Guduguntla Bhavna A, Yee Jared, Wise Paul E, Bazarbashi Ahmad Najdat
Department of Medicine, Barnes-Jewish Hospital/Washington University in St. Louis, 660 S. Euclid Ave., MSC 8066-22-6602, St. Louis, MO 63110, United States.
Division of General Surgery, Section of Colon and Rectal Surgery, Barnes-Jewish Hospital/Washington University in St. Louis, 4590 Children's Place, Suite 9600, St. Louis, Missouri 63110, United States.
J Surg Case Rep. 2025 Feb 19;2025(2):rjaf068. doi: 10.1093/jscr/rjaf068. eCollection 2025 Feb.
Large rectal adenomatous polyps are not uncommon. Proctectomy sparing interventions are favored when feasible. We present a case of a 62-year-old woman, who presented with diarrhea for several years. Colonoscopy revealed a very large 60 mm rectal polyp, biopsied as tubulovillous adenoma. This was successfully resected using a staged approach with endoscopic mucosal resection and trans-anal endoscopic microsurgery. Endoscopic mucosal resection removed 70% of the lesion with central scarred not amenable to resection but amenable to transanal excision. Pathology demonstrated tubulovillous adenoma with negative margins. Flexible sigmoidoscopy at 6-month follow-up revealed well healed scar without recurrence or residual disease. This demonstrates a staged resection for a large rectal polyp which is minimally invasive and organ preserving.
大的直肠腺瘤性息肉并不少见。可行时，保留直肠切除术的干预措施更受青睐。我们报告一例62岁女性，她有多年腹泻症状。结肠镜检查发现一个非常大的60毫米直肠息肉，活检为管状绒毛状腺瘤。采用内镜黏膜切除术和经肛门内镜显微手术的分期方法成功切除该息肉。内镜黏膜切除术切除了70%的病变，中央瘢痕无法切除但适合经肛门切除。病理显示管状绒毛状腺瘤，切缘阴性。6个月随访时的乙状结肠镜检查显示瘢痕愈合良好，无复发或残留疾病。这证明了一种针对大的直肠息肉的分期切除术，该手术微创且保留器官。
