Protein-losing pseudomembranous colitis with cap polyposis-like features

Abstract

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.

Case Report: Cap Polyposis in Advanced Pelvic Floor Dysfunction - Stronger Evidence of a Mechanical Prolapse-Related Pathology

“…These polyps can be found anywhere along the colon but are more commonly seen between the rectum and distal colon. The most common are abdominal pain, rectal bleeding, and mucoid diarrhoea [4,6,7]. It usually affects adults in a wide age range between 16-76 years old but is also observed in the paediatric population.…”

“…It has been hypothesised that chronic mechanical straining and recurrent mucosal trauma lead to prolapse at redundant folds, followed by ischemia, subsequent inflammatory reaction and polyp formation [1,13,14]. Protein-losing enteropathy occurs in advanced cases as persistent mechanical stimulation leads to mucosal hyperplasia and hypersecretion of serum proteins into the lumen [6]. The most commonly reported symptoms of abdominal pain, rectal bleeding, and mucoid diarrhoea potentially lead to a misdiagnosis of Inflammatory bowel disease as the clinical and endoscopic features can be similar.…”

“…Cap polyps may be found throughout the colon, most commonly localised in the rectum and rectosigmoid area. The most common symptoms include abdominal pain, rectal bleeding, and mucoid diarrhoea [1,5] and severe cases of cap polyposis can lead to protein-losing enteropathy [6]. The pathogenesis of cap polyposis remains unclear and is debated between infectious, inflammatory, and mucosal prolapse aetiologies.…”

Cap Polyposis: An Elusive Diagnosis in a Pediatric Patient Successfully Managed With Endoscopic Treatment

“… 2 The differential diagnoses include inflammatory bowel disease and severe pseudomembranous colitis/proctitis. 4 …”

“…2 The differential diagnoses include inflammatory bowel disease and severe pseudomembranous colitis/proctitis. 4 The etiology of cap polyposis is unclear, with evidence for infectious and inflammatory causes involving mucosal ischemia and Tcell-mediated inflammation as well as mechanical causes, such as abnormal bowel motility and trauma to the rectal mucosa from straining. A common first step for the treatment of cap polyposis is instructing the patient to avoid straining during defecation.…”