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Diffuse filiform polyposis of the small intestine without inflammatory bowel disease.

Jiang JW, Wang GY, Zhu YP, Chen RB, Zhang ZQ, Zhang YJ - World J Surg Oncol (2014)

Bottom Line: Two days later, the patient was noted to have melena again, and we performed an abdominal angiographic embolization, successfully stopping the bleeding.Histologic evaluation of the excised specimen revealed chronic inflammatory cells within the lamina propria without hyperplastic or adenomatous epithelial changes.Although the surgery was very successful, careful management of the patient was required, owing to the great risk of re-bleeding.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, East Qingchun Road, Hangzhou 310016, Zhejiang Province, China. zjuzycx@gmail.com.

ABSTRACT
Filiform polyposis is a rare disease, which typically occurs in patients with inflammatory bowel disease. We report a case of filiform polyposis occurring in a 56-year-old man with no history or evidence of inflammatory bowel disease. The patient's main symptoms were melena and anemia. We performed an emergency exploratory laparotomy, in which we observed worm-like polyps spread almost along the entire small intestine, and a partial resection of the small intestine to treat bleeding in the bowel was carried out. Two days later, the patient was noted to have melena again, and we performed an abdominal angiographic embolization, successfully stopping the bleeding. Histologic evaluation of the excised specimen revealed chronic inflammatory cells within the lamina propria without hyperplastic or adenomatous epithelial changes. Although the surgery was very successful, careful management of the patient was required, owing to the great risk of re-bleeding.

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Abdominal contrast-enhanced computed tomography and digital subtraction angiography of superior mesenteric artery of the patient. (A) Abdominal contrast-enhanced computed tomography demonstrated a round abnormal enhancement (arrow) in the small intestinal lumen within the left upper quadrant. (B) Digital subtraction angiography of superior mesenteric artery demonstrated a rim-like staining (arrow) in the left upper quadrant. (C) A microcatheter was inserted into the feeding artery (arrow head); rim-like staining (arrow) was revealed after contrast medium injected in the microcatheter. (D) Digital subtraction angiography of the superior mesenteric artery demonstrated no contrast medium extravasation when the blood pressure was 90/70 mmHg. (E) Digital subtraction angiography of the superior mesenteric artery demonstrated contrast medium extravasated into the intestinal tract (arrow) when the blood pressure was raised to 120/80 mmHg. (F) Digital subtraction angiography of the superior mesenteric artery demonstrated no contrast medium extravasation after injection of 5 ml suspension of gelatin sponge particles (500 μm) and contrast medium.
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Fig1: Abdominal contrast-enhanced computed tomography and digital subtraction angiography of superior mesenteric artery of the patient. (A) Abdominal contrast-enhanced computed tomography demonstrated a round abnormal enhancement (arrow) in the small intestinal lumen within the left upper quadrant. (B) Digital subtraction angiography of superior mesenteric artery demonstrated a rim-like staining (arrow) in the left upper quadrant. (C) A microcatheter was inserted into the feeding artery (arrow head); rim-like staining (arrow) was revealed after contrast medium injected in the microcatheter. (D) Digital subtraction angiography of the superior mesenteric artery demonstrated no contrast medium extravasation when the blood pressure was 90/70 mmHg. (E) Digital subtraction angiography of the superior mesenteric artery demonstrated contrast medium extravasated into the intestinal tract (arrow) when the blood pressure was raised to 120/80 mmHg. (F) Digital subtraction angiography of the superior mesenteric artery demonstrated no contrast medium extravasation after injection of 5 ml suspension of gelatin sponge particles (500 μm) and contrast medium.

