Inflammatory cloacogenic polyps in children: diagnostic yield of rectal retroflexion during colonoscopy

Abstract

Background and aims Inflammatory cloacogenic polyps (ICPs) are inflammatory lesions occurring around the anal transitional zone. These are rare in the pediatric population, and most reported cases are found in adults. Therefore, this study aimed to evaluate the usefulness of rectal retroflexion (RR) during colonoscopy in detecting ICPs in children. Methods A total of 1837 colonoscopies were performed in 1278 children between September 2003 and August 2020 at the Seoul National University Bundang Hospital. The laboratory test results and colonoscopic and histopathological findings were retrospectively reviewed. ICP was detected using the RR and was diagnosed based on the histologic findings of the polyp. Results A total of 69 patients were diagnosed with juvenile polyps (n = 62) or ICP (n = 7), with the latter being detected through RR. All children with ICP were diagnosed from 2013 onwards when RR during colonoscopy came to be routinely performed in our medical center. The patients with ICP were older at diagnosis and more associated with a family history of colorectal polyps than JP. Stool occult blood and the polyps’ endoscopic characteristics, such as number, location, volume, and shape, significantly varied between the two groups. Additionally, there was a statistically significant difference in the polypectomy method. During the long-term follow-up, there was no recurrence of ICP. Conclusions Due to their location at the anorectal junction, ICPs may be overlooked during colonoscopy, leading to misdiagnosis. Therefore, a retroflexion view during colonoscopy may help detect ICPs in pediatric patients, especially those presenting with hematochezia.

Successful Treatment of a Recurring Rectal Cloacogenic Polyp With Topical Steroids

“…As a general measure, constipation and straining ought to be treated with a highfiber diet, laxative treatment, and/or biofeedback for pelvic floor disorders to prevent recurrence. Nowadays, resection is usually conducted endoscopically [4] while size, location, and the number of polyps as well as the individual endoscope skill set of the operator determines the resection technique. Most often, conventional cold snare polypectomy is conducted due to its broad availability, cost-effectiveness, and low complication risk [4,9].…”

“…Nowadays, resection is usually conducted endoscopically [4] while size, location, and the number of polyps as well as the individual endoscope skill set of the operator determines the resection technique. Most often, conventional cold snare polypectomy is conducted due to its broad availability, cost-effectiveness, and low complication risk [4,9]. Just as in rectal adenomas and even early rectal cancer, endoscopic submucosal dissection (ESD) has been successfully attempted [5,10].…”

“…Hence, excessive straining with repetitive mucosal prolapse during defecation might play a role. Endoscopically, CP may occur as solitary or multiple and may appear sessile or pedunculated with sizes up to 5 cm and a potentially irregular pit pattern, mimicking anorectal malignancy [2,[4][5][6]. CPs occur more often in adults between 30 and 60 years of age, with male dominance, but have been described in children [2,4].…”

“…Endoscopically, CP may occur as solitary or multiple and may appear sessile or pedunculated with sizes up to 5 cm and a potentially irregular pit pattern, mimicking anorectal malignancy [2,[4][5][6]. CPs occur more often in adults between 30 and 60 years of age, with male dominance, but have been described in children [2,4]. Most patients are symptomatic, with hematochezia, constipation, or abdominal pain, however, 20% are asymptomatic [2,4].…”

“…CPs occur more often in adults between 30 and 60 years of age, with male dominance, but have been described in children [2,4]. Most patients are symptomatic, with hematochezia, constipation, or abdominal pain, however, 20% are asymptomatic [2,4].…”