Small-bowel tumors, both malignant and benign, are rare lesions accounting for no more than 2 % of gastrointestinal malignancies [1]. We report the case of an asymptomatic 61-year-old man who underwent a screening colonoscopy in an out-patient hospital conducted up to the ascending colon owing to a dolichocolon. A cecal mass was observed that could not be correctly defined. A subsequent computed tomography (CT)-based virtual colonoscopy showed a 6-cm finger-like-shaped polyp with its base in the terminal ileum approximately 5 cm proximal to ileocecal valve ([Fig. 1]). A repeat colonoscopy was again unsuccessful. Apart from a left nephrectomy for a renal clear cell carcinoma in 2006, the patient’s past medical history was otherwise unremarkable.
Fig. 1 Computed tomography-based virtual colonoscopy showing the finger-like-shaped ileal polyp (yellow circle).
He was referred to our center to undergo a retrograde single-balloon enteroscopy (SBE) (SIF-Q180; Olympus, Tokyo, Japan), which revealed the ileal polyp protruding into the cecum. The ileocecal valve was cannulated and the polyp’s origin in the ileum was confirmed. It had a finger-like shape with a pedicle 6 cm long and 2 cm thick with its base 5 cm proximal to ileocecal valve and was covered with hyperemic mucosa ([Fig. 2]). The thickness of the polyp, occupying more than half of the ileal lumen, and especially its unstable position, made polypectomy more difficult. An endoloop (Olympus) was deployed at the base of the thick stalk and, with the scope positioned in the cecum, a transvalvular hot snare polypectomy was performed ([Video 1]). The procedure was uneventful. The polyp was retrieved with a basket ([Fig. 3]).
Fig. 2 Endoscopic view of the ileal polyp.
Video 1 Transvalvular polypectomy of an ileal polyp.
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Fig. 3 Polyp 4 cm in length removed from the terminal ileum.
Histological examination showed an inflammatory fibroid polyp with clear margins (R0 resection) ([Fig. 4]). This is a rare benign mesenchymal neoplasm, usually solitary and intraluminal, that may affect any part of the GI tract, although in the majority of cases it affects the stomach (antrum 75 % and corpus 16 %) followed by the small bowel (4.3 %) [2]. Treatment may be surgical but can also be endoscopic with appropriate precautions. Such polyps do not recur following removal [2]
[3]
[4].
Fig. 4 Histological specimen of inflammatory fibroid polyp completely removed (clear margins).
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