mucosal prolapse syndrome mimicking Peutz-Jeghers syndrome in a pediatric patient

Mucosal prolapse syndrome (MPS) is a rare group of benign conditions characterized by a set of unifying histologic findings thought to be the result of repeated mucosal shearing and submucosal vascular congestion caused by straining. This set of conditions is often misdiagnosed as other polyposis syndromes, inflammatory bowel disease, or malignancy due to its clinical presentation, appearance, and rarity. We report a case of a 15-year-old male who presented with painless rectal bleeding. He was found to have four rectal polyps thought to be due to Peutz-Jeghers syndrome. A repeat colonoscopy with biopsies a year later revealed a diagnosis of MPS. Our case highlights the morphologic similarity between hamartomatous polyp and mucosal prolapse histology. Since MPS is a rare diagnosis even among the adult population, it has not been well described in pediatrics. This syndrome should be on the differential diagnosis for pediatric rectal polyps to prevent unnecessary invasive testing and a delay in treatment.

Mucosal prolapse syndrome presenting as rectal polyposis

Mucosal prolapse syndrome comprises a variety of clinical and histopathological entities, with mucosal prolapse as the underlying pathogenic mechanism. Due to variable clinical, endoscopic and histopathological presentation and rareness of symptomatic mucosal prolapse, misdiagnosis resulting in delayed or inappropriate treatment is frequent. This report describes a patient initially diagnosed with a colorectal polyposis syndrome consisting of multiple rectal hyperplastic and adenomatous polyps. But after careful review of medical history and histopathology, the patient was found to have a rare variant of solitary rectal ulcer syndrome presenting as rectal polyposis. The recognition of rectal polyposis as a manifestation of solitary rectal ulcer syndrome/mucosal prolapse syndrome will improve diagnosis and treatment and prevent inappropriate management of this condition.