Inflammatory Pseudopolyps Research Articles

Giant Inflammatory Pseudopolyp of the Duodenum

Purpose: Duodenal polyps are an uncommon finding. Typically, duodenal polyps are frequently seen in patients with genetic syndromes such as familial adenomatous polyposis syndrome, but also may occur sporadically. Unless large enough to cause symptoms, duodenal polyps are often discovered incidentally on upper endoscopy. Once discovered, therapeutic management depends on patient symptoms, histology, and/or size of the polyp. Management may include observation, endoscopic removal, or surgery. Here, we present a case of an unusually large duodenal pseudopolyp with unique histological features. We describe the management and course of the polyp over a 3-year time period. A 59-year-old male with a past medical history significant for prior myocardial infarction, diabetes and hyperlipidemia was referred by his gastroenterologist for evaluation of a large 4 cm duodenal polyp (not involving the ampulla) that encompassed one half the circumference of his duodenal lumen. Approximately 2 weeks prior, he underwent an upper endoscopy for an upper gastrointestinal bleed (attributed to a small gastric vessel) at which time this large polyp was incidentally discovered. Review of outside pathology reports were concerning for an adenomatous polyp with low-grade dysplasia. Upon review of the biopsy specimen by a pathologist at our institution, the polyp was found to consist of benign small bowel mucosa with non-specific inflammatory and reactive epithelial atypia with no definitive dysplasia. Due to the concerning size of this duodenal polyp, the patient subsequently underwent an MRI and upper endoscopy. MRI revealed no extra duodenal involvement and once again, biopsy revealed benign duodenal mucosa with chronic inflammation and reactive changes with no dysplasia. Following these investigational tests, general surgery was subsequently consulted for recommendations concerning surgical management. Due to the benign histology of the polyp, conservative measures with close observation were recommended. Thus, a follow up EGD with EUS was performed 8 weeks later. EUS demonstrated slight involvement of the submucosa and histology revealed reactive and regenerative changes with no malignancy. The patient continued to have regular surveillance with five upper endoscopies over the past 3 years. His most recent endoscopy has revealed a significant reduction in polyp size with biopsy showing benign mucosa, normal villous architecture and no active inflammation. There has been no progression to dysplasia or malignancy. This case highlights an unusual finding of a giant inflammatory pseudopolyp with unique histological features and the role of conservative management.

Relationship between Colonic Polyp Type and the Neutrophil/Lymphocyte Ratio as a Biomarker

We designed this study to investigate the neutrophil lymphocyte ratio as a biomarker in distinguishing colonic polyps which are neoplastic or non-neoplastic. One hundred and twenty-five patients with colonic polyps were enrolled into the study. The following data were obtained from a computerized patient registry database: mean platelet volume (MPV), uric acid (UA), platelet count (PC), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT) and the neutrophil to lymphocyte ratio (NLR). Exclusion criteria were active infectious disease, hematological disorders, and malignancies. Colonic polyps divided into two groups as neoplastic polyps (tubular adenoma, villous adenoma, tubulovillous adenoma) and non-neoplastic polyps (hyperplastic polyps, inflammatory pseudopolyps etc). The relationship between colonic polyp type and NLR was evaluated with statistical analysis. There were 67 patients (53.6%) with neoplastic and 58 (46.4%) patients with non-neoplastic polyps. Mean NLRs of neoplastic and non-neoplastic groups were respectively 3.32±2.54 and 2.98±3.16 (P<0.05). Although sensitivity and specificity are not high, NLR may be used as a biomarker of neoplastic condition of colonic polyps.

Pyogenic Granuloma of Gastrointestinal Tract: A Large Case Series and Review of Literature

