Colonic polyposis

Adrianna D’Mello^a, Ramesh B. Deshpande^b, Devendra Desai^c, Sudeep R. Shah^a

PD Hinduja Hospital, Mumbai, India

Divisions of GI ^aSurgery (Adrianna D’Mello, Sudeep R. Shah); ^bPathology (Ramesh B. Deshpande); ^cMedical GI (Devendra Desai), PD Hinduja Hospital, Mumbai, India

Conflict of Interest: None

Correspondence to: Dr. Sudeep Shah, Divisions of GI Surgery and Pathology, PD Hinduja Hospital, Mumbai 400 016, India, Tel.: +91 9820 087642, e-mail: shahsudeep@hotmail.com

Received 14 June 2013; accepted 21 June 2013

A 30-year-old female, with no significant family history, came with complaints of intermittent, colicky abdominal pain and abdominal distension of 5 months duration, with significant weight loss. CT abdomen showed multiple polypoidal lesions in the colon. Colonoscopy revealed multiple polyps carpeting the entire colon (Fig. 1A); biopsy of which revealed adenomatous polyps. The patient underwent total proctocolectomy with J-pouch ileo-anal anastomosis and ileostomy. Gross examination is depicted in Fig. 1B. Microscopic picture is demonstrated in Fig. 2. Patient is currently doing well on a one-month follow up.

Familial adenomatous polyposis (FAP) is an autosomal dominant, inheritable condition, characterized by over a hundred adenomatous polyps in the large intestine. It is linked to mutations of the adenomatous polyposis coli (APC) gene located on chromosome 5q21. Adenomatous polyps are present in nearly 100% by 40 years of age [1]. The lifetime risk of colorectal malignancy in untreated patients with FAP is near 100% with a median age of 39 years [2].

Surgical options include total abdominal colectomy with ileorectostomy, proctocolectomy with ileal pouch anal reconstruction, and total proctocolectomy with Brooke ileostomy [1-3].

References

1. Beech D, Pontius A, Muni N, Long WP. Familial adenomatous polyposis: a case report and review of the literature. J Natl Med Assoc 2001;93:208-213.

2. Ellis CN. Colonic adenomatous polyposis syndromes: clinical management. Clin Colon Rectal Surg 2008;21:256-262.

3. Al-Sukhni W, Aronson M, Gallinger. Hereditary colorectal cancer syndromes: familial adenomatous polyposis and Lynch syndrome. Surg Clin N Am 2008;88:819-844.