Abstract

INTRODUCTION: Tubular adenoma is a common finding in the colon accounting for majority of the colonic adenomas. Consensus guidelines have outlined surveillance intervals for patients with tubular adenoma in the colon based on the number and size. We present a unique case of a tubular adenoma in the interpositioned colon. Colonic interposition is a common surgery in patients with esophageal atresia. We present a unique case of a TA with high-grade dysplasia in the interpositioned colon. CASE DESCRIPTION/METHODS: A 50-year-old female with a past history of esophageal atresia who underwent colonic interposition between the upper esophagus and stomach at the age of five presented with dysphagia. A barium swallow was performed which showed delayed emptying in the mid-esophagus. An esophagogastroduodenoscopy (EGD) was performed which showed food material stuck in the proximal interpositioned colon. There were no strictures at the site of the anastomosis. Incidentally a 10 mm polypoid lesion was seen in the interpositioned segment of the colon [Figure 1]. The polypoid lesion was biopsied and histological examination showed disorganized glands in the background of normal colonic mucosa along with hyperchromatic nuclei with increased mitosis in the cells, consistent with tubular adenoma. Repeat EGD showed three sessile polyps ranging from 10 mm to 20 mm in size. The polyps were successfully resected using hot snare polypectomy. Pathological examination showed two tubular adenomas, and the largest polyp had tubular adenoma with focal high grade dysplasia [Figure 2]. Resection margins were negative for dysplasia. A colonoscopy was also performed which found two sub-centimeter adenomatous polyps as well. DISCUSSION: Esophageal atresia is a congenital malformation of the upper gastrointestinal tract. The prevalence varies from 1 in 2500 to 1 in 4500 births. Currently, there is no ideal replacement for the esophagus. Primary anastomosis of the esophagus is performed in about 90% of cases, and a colonic interposition is performed when there is an extremely long gap. Common complications with colonic interposition include stenosis of the anastomosis, esophageal dysmotility, and gastroesophageal reflux. Development of adenomatous polyps in the interpositioned segment of the colon are exceedingly rare and usually an incidental finding. Our case and other similar reports highlight that surveillance strategies need to be developed in these patients to prevent carcinoma.

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