Polyps in children. Clin Colon Rectal Surg. 2008;21:280-285. [PMID: 20011439 DOI: 10.1055/s-0028-1089943]

Multiplex immunohistochemistry reveals histological features of three different intestinal polyp subtypes in pediatric patients

BACKGROUND

Histologically, our understanding of intestinal polyps remains limited in scope, particularly regarding the diverse subtypes observed in pediatric patients. To enhance our comprehension, three different polyp subtypes including solitary juvenile polyps (SJPs), juvenile polyposis syndrome (JPS)-related polyps, and Peutz‒Jeghers syndrome (PJS)-related polyps were investigated.

METHODS

This study used advanced multiplex immunohistochemistry (mIHC) technology to analyze polyps comprising 4 SJP, 4 JPS and 4 PJS polyps from 12 individual patients who underwent colonoscopies or radical surgical procedures. subtypes.

RESULTS

These mIHC analyses revealed some differences among these polyp subtypes. PJS-related polyps, specifically, displayed epithelial dysplasia with dendritic gland hyperplasia and distinct villous structures adorned with finger-like projections on their surfaces. In contrast, SJP and JPS polyps exhibited cystic glandular dilation, with their surfaces lined with continuous but eroded epithelia. Furthermore, PJS polyps had an abundance of microvessels and thick smooth muscle fibers, whereas SJP and JPS polyps were characterized by lymphoid follicle-like structures.

CONCLUSIONS

These findings not only deepen our structural understanding of various intestinal polyp subtypes but also offer valuable insights that may inform the diagnosis of patients with these conditions.

Endoscopic features of solitary colorectal hamartomatous polyps: Solitary juvenile polyp and Peutz-Jeghers polyp

Background and study aims

The aim of this study was to clarify the endoscopic characteristics of colorectal hamartomatous polyps, including solitary juvenile polyp (JP) and solitary Peutz-Jeghers polyp (PJP).

Patients and methods

We reviewed the clinicopathological and endoscopic findings of 151 colorectal polyps with a diagnosis of solitary JP or solitary PJP. The clinicopathological and endoscopic findings of 119 JPs and 32 PJPs were retrospectively compared.

Results

Endoscopic findings included significantly higher incidences of erosion, whitish exudates, and chicken-skin mucosa in JPs compared with PJPs. A lobular surface was more common in PJPs. Magnified narrow-band imaging endoscopic findings indicated that expanded crypt openings, sparse marginal crypt epithelia, and proliferation of capillary vessels were characteristic of JPs. Branching structures were more prevalent in PJPs. Magnifying chromoendoscopy found a predominance of star-like pit patterns and decreased pit densities in JPs, whereas tubular and branching pit patterns were more frequent in PJPs. Neither type of polyp was found to contain adenomas, dysplasia, or malignant cells. Combinations of specific characteristic endoscopic findings in the JPs and PJPs showed high diagnostic accuracy for those polyps.

Conclusions

Solitary JPs and PJPs in the colorectum manifested characteristic endoscopic findings, and combinations of specific characteristic endoscopic findings may be useful for endoscopic diagnosis of solitary JPs and PJPs.

A Rare Case of Pedunculated, Prolapsed Juvenile Rectal Polyp in a Pediatric Patient

The prolapse of a pedunculated juvenile rectal polyp is a rare event. It occurs when the polyp protrudes through the anus and appears as a fleshy mass at the anus, leading to an alarming scenario for both the parent and patient and typically prompting a visit to the emergency department (ED). We report a case of a five-year-old male patient who presented to the ED with a prolapsed rectal mass. A careful examination revealed it to be a pedunculated prolapsed polyp through the anus. The polyp was excised in the ED without complication, and the patient was discharged home with follow-up appointments with both pediatric surgery and gastroenterology for colonoscopy. The pathology report later confirmed the diagnosis of the juvenile polyp. We present this case to raise awareness about the various presentations of juvenile polyps and to familiarize clinicians with this diagnosis.