Mentions: A 56-year-old man initially presented at our hospital complaining of having had melena for half a month. He did not have any personal or family history of bowel polyps, bowel cancer, or inflammatory bowel disease. He denied having chills, fever, nausea, vomiting, diarrhea, or abdominal pain. The flaring-up of melena was sudden and the patient was admitted, owing to tarry stools and melena. Results of a physical examination were unremarkable apart from an anemic appearance. A complete blood count test revealed anemia (hemoglobin level 4.8 g/dl) and the prothrombin time was 15.6 s (normal range, 11.5 to 14.5 s). Liver function, kidney function, and inflammatory indexes were noted to be normal. Abdominal contrast-enhanced computed tomography demonstrated a round abnormal enhancement in the lumen of the small intestine lumen in the left upper quadrant (Figure 1A), at about the level of L3, raising suspicion of tumors or vascular lesions. Computed tomography also demonstrated a hematocele in the small intestine and colon (especially in the ileocecum). Digital subtraction angiography revealed contrast agent staining in the left upper quadrant (Figure 1B) and a microcatheter was placed in the feeding artery (Figure 1C). Gastroscopy indicated multiple duodenal polyps. Colonoscopy was unsuccessful, owing to the presence of a hematocele. Subsequently, the patient underwent a partial resection of the small intestine. Worm-shaped polyps and small hematomas were noted; these were spread along almost the entire small intestine, and they could not be completely resected. To identify the bleeding section of the bowel, we injected methylene blue into the indwelling catheter, staining an approximately 30 cm section of jejunum. The stained section was subsequently resected. Grossly, the resected specimen revealed multiple worm-like polyps, which ranged in size from 0.2 cm to 0.5 cm; two 2-cm-diameter hematomas were also noted (Figure 2). The round, abnormal enhancement demonstrated on computed tomography was considered to be a hematoma. Histologically, the polyps consisted of normal mucosa characterized by nonspecific inflammatory changes (Figure 3). Two days after the surgery, the patient had melena again. We subsequently performed an abdominal angiographic embolization. Throughout the course of this procedure, no bleeding points were noted. There was no contrast medium extravasation when the blood pressure was 90/70 mmHg (Figure 1D). We raised the blood pressure, and digital subtraction angiography demonstrated contrast medium extravasated to the intestinal tract (Figure 1E). A 5 ml suspension of gelatin sponge particles was injected and successfully stopped the bleeding (Figure 1F). The patient was informed that he had a high risk of re-bleeding owing to polyps and careful management was required. After the operation, the patient recovered smoothly, the patient’s hemoglobin level increased to 10.7 g/dl and the patient was discharged from the hospital. No recurrent melena or bleeding was reported at the last follow-up in January 2014.Figure 1


Diffuse filiform polyposis of the small intestine without inflammatory bowel disease.

Jiang JW, Wang GY, Zhu YP, Chen RB, Zhang ZQ, Zhang YJ - World J Surg Oncol (2014)

Abdominal contrast-enhanced computed tomography and digital subtraction angiography of superior mesenteric artery of the patient. (A) Abdominal contrast-enhanced computed tomography demonstrated a round abnormal enhancement (arrow) in the small intestinal lumen within the left upper quadrant. (B) Digital subtraction angiography of superior mesenteric artery demonstrated a rim-like staining (arrow) in the left upper quadrant. (C) A microcatheter was inserted into the feeding artery (arrow head); rim-like staining (arrow) was revealed after contrast medium injected in the microcatheter. (D) Digital subtraction angiography of the superior mesenteric artery demonstrated no contrast medium extravasation when the blood pressure was 90/70 mmHg. (E) Digital subtraction angiography of the superior mesenteric artery demonstrated contrast medium extravasated into the intestinal tract (arrow) when the blood pressure was raised to 120/80 mmHg. (F) Digital subtraction angiography of the superior mesenteric artery demonstrated no contrast medium extravasation after injection of 5 ml suspension of gelatin sponge particles (500 μm) and contrast medium.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4364679&req=5

