Journal Article

OC94 Inflammatory cloacogenic polyp as a cause of rectal bleeding in a teenager

Urs, A, Thomson, M, Narula, P, Rajani, S, Cohen, M, Scluckebier, D

2023

Overview

Inflammatory cloacogenic polyp (ICP) is a rare lesion arising in the region of the anorectal transitional zone. It is considered to be a part of mucosal prolapse, which includes solitary rectal ulcer syndrome (SRUS), rectal prolapse, intussusceptions and rectocele. The etiopathogenesis is mucosal prolapse, which produces local trauma and ischemic injury followed by inflammation, repair and regenerative changes. The vast majority (85%) are located above the anal border and predominantly in the anterior lateral wall. The polyps vary in size from 3–4 cm in diameter and have a sessile appearance.1 The estimated annual incidence of ICPs is 1 to 3.6 per 1, 00,000 among all solitary rectal ulcers.2 It is rare in children. A review of clinical notes and investigations was undertaken along with review of literature.13-year boy, a Syrian refugee presented with history of pr bleeding for over 2 years which had increased over the past few weeks. There was no other significant medical history. He had a normal general and systemic examination on presentation. His weight and height were on the 25th centile. On presentation he had raised calprotectin(>4000)microgram/miligram. Haemoglobin of 128 g/dl on presentation, erythrocyte sedimentation rate-17 mm/hr. The MRI abdomen was normal.He underwent colonoscopy which revealed multilobulated polyp needing piecemeal resection (figure 1 and 2). Histopathology (figure 3) was suggestive of a polylobulated polyp in the rectum. There was smooth muscle passing up between the glands and the stroma appeared to be a mixture of smooth muscle and fibrotic tissue. Ulceration and inflammatory slough were noted on the surface. This was diagnostic of inflammatory cloacogenic polyp. Despite being on laxatives he required three piecemeal resections over a year. He continues to present with bleeding per rectum and is planned for endoscopic submucosal dissection (ESD).Awareness of this entity in children is important because of both the propensity for recurrence and persistence of the polyps. If the underlying etiology is not corrected, the long-term implications are of internal intussusception: procidentia, descending perineum syndrome, and ultimately, incontinence. Rectal bleeding is the most common presenting clinical symptom.Abstract OC94 Figure 1 and 2Endoscopic appearance of inflammatory cloacogenic polyp[Figure omitted. See PDF]Abstract OC94 Figure 3Histology appearance of inflammatory cloacogenic polyp[Figure omitted. See PDF] Calva-Rodríguez R, González-Palafox MA, Rivera-Domínguez ME, [Inflammatory cloacogenic polyp]. Rev Gastroenterol Mex. 2007 Oct-Dec;72(4):371–5. Ewertsen C, Svendsen CB, Svendsen LB, [Inflammatory cloacogenic polyp]. Ugeskr Laeger. 2008 Aug 25;170(35):2708.

• Publisher: BMJ Publishing Group LTD
• Subject: Endoscopy / Polyps / Smooth muscle