Novel classification of gastric polyps: The good, the bad and the ugly

Gastric polyps (GPs) are increasingly common. On upper endoscopy, they should be examined with white light and occasionally chromoendoscopy, and their morphology classified according to the Paris classification. Most GPs have a typical endoscopic appearance and can be associated with diseases like Helicobacter pylori infection. Histological examination is necessary for an accurate diagnosis. While most polyps are non-neoplastic and do not require treatment, some carry a risk of malignancy or are already malignant. Therefore, understanding the diagnosis, classification, and management of GPs is crucial for patient prognostication. Our new classification categorizes GPs into "good", "bad", and "ugly" based on their likelihood of becoming malignant. We aim to provide descriptions of the endoscopic appearance, pathology, treatment, and follow-up for different GPs, as well as clinical management flowcharts.

Successful detection and removal of predictable juvenile polyp: a case report

Juvenile polyp makes up 70% to 80% of pediatric colon polyp, and the average age of diagnosis is 2 to 5 years. The treatment of juvenile polyp in children is polypectomy through colonoscopy. The fact that the lumen of intestine is much smaller than that of adults and the need to perform polypectomy is a heavy burden on the endoscopists. Recently, fecal calprotectin (FC) has been found to be related to juvenile polyp. A previously healthy 34-month-old female patient presented to the pediatric gastroenterology department with intermittent bloody stools that were progressively worsening. FC level was abnormally elevated at 2,719 µg/g (normal, < 50 µg/g). The polyp was successfully removed with a endoscopic polypectomy. This is the first case in Korea to show that FC can be used to screen juvenile polyp in children. Caution must be taken that FC levels can increase with inflammation, regardless of the number or size of the polyps.

Solitary juvenile polyp of the rectum with intramucosal adenocarcinoma

We describe a case of solitary juvenile polyp of the rectum with intramucosal adenocarcinoma. A 55-year-old man presented to our hospital for evaluation after a positive fecal occult blood test. Colonoscopy revealed a pedunculated polyp of 25 mm in size which has an irregular shape and pale red color on the rectum. The polyp had a proliferation of blood vessels and an invisible surface pattern. Endoscopic mucosal resection was performed. Pathologically, it was diagnosed as a solitary juvenile polyp with intramucosal well-differentiated adenocarcinoma. When we encounter juvenile polyps, the possibility of malignancy should be taken into consideration for treatment.

Juvenile polyposis diagnosed with an integrated histological, immunohistochemical and molecular approach identifying new SMAD4 pathogenic variants

Juvenile polyposis (JP) is a rare familial syndrome characterized by the development of numerous hamartomatous polyps of the gastrointestinal tract and by an increased risk of developing gastrointestinal cancers. It follows a pattern of autosomal dominant inheritance and is associated with germline variants of SMAD4 or BMPR1A genes. Differential diagnosis may be difficult based on histology alone, due to morphological similarities to other familial syndromes. Here we report a case of familial JP diagnosed in a 50-years woman with a familial history positive for gastrointestinal cancers and other tumor types. The patient presented with severe iron deficiency anemia and showed numerous polyps in the stomach and jejunum according to endoscopy and imaging. She underwent an intra-gastric laparoscopic removal of the major gastric polyp, followed by jejunal exploration and resection of a segment with multiple neoformations. Histological examination revealed the presence of hamartomatous polyposis. Gastric and intestinal samples were analyzed with next-generation sequencing. Molecular analysis showed that the patient harbored a germline splicing site variant of SMAD4, c.1139 + 3A > G, which was complemented by different somatic variants of the same gene in the different polyps. Immunohistochemistry for SMAD4 confirmed loss of protein expression in the polyps, with regular expression in normal cells. cDNA sequencing further confirmed the findings. We thus definitively diagnosed the woman as having JP thanks to an integrated approach based on histology, immunohistochemistry and molecular analysis. The identified variants, all previously reported as variants of unknown significance, were classified as pathogenic as they complemented each other leading to SMAD4 loss.

Bleeding per rectum in pediatric population: A pictorial review

Bleeding per rectum in children can be seen in congenital as well as acquired conditions that may require medical or surgical management. The present review article is aimed to discuss the imaging findings of some common and uncommon causes of bleeding per rectum in children.

Bleeding per rectum in pediatric population: A pictorial review

Bleeding per rectum in children can be seen in congenital as well as acquired conditions that may require medical or surgical management. The present review article is aimed to discuss the imaging findings of some common and uncommon causes of bleeding per rectum in children.

