Filiform polyposis presenting with rapid growth and severe anemia case report

Abstract

Giant inflammatory polyposis (GIP) is a rare manifestation of inflammatory bowel disease (IBD), and it is described as a worm-like projection of 1.5cm or more in diameter with unclear pathogenesis. GIP may be related to the severity of IBD. GIP presents with a wide range of symptoms, including crampy abdominal pain, anemia, and intestinal obstruction. The histopathology of GIP is a polyp lined by normal colonic mucosa with superficial ulceration that may show mild crypt distortion. Our case reports a patient with ulcerative colitis diagnosed via colonoscopy and histopathology 10months before presenting with severe anemia due to lower gastrointestinal bleeding. Colonoscopy showed GIP obstructing the descending and sigmoid colon, and total colectomy showed the entire colon full of worm-like polyps up to 14cm the longest polyp. Giant inflammatory polyposis which is seen in 17% of UC with active colitis, as seen in our patient, the histopathology component was acute in addition to chronic, which formed within 6months. According to the data in the literature, the average duration reported for formation since diagnosis with UC is approximately 3 to 276months. With a length up to 16cm, the sigmoid colon is the most common site. Surgical intervention is indicated for filiform polyposis (FP) if it is complicated, such as bleeding or obstruction, which is reported in a few cases. However, there are no clear guidelines for surgical intervention for complicated FP, but the safest method is to tailor the management according to the guidelines for each underlying disease.