Rectal cap polyposis masquerading as ulcerative colitis with pseudopolyposis and presenting as chronic anemia: A case study with review of literature

Abstract

Cap polyposis (CP) is an under recognized form of non-neoplastic colonic polyps, characterised by the presence of inflammatory polyps with a distinct “cap” of granulation tissue. CP is often seen masquerading as chronic inflammatory bowel disease. The most common symptoms are mucoid diarrhoea, bloody stools, abdominal pain, and tenesmus. In this case report, we present a patient who was diagnosed with CP during the investigation of unexplained chronic long standing anemia secondary to intermittent rectal bleeding. CP, although rare, should be considered in the differential diagnosis of patients presenting with intermittent rectal bleeding and mucoid diarrhoea.

Polypectomy for Recurrent Inflammatory Cap Polyposis Combined with Argon Plasma Coagulation

“… 3 Recto-sigmoid cap polyposis can lead to anemia from chronic blood loss, or to hypoalbuminemia from protein loss. 4 - 7 …”

Successful laparoscopic resection for cap polyposis: case report, literature review

“…Previous literature showed that polypoid lesions were mainly associated with mucosal prolapse syndrome, fibromuscular obliteration, and chronic straining at defecation. Also, its rarity often made physicians diagnose ulcerative colitis or another inflammatory bowel disease with pseudopolyps [ 3 , 6 , 8 , 9 ]. The exact etiology of cap polyposis remains unknown and several medical treatments, including aminosalicylates, antibiotics, steroids, and anti-inflammatory agents, have been recommended.…”

“…Twelve cases of surgically treated cap polyposis were reported between 2004 and 2013, although several cases might have been experienced before 2002. In this reviewed series, last four cases [ 5 – 8 ] could not get the preoperative diagnosis of cap polyposis, and no case was confirmed which H. pylori was infected or not, and received H. pylori eradication therapy before any surgical treatment. One case underwent sigmoidectomy for cap polyposis and recurred after surgery [ 3 ].…”

“…Specific treatment has not been fully established, and since Williams et al reported the first cases in 1985 [ 1 ], etiology has remained unknown. Several reports have shown the clinical courses and surgical treatments for this disease, including some recurring cases [ 2 – 8 ]. Here, we present a case of successful laparoscopic resection of cap polyposis and review literature about the surgical interventions for this disease.…”