Case Series: Development of Polyps as a Late Effect After Total Body Irradiation-based Hematopoietic Cell Transplantation in Children With High-risk Leukemia

Advancements in hematopoietic cell transplantation (HCT) have led to increased survivorship rates in many childhood diseases. However, this growing group of long-term survivors face a myriad of late effects. There are currently limited guidelines for surveillance of gastrointestinal polyps for pediatric transplant patients. Here we describe 5 patients undergoing HCT with total body irradiation-based conditioning regimens for leukemia who developed symptomatic polyps a median of 4.5 (range: 0.75 to 5.75) years after HCT. Because of limited surveillance guidelines in children, we conclude that the development of new or progressive symptoms related to the gastrointestinal tract deserves prompt recognition and evaluation.

Meaningful relationships as a driving force in the experience of parents of a child living with polyposis conditions

While much research has been conducted on the experiences of individuals with inflammatory bowel diseases, there remains a dearth of research conducted on those affected by polyposis conditions. As a result, little is known about the lived experiences of those with polyposis conditions, especially in the cases of parents of pediatric patients with these conditions. Using a hermeneutical phenomenological qualitative research approach, this study sought to explore the lived experiences of parents of children with polyposis conditions, with specific attention paid to the processes in which parents engage in order to adapt to their realities. In total, three major themes were revealed from the experiences of seven participants. Parents discussed the importance of building collaborative relationships with family physicians, building reassuring relationships with other parents, and building educative relationships with their child. These findings demonstrate the need for family-centered care practices by physicians, and role of relevant relationships as a driving force in helping parents in the management of their child's illness.

Juvenile Retention Polyp in a Teenager

The proper management of a prolapsed rectal mass in a child or teenager is challenging. Given that the underlying etiology of a prolapsed rectal mass in this population is not always immediately clear, interdisciplinary assessment is often required. Juvenile polyps, more commonly presenting with bleeding than a prolapsed mass, can mimic the appearance of both hemorrhoids and the rectum itself - making a purely clinical diagnosis difficult. Presented here is a case of a prolapsed colorectal polyp in a teenage boy, who underwent manual reduction of the mass, followed by colonoscopy and endoscopic ligation. Further histological evaluation revealed it to be a juvenile retention polyp. Despite the rarity of polyp prolapse as a presenting symptom, this case underscores the importance of considering colonic polyps as the etiology of a prolapsed anorectal mass in a teenager.

The management of colonic polyps in children: a 13-year retrospective study

The aim of this study was to describe the frequency, major symptoms, and characteristics of colonic polyps in a cohort of children. A retrospective chart review of patients aged ≤ 18 years who were diagnosed with colonic polyp(s) from 2006 to 2019 in a tertiary hospital was included. Data collected included demographics, clinical presentation, interval of time between the onset of symptoms and the endoscopic diagnosis of colonic polyps, family history, characteristics of the polyp, and associated lesions. Over the study period, 35 Caucasian children were diagnosed with juvenile colonic polyps. Twenty-three patients (65.7%) were males. Lower gastrointestinal bleeding of a mean duration of 5.3 ± 4.9 months was the presenting symptom in nearly all cases (n = 34, 97%), and it was isolated in 17 patients. Clinical presentation did not significantly vary according to the age or the location or size of the polyp (p = 0.262, p = 1.000, and p = 0.149, respectively). The polyps were mainly located in the left colon (n = 29, 83%). Right colonic polyps were significantly larger than left colonic polyps (p = 0.037).Conclusion: Lower gastrointestinal bleeding represents the most common presentation of colonic polyps in children. Right-sided colonic polyps occur and may be even larger than left-sided ones. A total colonoscopy is therefore mandatory for all cases of suspected colonic polyps. This study represents a real-life contribution, and it can help improve the management strategies of this condition in childhood. What is Known: • Colonic polyps are quite common in children. • The majority of pediatric colonic polyps are solitary, benign, and located in the left colon. What is New: • Right-sided colonic polyps occur and may be even larger than left-sided ones. • A total colonoscopy is mandatory for all cases of suspected colonic polyps.

Faecal calprotectin and ultrasonography as non-invasive screening tools for detecting colorectal polyps in children with sporadic rectal bleeding: a prospective study

BACKGROUND

Colorectal polyps are reported in 6,1% of paediatric colonoscopies and in 12% of those performed for lower gastrointestinal bleeding. Although colonoscopy is widely used in paediatric patients, it requires bowel preparation and general anaesthesia or deep sedation, and in rare cases, it can cause complications. Non-invasive screening techniques able to predict polyps in children with isolated and sporadic rectal bleeding may play a key role in the selection of patients needing colonoscopy.