Purpose: To report all available cases of PG of intestinal tract, diagnosed at our hospital in the last 10 years and to review previously reported cases in the literature. Methods: A retrospective review of the pathology database was performed on all gastrointestinal biopsies in the last 10 years using diagnostic and pathology codes searching for PG of the gastrointestinal tract. Results: A total of 23 cases of pathologically proven PG were diagnosed over a 10 year period. The median age of patients was 64 (±9) years with 47.8% men and 52.2 % women. The most common location of the PG was the colon - 19 (82.6%) cases (14 cases in sigmoid colon, 3 cases in transverse colon and 1 case in splenic flexure) followed by esophagus - 4 cases (17.4%) and rectum - 1 case (4.3%). PG presented as a polyp in 16 patients (69.6%) and as an erythematous inflamed edematous mucosa in 6 patients (26%). The polyp was Sessile in most cases - 13 patients (81.3%) and pedunculated in the rest - 3 patients (18.7%). The size of polyp was <1 cm in 8 patients and >1 cm in the rest. Endoscopically, most lesions appeared as inflammatory pseudopolyps without features suggestive of adenoma. The most common indication for endoscopy was screening/surveillance colonoscopy (82.6% cases) with a family history of colon cancer or polyp in a first degree relative in 5 patients, a personal history of adenoma in the past in 4 cases and colorectal cancer in 3 cases. Other indications for endoscopy were melena in 4 cases (17.4%), iron deficiency anemia in 2 cases (8.7%) and acute flare of ulcerative colitis in 1 patient (4.3%). Conclusion: PG of gastrointestinal tract is rare. To date, only about 15-20 cases have been reported in the literature mainly from Japan and Korea. To our knowledge this is the largest case series (23 cases) of this rare pathological lesion of gastrointestinal tract. In our series, most cases of PG were incidental findings in an asymptomatic patient who had an endoscopy done for an unrelated reason, unlike previously reported cases which were mostly associated with gastrointestinal bleeding. In summary, PG is a rare pathological lesion in GI tract excluding the oral cavity and can present in various ways ranging from an asymptomatic polyp to a life threatening GI bleeding.

Retrospective Analysis and Pathogenesis of Inflammatory Pseudopolyps in Noninflammatory Bowel Disease Patients

Retrospective Analysis and Pathogenesis of Inflammatory Pseudopolyps in Noninflammatory Bowel Disease Patients

Cecal Patch Manifest as an Inflammatory Pseudopolyp and Characterized by Chromoendoscopy

Cecal Patch Manifest as an Inflammatory Pseudopolyp and Characterized by Chromoendoscopy

Regression of giant pseudopolyps in inflammatory bowel disease

Inflammatory pseudopolyps are formed in the regenerative and healing phases of ulcerated epithelium. Giant pseudopolyposis of the colon (pseudopolyp larger than 1.5cm in size) is a very rare complication of inflammatory bowel disease and it may lead to colonic intussusception or luminal obstruction, but the more important clinical significance is that it can be endoscopically confused with a malignancy, although it is generally regarded as having no malignant potential. It has been reported that giant pseudopolyposis of the colon rarely regresses with medical management alone and this sometimes require surgical or endoscopic resection. This report illustrates 2 unusual cases of giant pseudopolyps associated with Crohn's disease and ulcerative colitis, and these giant pseudopolyps were initially confused with villous adenoma or adenocarcinoma, but they showed regression after adequate medical therapy.

Confocal endomicroscopic evaluation of colorectal squamous metaplasia and dysplasia in ulcerative colitis

A 52-year-old woman with a 20-year history of ulcerative colitis (UC) underwent surveillance colonoscopy. She had received prednisone and then started infliximab therapy 4 months before colonoscopy for diarrhea and rectal bleeding, which resolved, but arthralgias and paresthesias led to infliximab discontinuation after the third induction dose. At the time of colonoscopy, the patient was asymptomatic on mesalamine monotherapy. Colonoscopy revealed only left-sided colitis and pseudopolyps abutting the anal verge. Random biopsies revealed moderate active colitis consistent with UC in the distal 40 cm of the colon. Rectal biopsy specimens 10 cm from the anus incidentally also contained areas of squamous epithelium with at least intermediate-grade squamous intraepithelial neoplasia. Biopsies of the distal rectum revealed inflammatory pseudopolyps as well as squamous epithelium with high-grade squamous intraepithelial neoplasia.