Fig1: Abdominal contrast-enhanced computed tomography and digital subtraction angiography of superior mesenteric artery of the patient. (A) Abdominal contrast-enhanced computed tomography demonstrated a round abnormal enhancement (arrow) in the small intestinal lumen within the left upper quadrant. (B) Digital subtraction angiography of superior mesenteric artery demonstrated a rim-like staining (arrow) in the left upper quadrant. (C) A microcatheter was inserted into the feeding artery (arrow head); rim-like staining (arrow) was revealed after contrast medium injected in the microcatheter. (D) Digital subtraction angiography of the superior mesenteric artery demonstrated no contrast medium extravasation when the blood pressure was 90/70 mmHg. (E) Digital subtraction angiography of the superior mesenteric artery demonstrated contrast medium extravasated into the intestinal tract (arrow) when the blood pressure was raised to 120/80 mmHg. (F) Digital subtraction angiography of the superior mesenteric artery demonstrated no contrast medium extravasation after injection of 5 ml suspension of gelatin sponge particles (500 μm) and contrast medium.
Mentions: A 56-year-old man initially presented at our hospital complaining of having had melena for half a month. He did not have any personal or family history of bowel polyps, bowel cancer, or inflammatory bowel disease. He denied having chills, fever, nausea, vomiting, diarrhea, or abdominal pain. The flaring-up of melena was sudden and the patient was admitted, owing to tarry stools and melena. Results of a physical examination were unremarkable apart from an anemic appearance. A complete blood count test revealed anemia (hemoglobin level 4.8 g/dl) and the prothrombin time was 15.6 s (normal range, 11.5 to 14.5 s). Liver function, kidney function, and inflammatory indexes were noted to be normal. Abdominal contrast-enhanced computed tomography demonstrated a round abnormal enhancement in the lumen of the small intestine lumen in the left upper quadrant (Figure 1A), at about the level of L3, raising suspicion of tumors or vascular lesions. Computed tomography also demonstrated a hematocele in the small intestine and colon (especially in the ileocecum). Digital subtraction angiography revealed contrast agent staining in the left upper quadrant (Figure 1B) and a microcatheter was placed in the feeding artery (Figure 1C). Gastroscopy indicated multiple duodenal polyps. Colonoscopy was unsuccessful, owing to the presence of a hematocele. Subsequently, the patient underwent a partial resection of the small intestine. Worm-shaped polyps and small hematomas were noted; these were spread along almost the entire small intestine, and they could not be completely resected. To identify the bleeding section of the bowel, we injected methylene blue into the indwelling catheter, staining an approximately 30 cm section of jejunum. The stained section was subsequently resected. Grossly, the resected specimen revealed multiple worm-like polyps, which ranged in size from 0.2 cm to 0.5 cm; two 2-cm-diameter hematomas were also noted (Figure 2). The round, abnormal enhancement demonstrated on computed tomography was considered to be a hematoma. Histologically, the polyps consisted of normal mucosa characterized by nonspecific inflammatory changes (Figure 3). Two days after the surgery, the patient had melena again. We subsequently performed an abdominal angiographic embolization. Throughout the course of this procedure, no bleeding points were noted. There was no contrast medium extravasation when the blood pressure was 90/70 mmHg (Figure 1D). We raised the blood pressure, and digital subtraction angiography demonstrated contrast medium extravasated to the intestinal tract (Figure 1E). A 5 ml suspension of gelatin sponge particles was injected and successfully stopped the bleeding (Figure 1F). The patient was informed that he had a high risk of re-bleeding owing to polyps and careful management was required. After the operation, the patient recovered smoothly, the patient’s hemoglobin level increased to 10.7 g/dl and the patient was discharged from the hospital. No recurrent melena or bleeding was reported at the last follow-up in January 2014.Figure 1

Bottom Line: Two days later, the patient was noted to have melena again, and we performed an abdominal angiographic embolization, successfully stopping the bleeding.Histologic evaluation of the excised specimen revealed chronic inflammatory cells within the lamina propria without hyperplastic or adenomatous epithelial changes.Although the surgery was very successful, careful management of the patient was required, owing to the great risk of re-bleeding.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, East Qingchun Road, Hangzhou 310016, Zhejiang Province, China. zjuzycx@gmail.com.

ABSTRACT
Filiform polyposis is a rare disease, which typically occurs in patients with inflammatory bowel disease. We report a case of filiform polyposis occurring in a 56-year-old man with no history or evidence of inflammatory bowel disease. The patient's main symptoms were melena and anemia. We performed an emergency exploratory laparotomy, in which we observed worm-like polyps spread almost along the entire small intestine, and a partial resection of the small intestine to treat bleeding in the bowel was carried out. Two days later, the patient was noted to have melena again, and we performed an abdominal angiographic embolization, successfully stopping the bleeding. Histologic evaluation of the excised specimen revealed chronic inflammatory cells within the lamina propria without hyperplastic or adenomatous epithelial changes. Although the surgery was very successful, careful management of the patient was required, owing to the great risk of re-bleeding.

Show MeSH
Related in: MedlinePlus