This case has been accepted as a poster presentation at the Korean Society of Coloproctology’s 46th Annual Meeting in Gyeongju, Korea.
Small-bowel tumors, both benign and malignant, are rare lesions that clinicians often do not encounter, accounting for less than 2% of gastrointestinal malignancies. Usually, benign small-bowel tumors, including polyps, are asymptomatic. The diagnosis of small-bowel tumors is difficult because of an often-delayed presentation and nonspecific signs and symptoms. We report an incidentally detected case of a long, pedunculated, large polyp of the terminal ileum, which protruded through the ileocecal valve into the cecum that was removed by colonoscopy in a 41-year-old male with intermittent right-sided lower-abdominal pain. The polyp was resected through snare polypectomy without complications. The histopathology of the resected polyp was confirmed as an ileal hyperplastic polyp. Two years later, there was no recurrence observed via postpolypectomy surveillance colonoscopy.
Small-bowel tumors, including both benign and malignant tumors, are lesions that clinicians often do not encounter. Smallbowel tumors are very rare, accounting for less than 2% of gastrointestinal malignancies [
This study was approved by the electronic Institutional Review Board of the Korea National Institute for Bioethics Policy (P01-201809-21-001) and the need for informed consent was waived.
A 41-year-old male visited our clinic with intermittent right-sided lower-abdominal pain without diarrhea, fever, weight loss, or other general symptoms. His past medical history and family history were unremarkable. His laboratory blood test results including white blood cell count and hemoglobin, platelet, alanine aminotransferase, and aspartate transaminase levels were within normal limits. A viral marker test for hepatitis B and a serologic investigation for an immunocompromised state (i.e., human immunodeficiency virus antibody) yielded negative results. The rapid plasma reagin test for syphilis was nonreactive.
At this point, he underwent a colonoscopy, where 2 small sessile polyps of the sigmoid colon and a long, pedunculated polyp measuring about 2 cm with surface erosion of the terminal ileum protruding through the ileocecal valves into the cecum (
The small bowel accounts for nearly 75% of the length and 90% of the mucosal surface of the gastrointestinal tract; however, smallbowel tumors are rare, accounting for less than 2% of all malignant gastrointestinal tumors [
The incidence of small-bowel tumors is more common in men than in women with a male preponderance ratio of 3:2, and most patients present with these tumors in their sixth to seventh decade of life [
Approximately 40 different histologic types of both benign and malignant small-bowel tumors have been identified [
According to one report, of 23 benign small-bowel tumors, 19 were in the duodenum, 3 were in the ileum, and 1 was in the jejunum; however, only one ileal hyperplastic polyp was observed [
In our case, although it may be a coincidence, the patient’s intermittent right-sided, lower-abdominal pain improved after polypectomy. Our colonoscopic images show that the polyp could not return to the ileum; therefore, we assumed that it would cause intermittent intestinal obstruction or intussusception, leading to abdominal pain. When the patient visited our clinic, there was no abdominal pain and no abnormal findings were noted during the physical examination of the abdomen at the time. The colonoscopy was performed on the patient’s request. Unfortunately, we did not obtain an abdominal radiograph or a computed tomography scan to confirm this assumption before colonoscopy. In the etiology of intussusception, polyps have an important role, acting as a trigger or leading point [
We think that many cases and more research are needed for small-bowel polyps because the 2 terms, small-bowel tumors and small-bowel polyps, have been used interchangeably in various studies, causing confusion.
In general, endoscopic polypectomy for pedunculated tumors and surgical resection for large sessile lesions are appropriate [
In conclusion, small-bowel polyps, especially ileal hyperplastic polyps, are rare. We report an incidentally detected case of a long, pedunculated, large ileal hyperplastic polyp that was removed by endoscopic mucosal resection using colonoscopy in a 41-year-old male with intermittent right-sided lower-abdominal pain.
No potential conflict of interest relevant to this article was reported.
(A, B) A large, pedunculated ileal polyp with erosion was detected in the cecum during colonoscopy. (C, D) Snare polypectomy was performed after the injection of an indigo carmine-epinephrine mixture and a hemoclip was placed at the polyp base.
Histopathologic view of the ileal hyperplastic polyp. (A) The proliferation of multiple glands and dilated glands was observed (H&E stain, ×10). (B) Hyperplastic glands without dysplasia, and inflammatory cell infiltration were observed in the stroma (H&E stain, ×100).
Two years after polypectomy, no recurrence was observed during postpolypectomy surveillance colonoscopy. (A) Cecum, (B) terminal ileum.