METHODS

We enrolled all children undergoing colonoscopy for isolated and sporadic rectal bleeding to determine the diagnostic accuracy of faecal calprotectin, ultrasonography (US) and digital rectal examination as diagnostic methods for screening colorectal polyps.

RESULTS

A total of 26 of 59 enrolled patients (44.1%) had colonic polyps, one patient had multiple polyps, and 23% of children had polyps proximal to the splenic flexure. The diagnostic accuracy of faecal calprotectin for detecting colorectal polyps was 96.6%, with a sensitivity of 100%. False-positive faecal calprotectin was shown in 2 patients with non-steroidal anti-inflammatory drug-related lesions. The diagnostic accuracy of ultrasound was 77.9%. Polyps not seen with ultrasound tended to be relatively smaller (1.5 vs 2.3, p = 0.001) and located in the rectum. The combined use of FC, US and digital rectal examination obtained a specificity and PPV of 100%.

CONCLUSIONS

FC combined with US and digital rectal examination is a good and promising non-invasive screening test for detecting colorectal polyps in children with isolated and sporadic rectal bleeding.

The pediatric gastrointestinal tract: ultrasound findings in acute diseases

The study of the gastrointestinal tract by imaging, particularly using ultrasound, is a required instrument for diagnosis of acute and chronic gastrointestinal pathologies in pediatric age. Actually, ultrasound plays an increasing role in the evaluation of gastrointestinal tract in neonatal and pediatric patients because of their small body habitus and the presence of less fat tissue in the abdominal wall and peritoneal cavity. Ultrasound has certain advantages, thanks to the new wide-spectrum frequency probes able to assess a detailed study of the morphological aspects and functional characteristics of bowel loops, adding a new dimension to the imaging of this body system. In this paper, we review anatomy, ultrasound technique and sonographic findings of bowel pathology frequently encountered in neonatal and pediatric emergency setting.

Chromoendoscopy Plus Mucosal Resection Versus Conventional Electrocoagulation for Intestinal Polyps in Children: Two Case Series

BACKGROUND

Conventional high-frequency electrocoagulation (HFEC) of intestinal polyps may be difficult in children and endoscopic mucosal resection (EMR) could be a less invasive option. Chromoendoscopy improves tissue localization during endoscopy, but its exact influence on the outcomes of children with intestinal lesions is still unknown.

AIMS

To analyze a series of children treated with EMR or HFEC and assess the value of chromoendoscopy.

METHODS

This was a retrospective analysis of two case series of patients treated at the Gastroenterology Department of the Guiyang Children's Hospital between February 2014 and November 2016. The children underwent EMR (n = 34) or conventional HFEC (n = 120). Demographic, clinical, and perioperative data were analyzed.

RESULTS

The polyps were larger in the HFEC group [median, 3.9 (0.1-27.0) versus 1.3 (0.03-64.0) mm, P = .03]. There was a higher frequency of multiple polyps in the EMR group (50.0% versus 15.1%, P < .001). Operation time and intraoperative bleeding were similar between the two groups (both P > .05). Hospital stay was longer with EMR than with HFEC [median, 5 (3-12) versus 4 (2-14) days, P = .02]. There was no intestinal perforation in either group. Postoperative bleeding amount was similar in both groups (P = .73). In the EMR group, 19 patients were operated using chromoendoscopy, whereas only 2 patients in the HFEC group were operated.

CONCLUSION

EMR could be appropriate for the treatment of intestinal polyps in children.

Solitary Peutz-Jeghers Polyp of Jejunum: A Rare Cause of Childhood Intussusception

An extremely rare case of solitary jejunal Peutz–Jeghers polyp causing intussusception in an 8-year-old boy is reported. The polyp was excised by laparoscopic-assisted surgery. This appears to be only the fourth and the youngest patient with such a polyp reported in the indexed English language literature.

