A GIANT ILEAL PSEUDOPOLYP IN CROHN'S DISEASE RESECTED BY DOUBLE-BALLOON ENTEROSCOPY

Aims:

Giant pseudopolyps (> 1.5 cm) are unusual in Crohn's Disease (CD), and oftenly cause intestinal obstruction among other complications that may require surgical management. Endoscopic therapy could be an alternative in such circumstances. We describe a case report of a giant pseudopolyp treated by enteroscopy.

Case report:

A 63-year-old patient diagnosed with CD presented unexplained iron-deficiency anemia and subocclusive symptoms. Therefore, capsule endoscopy was performed, identifying an ulcerated ileal mass with leafy hypertrophic villi near a typical substenosis of CD. By Double-Balloon Enteroscopy (DBE) with 3.2 mm working channel and CO2 insufflation, a 4 cm ulcerated mass was identified prolapsing through the substenosis. Diluted adrenalin (1: 10000) was injected at its base, and lastly, the lesion was resected with a snare and removed using fishnet basket. Histology was consistent with the diagnosis of a CD associated pseudolyp. The patient now remains asymptomatic.

Conclusions:

Giant pseudopolyps are uncommon in the small bowel. When symptomatic, they are usually diagnosed and treated by surgery. Resection by DBE with large working channel can be a feasible and safe approach in some patients.