Obstructive Giant Inflammatory Polyposis: Is It Related to the Severity or the Duration of the Inflammatory Bowel Disease? Two Case Reports

Abstract

We report two cases of giant inflammatory polyposis (GIP) with totally different presentation and evolution. The first patient had two giant pseudopolyps after one year of the diagnosis of UC. The second patient had one obstructive giant pseudopolyp secondary to CD at the level of the transverse colon, being totally asymptomatic years before the presentation. GIP is a rare complication of inflammatory bowel disease (IBD). It consists of numerous filiform polyps that look like a “mass of worms” or a “fungating” mass. Surgical resection is inevitable when GIP presents with obstructive symptoms.

Filiform polyposis presenting with rapid growth and severe anemia

“…(7) As seen in our patient, the histopathology component was acute in addition to chronic, which formed within 6 months. According to the data in the literature, the average duration reported for formation since diagnosis with UC is approximately 3 to 276 months (4). With a length up to 16 cm (8), the sigmoid colon is the most common site, (9, 6) which is consistent with the fact that 30-50% of UCs are con ned to the rectum and sigmoid colon.…”

“…In ammatory polyps have no speci c management except in complicated cases, which have been reported in a few cases (3)(4)(5)1). Otherwise, colonoscopy surveillance with multiple biopsies may be considered a safe option (11) because the risk of malignancy transformation is not clearly understood, which indicates further study.…”

Giant Inflammatory Polyposis of the Rectum as a Complication of Ulcerative Colitis

“…The development of GIP may be related to the severity of the disease in ulcerative colitis, but it occurs in Crohn disease due to the duration of the disease itself (2). GIPs are an uncommon manifestation, and their presence can be correlated with the duration and the severity of IBD (4).…”

“…It is diagnosed when an inflammatory polyp is >1.5 cm in any given dimension or with the presence of filiform projections that look like "mass of worms" or a "fungating mass." It occurs more frequently in ulcerative colitis than in Crohn disease (2,3). However, the presence of GIP in the rectum is very rare; if present, it appears continuous with the colon.…”

Giant Inflammatory Polyps in Diverticular Disease Mimicking a Colonic Mass: A Potential Malignant Masquerader

“…Usually, patients with GIPs present with hematochezia, weight loss, obstruction, and abdominal pain with discomfort [ 10 ]. It has been proposed that GIPs presentation are correlated with the duration and severity of IBD [ 11 ]. GIP is a common pitfall for clinicians and radiologists because it is similar to neoplastic lesions and is frequently mistaken as colon cancer, as in our case which was highly suspicious for malignancy which prompted large surgical excision and thorough evaluation of lymph node metastasis.…”