Coleman Garrett Thomas, Dayah Rawan, Qiu Suimin, Luthra Gurinder
John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, USA.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, USA.
Case Rep Gastroenterol. 2025 May 5;19(1):314-319. doi: 10.1159/000545182. eCollection 2025 Jan-Dec.
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.
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 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.
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.
帽状息肉综合征是黏膜脱垂疾病的一种罕见亚型，其特征为红斑性、炎症性结肠息肉被纤维脓性黏液帽覆盖。尽管是良性疾病，但患者可能出现明显症状，这些症状可能提示炎症性肠病或结直肠癌。
我们描述了一名34岁男性的病例，该患者在因产肠毒素性结肠炎住院后，出现了5个月的腹泻病史和体重减轻40磅的情况。患者既往有结肠镜检查发现数百个息肉的病史，其父亲在45岁时死于结直肠癌。多次重复的感染性粪便检查均为阴性，抗生素治疗未能缓解患者症状。患者接受了内镜检查，发现从直肠到回肠末端有大量息肉，这些息肉看起来类似假息肉，令人担心是炎症性肠病。随后的组织学检查显示表面糜烂和炎症，无发育异常。内镜复查显示炎症性息肉伴有纤维脓性黏液帽。由于不存在慢性炎症（住院后C反应蛋白在正常范围内），内镜和组织学检查结果提示帽状息肉综合征。
帽状息肉综合征通过内镜和组织学检查进行诊断。虽然大多数帽状息肉病例局限于远端结肠和直肠，但我们认为这是首例帽状息肉综合征延伸至回肠末端的病例。帽状息肉综合征的治疗取决于症状的严重程度。
