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- W2912104576 abstract "Introduction: Polyps within the lumen of a diverticulum are very rare and pose a special challenge for removal due to lack of mucosa and high risk for perforation. We present a case of a sigmoid polyp extending inside of an adjacent diverticulum successfully excised by Endoscopic Mucosal Resection (EMR). Case report: Our patient is a 59 years old male with history coronary artery disease, hypertension and tubular adenomas who was undergoing a surveillance colonoscopy. The colonoscopy revealed a large sigmoid sessile polyp estimated to be larger than 4 cm in diameter and extended into an adjacent large diverticulum. EMR technique was used; the polyp was lifted using a dilute of methylene blue, saline and epinephrine 1:10,000. The polyp was then removed in piecemeal fashion with hot snare method. The rim of the diverticulum was treated with Argon Plasma Coagulation (APC), the polypectomy appeared to be complete. Histology revealed tubulovillous adenoma with focal changes amounting to severe dysplasia. Pt was observed over night and was discharged the next day. Repeat colonoscopy 3 months later revealed a small amount of polypoid tissue within the large adjacent diverticulum. This was not amenable to endoscopic removal because of the risk of perforation, so colorectal surgery was consulted. Discussion: To our knowledge, this is the first case of severely dysplastic polyp arising within the diverticulum. The polyps arising within the lumen of diverticulum are exposed to the on going inflammation of diverticulum. The inflammation accelerates the malignancy potential as reported by Barr et al. Carcinoma arising from diverticulum, is at higher risk of spread to the serosa and perforation due to the lack of muscular coat. Take home message. Sessile polyps arising within the lumen of the Diverticulum have higher malignancy potential and pose greater challenge for endoscopic removal. It is essential to have a low threshold to involve surgery.Figure: Sessile Polyp withing the Lumen of Diveritculum.Figure: Post Polypectomy image." @default.
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- W2912104576 date "2017-10-01" @default.
- W2912104576 modified "2023-09-26" @default.
- W2912104576 title "Rare Case of a Sigmoid Sessile Polyp With Severe Dysplasia Extending Within a Diverticulum" @default.
- W2912104576 doi "https://doi.org/10.14309/00000434-201710001-01489" @default.
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