Inflammatory cap polyposis in a 42-year-old male

Cap Polyposis Syndrome Imitating Inflammatory Bowel Disease with Polyps Extending to the Terminal Ileum

Introduction

Cap polyposis syndrome is a rare subtype of mucosal prolapse disease characterized by erythematous, inflammatory colonic polyps covered by a cap of fibrinopurulent mucous. Although a benign condition, patients may present with significant symptoms that can be suggestive of inflammatory bowel disease or colorectal cancer.

Case Presentation

We describe the case of a 34-year-old male who presented with a 5-month history of diarrhea and 40-lb weight loss following hospitalization for enterotoxigenic Escherichia coli colitis. The patient had a past medical history significant for prior colonoscopy revealing hundreds of polyps and a father who died of colorectal cancer at age 45. Multiple repeat infectious stool workups were negative, and antibiotics failed to resolve the patient's symptoms. The patient underwent endoscopy which revealed numerous polyps from the rectum to the terminal ileum that appeared similarly to pseudopolyps giving concern for inflammatory bowel disease. Subsequent histology demonstrated surface erosion and inflammation without dysplasia. Review of endoscopy showed inflammatory polyps with a cap of fibrinopurulent mucous. In the absence of chronic inflammation (C-reactive protein was within normal limits following hospitalization), endoscopic and histologic findings were suggestive of cap polyposis syndrome.

Conclusion

Cap polyposis is diagnosed endoscopically and histologically. While most cases of cap polyposis are confined to the distal colon and rectum, we believe that this is the first case of cap polyposis syndrome extending to the terminal ileum. Treatment of cap polyposis syndrome is dependent on the severity of symptoms.

Inflammatory cap polyp of the sigmoid colon: a case report

BACKGROUND

Inflammatory cap polyp is a very rare benign entity of the distal left colon, characterized by inflammatory polyp with a "cap" of fibrinopurulent exudates. They are usually multiple and commonly present with bleeding per rectum or mucoid discharge. Solitary polyp presenting with intermittent intussusceptions is rare.

CASE PRESENTATION

We report the case of a 45-year-old Nepalese male with a solitary inflammatory sigmoid colon polyp. The patient presented with a 1-month history of rectal bleeding, mucoid discharge, and severe colicky abdominal pain due to intussusceptions. On colonoscopy, there was an exophytic mass with surface exudates. Colonic resection and anastomosis were performed, due to recurring partial intestinal obstruction. At a 6-month follow-up, the patient was asymptomatic.

CONCLUSION

Inflammatory cap polyp is a benign entity, and it should be kept in mind as an important differential diagnosis of exophytic colonic mass with surface exudates.

Successful laparoscopic resection for cap polyposis: case report, literature review

Background

Cap polyposis is a rare gastrointestinal disease with endoscopically and pathologically distinctive features. Its exact etiology has not been fully elucidated. In a few cases, there was recurrence after inadequate treatment. Efficacy of Helicobacter pylori eradication therapy, however, has been shown in some published research.

Case presentation

A 70-year-old female patient developed intermittent mucous diarrhea with loss of body weight and visited a physician. Total colonoscopy showed multiple sessile polyps which were partially coadunated from the rectum to the sigmoid colon. Histopathological finding was tubular adenoma with mild atypia. The patient stayed for observation. Worsening symptoms following protein-losing enteropathy demanded surgical treatment because malignancy could not be ruled out. Laparoscopic resection was performed, and the surgical specimens revealed that the polypoid lesion mainly consisted of mild adenomatous glands which were covered with purulent granulation tissues. We made final diagnosis of cap polyposis and saw rapid improvement of her symptoms. Long-term observation is required after surgery.

Conclusions

We reported a case of successful laparoscopic resection of cap polyposis with protein-losing enteropathy (170 words).

Polypectomy for Recurrent Inflammatory Cap Polyposis Combined with Argon Plasma Coagulation

A 15-year-old adolescent boy presented with chronic constipation, difficulty in defecation, and episodic bloody stools. A rectal mass lesion was digitally palpated. Colonoscopy showed a large circumferential polypoid lesion of the mid-rectum. Snare polypectomy was performed, and histopathology confirmed a diagnosis of benign inflammatory cap polyposis. At 3-month follow-up, sigmoidoscopy showed multiple recurrences of polyps at the site of the previous rectal polypectomy, which were removed by combined hot snare polypectomy and argon plasma coagulation. At 1-year follow-up, the patient was symptom-free and had no more episodes of bloody stool. Follow-up sigmoidoscopy showed a post-polypectomy rectal mucosal scar without recurrent polypoid lesions.

A Case of Cap Polyposis with Epidermal Nevus in an Infant

Cap polyposis is extremely rare in children. We report a case of an 11-month-old male infant who visited our hospital because of rectal prolapse and small amount of hematochezia lasting several days. He also had an epidermal nevus in the sacral area. Colonoscopy showed erythematous, multilobulated, circumferential, polypoid lesions with mucoid discharge from the rectum. He was diagnosed with cap polyposis by endoscopy and histologic examination. He was treated with surgical resection, and was closely followed up. In the relevant literature, there is no report of cap polyposis in an infant. We report the first case of cap polyposis in the youngest infant.