Rapid Development of Localized Pesudopolyposis in Ulcerative Colitis

Purpose: Pesudopolyposis is a common complication of ulcerative colitis with a reported incidence varying from 12.5% to 74.5%. Pseudopolyps are raised areas of inflamed tissue formed by repeated cycles of ulceration and healing. Larger size pseudopolyps, i.e giant pseudopolyps of the colon, are a rare complication of inflammatory bowel disease. A 54-year-old female with history of ulcerative colitis presented for acute rectal bleeding and abdominal pain of several days duration. She had a colonoscopy performed 10 months previously during a disease flare, which showed active ulcerative colitis and scattered fililform polyps in the left colon. After a course of corticosteroids she was maintained on 6-merrcaptopurine (75 mg) and was asymptomatic for several months, after which her symptoms recurred. Colonoscopy was performed and demonstrated active disease from the anus to the proximal transverse colon. In the transverse colon, a clearly demarcated area containing multiple polypoid lesions was seen. Pathological examination revealed inflammatory pseudopolyps without dysplasia. Pathological examination also showed moderate-to-marked chronic active colitis in different segments of the left colon. Localized pseudopolyposis may be a manifestation of both ulcerative colitis and Crohn's disease. Pseudopolyposis may be seen during either the active or quiescent states of ulcerative colitis and can be diffuse or focal in distribution. Pseudopolyposis can present in a number of different ways, including acute rectal bleeding, crampy abdominal pain, hypoproteinemia, palpable abdominal mass or obstruction. The most unusual finding in this case is the finding of masses of pseudopolyps in a patient with a short duration of symptoms. The main concern in such a patient, with longstanding ulcerative colitis, is the development of dysplasia or adenocarcinoma of the colon. It has been reported that the severity of colonic inflammation is an important determinant of the risk of colorectal neoplasia in long-term extensive ulcerative colitis. While histologically benign, the rapid growth of the giant peseudopolyps suggests a heightened risk for dysplasia and colorectal cancer.Figure: [966] Localized pseudopolyposis.

Esophageal Crohnʼs Disease, Depression, and Eating Disorder: A Clinical Conundrum

Purpose: Involvement of the esophagus occurs in only 0.2% of Crohn's disease cases. Isolated Crohn's disease of the esophagus is exceedingly rare with only a handful of cases reported in the literature. This is a case of Crohn's disease with only esophageal involvement, but with the diagnosis made challenging in the setting of severe depression and possible eating disorder. Methods: A 29 year old female with a history of depression and possible eating disorder presented to a tertiary referral medical center for further evaluation of weight loss in the context of esophageal strictures. She had a long history of depression as well as previous diagnosis of nonspecific eating disorder with past hospitalization in an inpatient eating disorder unit. She initially presented with symptoms of dysphagia and 12 kg weight loss to an outside institution where upper endoscopy was notable for diffuse inflammation mucosal edema, multiple pseudopolyps, diffuse scarring, esophageal ulcer and strictures. Initial concerns included caustic ingestion but the patient and her spouse repeatedly denied any such history. Colonoscopy with terminal ileum exam was negative. Despite multiple endoscopic dilatations, she remained symptomatic and presented to our institution for further evaluation. Repeat upper endoscopy was notable for findings limited to the esophagus which included superficial ulcerations, multiple inflammatory pseudopolyps, and a stricture in the distal esophagus. Multiple biopsies were obtained and notable for findings of a non-necrotizing epithelioid granuloma and deep mucosal inflammation. Small bowel interrogation with MR Enterography was negative. Evaluation by Psychiatry was notable for findings consistent with depression but equivocal for an eating disorder. Initial therapy for Crohn's disease was started with oral budesonide gel. Following ten weeks of therapy, she remained symptomatic. Results: Although plans were made to escalate therapy, this was postponed as the patient was hospitalized in an inpatient psychiatric unit due to worsening depression. Conclusion: Crohn's disease with esophageal involvement is rare and exceedingly so when it is isolated to the esophagus. Psychiatric disorders are significant comorbidities and are common in the community. This is a case of Crohn's disease limited to the esophagus, in which the diagnosis and management were complicated by significant psychiatric comorbidities. This emphasizes the importance of clinical vigilance as well as impact of psychiatric comorbidities on medical care.

Fibroepithelial Polyps of the Ureter: A Single-Institutional Experience

Ureteral fibroepithelial polyps (UFP) are rare lesions that may mimic ureteral malignancy, and management is not well defined. We report our experience with the management of UFP. Between 1945 and 2008, review of our clinical database identified 27 patients who were found to have UFP. Single-pathologist review excluded five patients (three papilloma, one inflammatory pseudopolyp, and one nondiagnostic). Fisher's exact methods were utilized to assess significance of clinical associations. Mean age at diagnosis was 40 years (range 7-73 years) and 68% were male. Mean follow-up was 37 months (range 2-276 months). History of urologic conditions occurred in 13 patients: 7 (32%) urolithiasis, 2 (9%) ureteral stents, 1 (5%) recurrent urinary tract infection, and 3 (14%) ureteropelvic junction obstruction. Mean UFP diameter was 2 cm (range 0.5-4 cm). UFP was more common in the left ureter (68%, 15/22). UFP location within the ureter was proximal in 13 (59%, 15/22), mid in 4 (18%, 4/22), and distal in 4 (18%, 4/22) with multiple UFP along the length of one ureter. Six patients (27%) had multiple UFP. Open surgery, last performed in 1994, was the initial treatment in 10 (45%, 10/22) patients. Endoscopic treatment was performed in 12 (55%, 12/22) patients and was successful in 11. After endoscopic treatment, open surgical treatment was required in 3 patients with ureteral stricture and 1 patient with incomplete polyp resection. UFP reoccurred in 1 patient (1/12) at 26 months and was successfully treated with ureteroscopy. We conclude that UFP can be successfully managed with endoscopic techniques. Postoperative surveillance is recommended for potential early detection of ureteral stricture or recurrence.

