Diffuse filiform polyposis of the small intestine without inflammatory bowel disease

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.

Giant filiform polyposis in a patient with inflammatory bowel disease presenting with intestinal obstruction

“…The exact pathogenesis of FP is uncertain. It is likely that, long-standing inflammation of the colonic mucosa in chronic inflammatory bowel disease with alternating mucosal damage and healing may lead to exuberant mucosal regeneration giving rise to the mentioned unique appearance in FP [4,6]. In the present case, long standing ulcerative colitis with poor response to medical treatment, resulting in frequent relapses, might have contributed to FP.…”

“…However, patients may present with a variety of symptoms, including cramping abdominal pain, anaemia, weight loss, malena and diarrhoea. The condition can also produce obstruction and intussusception, especially in localized large fungating mass lesions as in this case [4].…”

“…Furthermore, numerous conglomerated localized polyps as in our patient could mimic malignancy in colonoscopy and radiological studies. The solitary individual filiform polyps are difficult to distinguish from villous adenomas, necessitating a biopsy or polypectomy to establish a definitive diagnosis and to exclude malignancy [4,7]. Absence of dysplasia on microscopy excludes the possibilities of DALM and adenoma.…”

“…The colon remains the most involved site and the sigmoid colon is the commonest location; additionally oesophageal, gastric and small intestinal involvement has been described. Sparing of the rectum is also documented in the literature [4,5].…”

Colonic Filiform Polyposis in a Patient without Inflammatory Bowel Disease

“…It has been suggested that the continuous inflammatory process and the alternating periods of ulceration and healing may lead to the formation of finger-like projections [15]. To the best of our knowledge, 22 similar cases of filiform polyposis in patients without a history of inflammatory bowel disease (7 women, 15 men) have been reported at the time of writing [16]. Filiform polyposis may be sequelae of prior injury or inflammation and has been reported to be associated with necrotizing enterocolitis, enema-induced colitis, ureterosigmoidostomy, stercoral ulcer, Langerhans cell histiocytosis X, or colonic tuberculosis [11].…”