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Solitary rectal ulcer transformation to cap polyposis in a 15-year-old child
Abdolreza Emami1, Javad Shokri Shirvani2, Akramasadat Hosseini3
1Student Research Committee, School of Medicine, Babol University of Medical Sciences, Babol, Islamic Republic of Iran.
Insights
Solitary rectal ulcer (SRU) can transform into cap polyposis (CP), a rectal inflammatory condition. This case highlights the importance of serial histologic evaluation in children presenting with rectal bleeding to ensure accurate diagnosis and avoid interventions.
Area of Science:
- Gastroenterology
- Pediatric Gastroenterology
- Colorectal Surgery
Background:
- Cap polyposis (CP) is a rare, benign rectal inflammatory condition with unknown etiology.
- Clinical, endoscopic, and histologic features of CP can mimic inflammatory bowel disease.
- Accurate diagnosis is crucial to prevent unnecessary medical or surgical interventions.
Observation:
- A 15-year-old boy with a history of solitary rectal ulcer (SRU) presented with rectal bleeding, mucoid discharge, and abdominal pain.
- Colonoscopy revealed multiple rectal polyps.
- Histologic examination confirmed the transformation of SRU into CP, characterized by a granulation tissue cap over nondysplastic crypts.
Findings:
- The study presents a pediatric case of solitary rectal ulcer (SRU) progressing to cap polyposis (CP).
- Histologic findings confirmed the characteristic features of CP, including a granulation tissue cap.
- This suggests a potential etiological link between SRU and CP.
Implications:
- The transformation from SRU to CP may represent a distinct pathway in the development of cap polyposis.
- Thorough and serial histologic evaluation is essential for pediatric patients with rectal bleeding.
- Accurate diagnosis prevents misdiagnosis and avoids potentially harmful or unnecessary treatments.
Background:
Cap polyposis (CP) is a benign, non-malignant inflammatory disease that affects the rectum. It usually occurs during the 5th decade of life, but children could also be affected. Its specific pathology is unknown. Due to the clinical, endoscopic, and histologic similarities with other disorders such as inflammatory bowel disease, a thorough histologic evaluation is critical to avoid unnecessary interventions. This study presents a 15-year-old child with a previously reported case of solitary rectal ulcer (SRU) that developed into CP determined by colonoscopy and histologic findings.
Case Presentation:
A 15-year-old boy who was previously diagnosed with SRU presented to our office with rectal bleeding, mucoid discharge, and abdominal pain. Additional colonoscopy evaluation revealed multiple polyposes varying in size and shape limited to the rectum. Histologic examination revealed a characteristic cap of granulation tissue covering tortuous nondysplastic crypts in the inflamed stroma, indicating that SRU had transformed into CP. Based on the assessments, we planned to perform endoscopic mucosal resection of the lesions in multiple sessions.
Conclusions:
Despite the rarity of CP, the transformation from SRU may be one of its etiologies. Thus, thorough serial histologic evaluation is critical in children with rectal bleeding to avoid unnecessary or harmful interventions.
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