Alkhuzaie Abdullah, Jameel Waed, Sultan Noran, Aldosari Mohammed
Department of General Surgery, King Abdulaziz General Hospital, Makkah, Saudi Arabia.
Department of General Surgery, King Abdulaziz General Hospital, Makkah, Saudi Arabia.
Int J Surg Case Rep. 2022 Nov;100:107771. doi: 10.1016/j.ijscr.2022.107771. Epub 2022 Nov 1.
Giant inflammatory polyposis (GIP) is a rare manifestation of inflammatory bowel disease (IBD), and it is described as a worm-like projection of 1.5 cm or more in diameter with unclear pathogenesis. GIP may be related to the severity of IBD. GIP presents with a wide range of symptoms, including crampy abdominal pain, anemia, and intestinal obstruction. The histopathology of GIP is a polyp lined by normal colonic mucosa with superficial ulceration that may show mild crypt distortion.
Our case reports a patient with ulcerative colitis diagnosed via colonoscopy and histopathology 10 months before presenting with severe anemia due to lower gastrointestinal bleeding. Colonoscopy showed GIP obstructing the descending and sigmoid colon, and total colectomy showed the entire colon full of worm-like polyps up to 14 cm the longest polyp.
Giant inflammatory polyposis which is seen in 17 % of UC with active colitis, as seen in our patient, the histopathology component was acute in addition to chronic, which formed within 6 months. According to the data in the literature, the average duration reported for formation since diagnosis with UC is approximately 3 to 276 months. With a length up to 16 cm, the sigmoid colon is the most common site.
Surgical intervention is indicated for filiform polyposis (FP) if it is complicated, such as bleeding or obstruction, which is reported in a few cases. However, there are no clear guidelines for surgical intervention for complicated FP, but the safest method is to tailor the management according to the guidelines for each underlying disease.
巨炎性息肉（GIP）是炎症性肠病（IBD）的一种罕见表现，被描述为直径1.5厘米或更大的蠕虫样突起，其发病机制尚不清楚。GIP可能与IBD的严重程度有关。GIP表现出广泛的症状，包括痉挛性腹痛、贫血和肠梗阻。GIP的组织病理学表现为息肉表面覆盖正常结肠黏膜，伴有浅表溃疡，可能显示轻度隐窝扭曲。
我们的病例报告了一名溃疡性结肠炎患者，在因下消化道出血出现严重贫血前10个月通过结肠镜检查和组织病理学确诊。结肠镜检查显示GIP阻塞降结肠和乙状结肠，全结肠切除术显示整个结肠充满蠕虫样息肉，最长的息肉达14厘米。
如我们的患者所示，在17%的活动性结肠炎的溃疡性结肠炎患者中可见巨炎性息肉，其组织病理学成分除了慢性病变外还有急性病变，在6个月内形成。根据文献数据，自溃疡性结肠炎诊断以来报道的形成平均持续时间约为3至276个月。乙状结肠是最常见的部位，长度可达16厘米。
丝状息肉（FP）如果出现并发症，如出血或梗阻，则需要进行手术干预，少数病例有相关报道。然而，对于复杂FP的手术干预尚无明确指南，但最安全的方法是根据每种基础疾病的指南进行个体化管理。
