Extensive Giant Inflammatory Pseudopolyposis in Ulcerative Colitis

Abstract

Giant Inflammatory pseudo polyposis are rare complications seen usually in inflammatory bowel disease. We report a case of extensive giant inflammatory pseudo-polyposis in a 48 year old male with long standing history of ulcerative colitis (UC). His colonoscopy revealed large polypoidal mass in colon. He underwent procto-colectomy with ileal pouch anastomosis. Colectomy specimen revealed extensive circumferential polyposis (>500) filling the entire colon which on histology showed inflammatory polyps. This case highlights extensive polyposis disease in a long standing case of UC masquerading as a neoplasm. Keywords: Giant inflammatory pseudopoluposis; Ulcerative colitis Case ReportA 48 year old male from Afghanistan diagnosed as ulcerative colitis in 2000. He did not receive any specific treatment till 2015. Patient presented in April 2015 with diarrhoea and blood in the stools. He underwent colonoscopy which revealed pancolitis. He was put on ASA, Azathioprine and steroids. Patient came for a follow-up in May 2016. He was having non bloody stools 3-4 episodes/day which were semisolid. He was not able to taper his steroids dose below 20 mg/day. There was no history of abdominal pain. He underwent colonoscopy which revealed a large polypoidal lesion with smooth surface occupying the entire lumen of the colon. Numerous small polyps were seen in rectum. Colonoscope could not be negotiated through the growth. Biopsy taken for histopathology revealed inflammatory polyp. Patient underwent procto-colectomy with ileal pouch anal anastomosis. Gross examination of specimen revealed more than five hundred polyps filling the entire colon and rectum. Histology from these polyps show benign inflammatory pseudopolyposis.