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DOI: 10.1055/s-0035-1569649
Endoscopic resection of a giant ileal inflammatory fibroid polyp by retrograde double-balloon enteroscopy
Publication History
Publication Date:
22 January 2016 (online)
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A 70-year-old woman with a longstanding history of ileocolonic Crohn’s disease was reviewed in our inflammatory bowel disease clinic. Although her Crohn’s disease-related symptoms were well controlled on azathioprine and 5-aminosalicylic acid therapy, computed tomography enterography (CTE) demonstrated active disease affecting the distal ileum and right colon with an ileal polyp that had increased in size from 14 mm to 30 mm over a 2-year follow-up period ([Fig. 1]). Histopathology of biopsies taken from the distal ileal polyp were consistent with an inflammatory etiology but, because of its increasing size and the risk of intussusception, the lesion was deemed to merit endoscopic excision.
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Retrograde double-balloon enteroscopy (DBE) identified the ulcerated polypoid lesion located within a segment of severely active Crohn’s disease that was affecting the last 40 cm of the terminal ileum ([Fig. 2]). The head of the polyp was injected with a 1 : 10 000 epinephrine solution to reduce its size and bleeding risk [1]. The lesion was then removed by en bloc endoscopic mucosal resection ([Fig. 3]). Histopathological examination confirmed complete excision of a submucosal lesion composed of sparsely cellular proliferating spindle cells, set within an edematous stroma containing small and large vessels and inflammatory cell infiltrate rich in eosinophils ([Fig. 4]), consistent with an inflammatory fibroid polyp (IFP).
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IFPs are rare benign submucosal lesions which, although they may arise anywhere within the gastrointestinal tract, affect the small bowel in only 18 % of cases [2]. Intussusception, obstruction, and bleeding are recognized complications of small-bowel IFPs [3]. Simultaneous occurrence of active Crohn’s disease with such lesions has rarely been described, and it has been proposed that disease activity may be the local stimulus for the formation of this apparently reactive lesion [4]. To the best of our knowledge, this is the largest small-bowel IFP (and only the third such case) to be resected by balloon-assisted enteroscopy [2] [5].
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References
- 1 Hogan RB, Hogan 3rd RB. Epinephrine volume reduction of giant colon polyps facilitates endoscopic assessment and removal. Gastrointest Endosc 2007; 66: 1018-1022
- 2 Mohamud S, Motorwala S, Daniel R et al. Giant ileal inflammatory fibroid polyp causing small bowel obstruction: a case report and review of the literature. Cases Journal 2008; 1: 341
- 3 Yoon DW, Lee BJ, Lee JH et al. A case of giant inflammatory ileal polyp removed by double-balloon enteroscopy. Clin Endosc 2012; 45: 198-201
- 4 Deschamps L, Bretagnol F, Couvelard A et al. Inflammatory fibroid polyp in Crohn’s disease revealed by ileo-ileal intussusception: case report and review of the literature. Inflamm Bowel Dis 2008; 14: 1317-1320
- 5 Wolff J, Twaddell W, Darwin P. Endoscopic resection of an ileal inflammatory fibroid polyp using retrograde single balloon enteroscopy. Clin Gastroenterol Hepatol 2009; 7: e66-e67