S2108 Rare Inflammatory Granulation Polyp Inside a Diverticulum

Abstract

Introduction: Inflammatory granulation polyps arising from a diverticulum are rarely reported in literature. They are typically observed in the setting of recurrent inflammation such as inflammatory bowel disease (IBD) or diverticulitis. They are difficult to distinguish from malignancy as these lesions are usually friable and occasionally covered in exudates. Endoscopic management can be technically challenging and often associated with increased risk of perforation and bleeding. We present a case of inflammatory granulation polyp arising from a diverticulum which was removed endoscopically. Case Description/Methods: 47-year-old Spanish-speaking female with a past medical history of obesity and hyperlipidemia was referred to us for evaluation of ongoing abdominal pain and acid reflux. Labs were notable for a hemoglobin of 12.3 g/dL. She had no prior history of endoscopy. Computed tomography of the abdomen and pelvis with contrast was normal. She subsequently underwent upper endoscopy and screening colonoscopy. Colonoscopy showed diverticulosis and a 7 mm polyp arising from the diverticulum in the sigmoid colon. An attempt was made to lift the polyp through submucosal injection with ORISETM gel but only minimal lifting effect was observed. Polypectomy was subsequently performed with cold biopsy forceps. Pathology was consistent with edematous granulation tissue (Figure). Discussion: Inflammatory granulation polyps are rarely encountered on colonoscopy and owing to it closely mimicking colon neoplasm endoscopists should be able to differentiate between the 2. Granulation polyps have irregular vessels on the surface along with absence of pit patterns. Removal of these polyps when arising from the diverticulum involves endoscopic mucosal resection and closing of the site using clips or sutures to prevent complications. When associated with diverticulitis these are benign polyps and hence could be approached with possible surveillance.Figure 1.: Top: Colonoscopy demonstrating a granulation polyp inside of a diverticulum in the sigmoid colon. Bottom: Narrow band imaging magnified irregular micro-vessels on the surface of the sigmoid colon polyp.