Polyp Genetics

The genetic events involved in the transformation of normal colonic epithelium to neoplastic polyps to invasive carcinoma, as initially proposed by Fearon and Vogelstein, form the foundation of our understanding of colorectal cancer. The identification of the polyp as the precursor lesion to colorectal cancer is the basis of many of our current practices for screening, surveillance, and prevention. The last three decades have seen a veritable explosion in our understanding of the molecular events involved in the pathogenesis of colorectal cancer. It is now clear that there are multiple genetic pathways in the polyp to carcinoma sequence. Some polyps previously thought to be nonneoplastic have now been shown to have malignant potential. Finally, increased understanding of the sequence of genetic events has led to the development of targeted therapeutics. The clinical translation of these scientific advances has made a significant impact on the management of patients with colorectal cancer. Accordingly, it is imperative that all clinicians caring for these patients have an understanding of the genetics of colorectal polyps and cancer. In this article, we review the etiology and genetic pathways to carcinoma associated with a range of polyps of the colon and rectum.

Smith-Kingsmore syndrome: A third family with the MTOR mutation c.5395G>A p.(Glu1799Lys) and evidence for paternal gonadal mosaicism

Heterozygous germline mutations in MTOR have been shown to underlie Smith-Kingsmore syndrome, a rare autosomal dominant syndrome characterized by macrocephaly, developmental delay, and dysmorphic facial features. Recently, two unrelated families with the MTOR mutation, c.5395G>A p.(Glu1799Lys), were reported. Here, we describe siblings from a non-consanguineous German family in whom we identified the same heterozygous missense mutation in MTOR. Remarkably, in all reported families with Smith-Kingsmore syndrome and the MTOR c.5395G>A mutation, including the family described herein, healthy parents of recurrently affected children do not have detectable levels of the mutation in tested tissues, lending credence to gonadal mosaicism as the underlying mechanism. Furthermore, the glutamic acid at position 1799 was shown to present a recurrent somatic mutation site in several cancers, including colon cancer, pointing to a somatic mutational hotspot in MTOR. Importantly, we highlight the occurrence of multiple intestinal polyps in the older sibling. Further patients are required to establish definitively whether polyp formation forms part of the SKS clinical spectrum. © 2016 Wiley Periodicals, Inc.

Gastric Hamartomatous Polyps-Review and Update

Gastric polyps are frequently encountered on endoscopic examinations. While many of these represent true epithelial lesions, some of the polyps may result from underlying stromal or lymphoid proliferations or even heterotopic tissue. Histologic examination is essential for accurate typing of the polyps to predict malignant potential and underlying possible genetic abnormalities. The focus of this review is on gastric hamartomatous polyps, which are relatively rare and diagnostically challenging. Though most of the gastric hamartomatous polyps are benign, certain types are associated with increased malignant potential. These include certain polyps associated with specific genetic familial polyposis syndromes and gastric inverted hamartomatous polyps. Identification of these polyps can result in the prevention or early diagnosis of gastric carcinoma and also help in the identification of family members with polyposis syndromes. The aim of this review is to categorize gastric hamartomatous polyps and aid in the identification of high-risk categories.

Clinical features, endoscopic polypectomy and STK11 gene mutation in a nine-month-old Peutz-Jeghers syndrome Chinese infant

AIM

To investigate multiple polyps in a Chinese Peutz-Jeghers syndrome (PJS) infant.

METHODS

A nine-month-old PJS infant was admitted to our hospital for recurrent prolapsed rectal polyps for one month. The clinical characteristics, a colonoscopic image, the pathological characteristics of the polyps and X-ray images of the intestinal perforation were obtained. Serine threonine-protein kinase 11 (STK11) gene analysis was also performed using a DNA sample from this infant.

RESULTS

Here we describe the youngest known Chinese infant with PJS. Five polyps, including a giant polyp of approximately 4 cm × 2 cm in size, were removed from the infant's intestine. Laparotomy was performed to repair a perforation caused by pneumoperitoneum. The pathological results showed that this child had PJS. Molecular analysis of the STK11 gene further revealed a novel frameshift mutation (c.64_65het_delAT) in exon 1 in this PJS infant.

CONCLUSION

The appropriate treatment method for multiple polyps in an infant must be carefully considered. Our results also show that the STK11 gene mutation is the primary cause of PJS.

Value of Fecal Calprotectin as a Biomarker for Juvenile Polyps in Children Investigated With Colonoscopy

OBJECTIVES

The clinical presentation of colonic juvenile polyps with abdominal discomfort and occult rectal bleedings make them difficult to recognize. The aim of this study was to report the clinical features of colonic juvenile polyps in children referred to colonoscopy and evaluate fecal calprotectin (FCP) as a screening biomarker for their diagnosis.

