Cap polyposis: A rare cause of rectal bleeding in children

Li, Jia Hui; Leong, May Ying; Phua, Kong Boo; Low, Yee; Kader, Ajmal; Logarajah, Veena; Ong, Lin Yin; Chua, Joyce Hy; Ong, Christina

doi:10.3748/wjg.v19.i26.4185

Cited by 17 publications

(33 citation statements)

References 18 publications

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“…Additionally, our patient presented with rectal bleeding, mucoid discharge, abdominal pain, and a fiveyear history of straining during defecation, progressing in severity over time. Although anemia, changes in serum inflammatory markers, and a decrease in total serum protein or albumin levels have been reported in some cases [4], our patient had no laboratory abnormalities. Almost all lesions found during colonoscopy evaluation of adults or children are located in the rectum, occasionally extending to the anal canal, and less frequently in the sigmoid colon [2].…”

Section: Discussioncontrasting

confidence: 54%

“…Structure of a polypoid with an ulcerated granulation tissue cap and inflammatory exudates on the surface Fig. 4 At a higher magnification, granulation tissue is visible overlying tortuous crypts with basally located nuclei, as well as the presence of smooth muscle fibers and congested vessels in the inflamed stroma diseases such as IBD and mucosal prolapse syndrome, which results in frequent misdiagnosis and unnecessary or harmful evaluations or therapeutic strategies [2,4].…”

Section: Discussionmentioning

confidence: 99%

“…During colonoscopy evaluation, single or multiple polyps varying in size and shape in the rectum or colon may be observed [ 2 ], raising the possibility of cap polyposis. A definitive diagnosis requires the collection of numerous tissue samples in order to confirm the disease histologically [ 4 ]. We present a case of solitary rectal ulcer (SRU) in a 15-year-old boy that developed into CP over time.…”

Section: Introductionmentioning

confidence: 99%

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Solitary rectal ulcer transformation to cap polyposis in a 15-year-old child

et al. 2022

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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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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Solitary rectal ulcer transformation to cap polyposis in a 15-year-old child

et al. 2022

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“…No distinct polyps could be found. Generally, cap polyps manifest as polypoid lesions with intervening normal mucosa[ 6 , 8 ]. However, contiguous polyps have been described and it is not uncommon that CP is often misinterpreted as chronic inflammatory bowel disease[ 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

Protein-losing pseudomembranous colitis with cap polyposis-like features

Kreisel

Ruf

Salm

et al. 2017

WJG

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Protein-losing enteropathy (PLE) is characterized by loss of serum proteins into the gastrointestinal tract. It may lead to hypoproteinemia and clinically present as protein deficiency edema, ascites, pleural or pericardial effusion and/or malnutrition. In most cases the site of protein loss is the small intestine. Here we present an unusual case of severe PLE in a 55-year old female with a one-year history of recurrent diarrhea, crampy abdominal pain, and peripheral edema. Endoscopy and MRI showed a diffuse inflammatory thickening of the sigmoid colon and the rectum. Surgical resection of the involved colon was performed and the symptoms were significantly resolved. The final histologic evaluation confirmed a diagnosis of a pseudomembranous colitis with cap polyposis-like features. Such a cause of PLE has never been described before.

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“…A case series showed that patients' median age was 52 years and the age range was from 12 years to 76 years (2). Li et al (3) reported the youngest case of cap polyposis in a 5-year-old male in 2013. The most common site of polyposis is the rectosigmoid colon, but lesions have also been detected proximal to the colon and in the stomach (4).…”

Section: Introductionmentioning

confidence: 99%

A Case of Cap Polyposis with Epidermal Nevus in an Infant

et al. 2017

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Cap polyposis is extremely rare in children. We report a case of an 11-month-old male infant who visited our hospital because of rectal prolapse and small amount of hematochezia lasting several days. He also had an epidermal nevus in the sacral area. Colonoscopy showed erythematous, multilobulated, circumferential, polypoid lesions with mucoid discharge from the rectum. He was diagnosed with cap polyposis by endoscopy and histologic examination. He was treated with surgical resection, and was closely followed up. In the relevant literature, there is no report of cap polyposis in an infant. We report the first case of cap polyposis in the youngest infant.

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Cap polyposis: A rare cause of rectal bleeding in children

Abstract: Cap polyposis is a rare and under-recognised cause of rectal bleeding in children. Our study has characterized the disease phenotype and treatment outcomes in a pediatric cohort.

Cited by 17 publications

References 18 publications

Solitary rectal ulcer transformation to cap polyposis in a 15-year-old child

Solitary rectal ulcer transformation to cap polyposis in a 15-year-old child

Protein-losing pseudomembranous colitis with cap polyposis-like features

A Case of Cap Polyposis with Epidermal Nevus in an Infant

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