P0590 ADENOMATOUS POLYPOSIS IN A NINE YEAR OLD BOY. A CASE REPORT

Abstract

Introduction: According to Morisson’s histologic classification of epithelial polyps of the colon, adenomas are premalignant, which is of particular interest in cases with great abundance of adenomas, i.e. adenomatous polyposis. Unlike hamartomas, which are histologically more frequent in children, adenomas, particularly those located in the colon, are much less frequent. Methods: We report a case of adenomatous polyposis in a nine-year-old boy, who, had occasional, short lasting abdominal pain and small amounts of blood in the stool, from the age of four. These complaints were attributed to haemorrhoids. He also had sideropaenic anaemia treated with iron supplementation. Results: Two months prior to the admission to hospital, the abdominal pain started to occur daily and very frequently, accompanied with bloody stools. On admission, the boy was at the age of 9.5 yr. He had a “sick” look, with BW (10.p.), H (50.p.). Abdomen was distended, not sensitive on palpation. On rectal examination, numerous small polyps were palpated. Other physical examination was normal. Blood analysis showed sideropenic anaemia and trombocytosis, raised ESR rate and increased levels of fibrinogen and alpha2 and gamma globulins. Liver and kidney function tests were normal. On barium, double-contrast enema, multiple polyps and diverticulosis were seen along the colon (the highest distribution being in the left colon), causing dilations of the intestines and subsequent impaired innervations in all segments. Colonoscopy revealed hundreds of smooth-surface polyps of 0.7 cm approx. size. On histology, they were tubular adenomas, without dysplasia in all sections. Ultrasonography, esophagogastro-duodenoscopy and enteroclysis were performed and the findings excluded the possibility of neoplasms in other locations of the digestive tract. In order to determine the presence of a familial pattern, the parents of the patient were examined (abdominal ultrasound, barium enema and follow through of the small and large intestine). Since the results obtained were normal and excluded the presence of FAP, it was concluded that this was a case of a new mutation on the APC site of chromosome 5. A thorough genetic study was not possible. Conclusion: Surgery was recommended (total proctocolectomy with a jejunal patch), to which the parents consented three months later. The boy was well on forst follow-up.