T2013 Deregulated Expression of MicroRNA-143, -145, -7, -21 and -34a in Colon Tumor Development

G A A b st ra ct s polarity, minor vascular abnormalities. Inflammatory infiltrates were detected in all inflammatory (pseudo)polyps. In Vivo histology predicted the ex vivo data with sensitivity of 96%, specificity of 93% and accuracy of 95%. Interobserver agreement for diagnosis of colorectal adenomas was high (K coefficients: pathologist, 0.90, endomicroscopist, 0.80). Conclusion: C-CLE enables accurate differentiation between adenomatous and non-adenomatous colorectal polyps during ongoing endoscopy. Systematic, reproducible classifications are needed to comprehensively classify all types of colorectal polyps. This approach may ultimately save time, reduce pathology costs and allow individualized endoscopic management.

Occult Dysplasia in a Localized Giant Pseudopolyp in Crohn’s Colitis: A Case Report

Localized giant pseudopolyposis of the colon (pseudopolyp larger than 1.5 cm in size) is a rare complication of inflammatory bowel disease. There is one report of an occult carcinoma within such a lesion, and no reports of sole dysplasia. A case of a 42-year-old man with longstanding Crohn's colitis who underwent a colonoscopy revealing a large, multilobulated mass at the splenic flexure that was not amenable to endoscopic removal, is described. Multiple biopsies showed no dysplasia and histology was consistent with an inflammatory pseudopolyp. Computed tomographic colonography demonstrated a mass resembling a large villous tumour. A decision for surgery was made. The surgical specimen was a complex anastomosing inflammatory pseudopolyp 5 cm x 4 cm x 3 cm in size, with a focus of low-grade dysplasia in an area free of inflammation. The present case is the first reported occult dysplasia in a giant pseudopolyp. Occult dysplasia without superficial dysplasia may exist in these lesions and further studies are needed to examine risk factors that make a giant pseudopolyp more likely to harbour dysplasia and/or carcinoma.

Mycobacterial Spindle Cell Pseudotumor of the Colon

Purpose: Inflammatory pseudotumors are a type of solid tumor that may be comprised of spindle cells, myofibroblasts, plasma cells, or histiocytes as a secondary reaction to an underlying inflammatory process. Infection in an immunocompromised host is a common etiology of inflammatory spindle cell pseudotumors. Many infectious agents have been reported to cause inflammatory spindle cell pseudotumors although non-tuberculous Mycobacterial species are the most commonly reported infectious etiology in patients with Human Immunodeficiency Virus infection. To our knowledge this is the first reported case of a Mycobacterial spindle cell pseudotumor of the colon. Methods: A 30 year man with a diagnosis of AIDS presented for evaluation of progressive fatigue and weakness for 3 weeks. The patient also complained of abdominal pain and diarrhea for 1 week with one episode of melena. He underwent an EGD and colonoscopy. The colonoscopy showed a 4 millimeter polyp in the transverse colon which was resected with jumbo cold forceps. The pathology of the transverse colon polyp was consistent with a Mycobacterial spindle cell pseudotumor. Results: The lesion described as the transverse colon polyp was examined using a routine hematoxylin-eosin (H & E) stain, AFB stain, GMS histochemical stains, and CMV immunohistochemical stain. The lesion was described as a polypoid spindle cell proliferation and non-caseating epithelioid granuloma with numerous acid fast bacilli consistent with Mycobacteria. These findings were consistent with a Mycobacterial spindle cell pseudotumor. Duodenal biopsies were evaluated with AFB stain, GMS stain, PAS stain, Trichrome stain, and immunostain for CMV. The biopsies showed acute and chronic inflammation and macrophages containing numerous acid fast bacteria consistent with Mycobacteria. Conclusion: The patient was placed on clarithromycin 500 mg every 12 hours, which was ultimately changed to azithromycin 500 mg daily, and ethambutol 1200 mg daily for Mycobacterium avium complex. He continued darunavir, raltegravir, ritonavir, and emtricitabine-tenofovir for his HIV/AIDs. The patient was seen in a clinic follow up visit two months after the initial presentation to the hospital. He continued his antiretroviral medication and azithromycin and ethambutol. The patient's diarrhea and abdominal pain had resolved. He had a good appetite and was gaining weight. This case is an example of an inflammatory pseudopolyp caused by MAC found in the colon in a patient with AIDS. It highlights the importance of recognizing that inflammatory pseudopolyps may be a result of infection in an immunocompromized patient and the importance of providing the appropriate clinical treatment.