METHODS

The study included a total of 266 children (range 3.1-19.0 years, median age 15.8 years) investigated with ileocolonoscopy; of whom, 239 (89%) were investigated for inflammatory bowel disease (IBD). FCPs were analyzed as a marker of colonic inflammation, and levels < 50 mg/kg was considered to be negative.

RESULTS

Juvenile polyps were detected in 12 (4.5%) children; the remaining 67 (25.2%) had Crohn disease, 57 (21.4%) ulcerative colitis, 5 (1.9%) unclassified IBD, 4 (1.5%) allergic colitis, bleeding source was localized in 6 (2.3%), and 115 (43.2%) had unspecific or normal findings. FCP was available in 203 (76.3%) children before colonoscopy; levels of FCP were higher in children with juvenile polyps (range 28-2287 mg/kg, median 844 mg/kg) compared with those with normal colonoscopies (range < 20-2443 mg/kg, median 130 mg/kg, P < 0.0001), but not compared with those with active IBD (range < 20-7780 mg/kg, median 962 mg/kg, P = 0.6299). FCPs were available in 9 of 12 children after polypectomy, of whom all had their FCP levels significantly reduced (range 0-281 mg/kg, median 49 mg/kg, P <  .0001).

CONCLUSIONS

Colonic juvenile polyps are frequently found in pediatric patients presenting with hematochezia and elevated FCP levels. Colonic juvenile polyps are difficult to differentiate from pediatric IBD without a colonoscopy.

Laparoscopic-assisted resection of jejunojejunal intussusception caused by a juvenile polyp in an adult

Most bowel intussusceptions in adults have a leading point. However, there have been few reports of jejunojejunal intussusception secondary to a solitary juvenile polyp in adult. We report herein the case of a 19-year-old female with a solitary juvenile polyp in the jejunum causing intussusception. Laparoscopic-assisted reduction and segmental resection of the jejunum were successfully done for the patient.

Significance of expression of E-cadherin and β-catenin in juvenile colorectal polyps in children

AIM: To detect the expression of E-cadherin and β-catenin mRNAs and proteins in human colorectal juvenile polyps (JP) in children.

METHODS: The expression of E-cadherin and β-catenin mRNAs and proteins in 22 juvenile colorectal polyp specimens and 8 normal colorectal specimens was assayed by real-time PCR and Western blot, respectively. Immunohistochemistry was used to determine the expression and localization of E-cadherin and β-catenin in 30 juvenile colorectal polyp specimens and 10 normal colorectal specimens.

RESULTS: Real-time PCR and Western blot analyses showed that the expression levels of E-cadherin mRNA and protein were significantly lower in juvenile colorectal polyps than in normal colorectal specimens (1.1526 ± 0.3801 vs 0.4094 ± 0.2305, P < 0.05; 0.6028 ± 0.1778 vs 0.3257 ± 0.1168, P < 0.05). Although there was no significant difference in the expression level of β-catenin mRNA between the two groups, the expression of β-catenin was significantly higher in juvenile colorectal polyps than in normal colorectal specimens (0.8010 ± 0.1380 vs 1.2064 ± 0.3587, P < 0.05). Immunohistochemistry indicates that E-cadherin expression was down-regulated in juvenile polyps compared with controls (102.5155 ± 25.2988 vs 53.5772 ± 15.3205, P < 0.05). Positive staining for E-cadherin was predominantly localized on the epithelial cell membrane. The expression of β-catenin was increased in juvenile polyp specimens (112.0805 ± 24 9572 vs 260.3554 ± 86.6987, P < 0.05), and the positive rates of membrane, cytoplasmic and nuclear staining in juvenile polyp tissue was significantly higher than those in normal control tissues.

CONCLUSION: Dysregulation of E-cadherin and β-catenin expression may be an important feature of juvenile colorectal polyps.

Laparoscopic-assisted resection of juvenile polyp of the jejunum in a 3-year-old girl

Sporadic juvenile polyp of the jejunum is exceedingly rare, reported only once in the English literature. We describe a 3-year-old girl with a long-lasting history of chronic iron deficiency anemia and a delayed diagnosis of jejunal polyp. The lesion was eventually discovered by ultrasonography and successfully resected using a laparoscopic-assisted transumbilical approach.