Successful Treatment of Severe Gastrointestinal Bleeding Secondary to Crohn Disease with Recombinant Factor VIIa

A 58-year-old man diagnosed with ileocolonic Crohn disease was admitted to the emergency room with massive lower gastrointestinal hemorrhage and hypovolemic shock. Treatment was started with methylprednisolone, metronidazole and omeprazole. Within the next 24 hours, he received a total of 9 U of red blood cell concentrate and 2 U of fresh frozen plasma. Because of persistence of bleeding, hypovolemic shock and life-threatening situation, we started therapy with rFVIIa. One dose of 120 microg/kg and another dose of 120 microg/kg three hours after the first dose were administered as compassionate use, with resolution of bleeding in the next 12 hours. On day 4 the patient was stabilized. We performed a total colonoscopy and intubation of the ileocecal valve that showed patchy deep ulcerations in the rectum with bleeding inflammatory pseudopolyps. Acute gastrointestinal bleeding is an unusual complication in Crohn disease. In this case, the use of recombinant activated factor VIIa controlled the massive gastrointestinal bleeding secondary to Crohn disease and without clinically significant adverse effect. There are few case reports documenting the use of recombinant activated factor VIIa for this type of off-label indication. Clinical trials should be carried out to define the dosage and dose interval schedule of rFVIIa in the treatment of uncontrolled massive gastrointestinal bleeding secondary to Crohn disease.

A Case of Intestinal Behcet's Disease Similar to Crohn's Colitis

Behcet's disease is a multi-systemic vasculitis and characterized by systemic organ involvement. Although the gastrointestinal and systemic features of Behcet's disease and inflammatory bowel disease overlap to a considerable extent, they are generally viewed as two distinct diseases. A 39-yr-old female was diagnosed as having Behcet's disease. She was admitted to our hospital because of oral and genital ulcer, lower abdominal pain, and frequent diarrhea. Colonosopy showed diffuse involvement of multiple longitudinal ulcers with inflammatory pseudopolyps with a cobblestone appearance and ano-rectal fistula was suspected. These findings are extremely rare in Behcet's disease. However, there were no granulomas, the hallmark of Crohn's colitis. Microscopically, perivasculitis and multiple lymph follicles compatible with Behcet's disease were seen. Although being rarely encountered, multiple longitudinal ulcers, cobblestone appearance, and ano-rectal fistula can develop in Behcet's disease, as in Crohn's colitis. Therefore, Behcet's disease and Crohn's disease may be closely related and part of a spectrum of disease.

Endobronchial Mimics of Primary Endobronchial Carcinoma: A Clinical Study of 25 Cases

While endobronchial lesions that present with symptoms of obstruction may be reflective of primary bronchogenic malignancy, there have been a number of reports of bronchial lesions other than primary bronchogenic carcinoma simulating primary endobronchial epithelial malignancy clinically. Twenty-five cases of symptomatic endobronchial disease were encountered with pathological assessment demonstrating an endobronchial process other than carcinoma, representing metastatic disease (breast, colon, renal, head and neck origin), fungal infection, Hodgkin's lymphoma, primary bronchogenic melanoma, lipoma, broncholith and inflammatory pseudopolyp. The present report underscores the potential pathogenetic heterogeneity encountered in lesions presenting with signs and symptoms of endobronchial obstruction, emphasizing the critical role of biopsy for establishing a definitive diagnosis.

Colitis cystica profunda and giant inflammatory pseudopolyp in Crohn’s disease

Colitis cystica profunda and giant inflammatory pseudopolyp in Crohn’s disease

SCHISTOSOMAL COLONIC POLYPOSIS

A 24 year old male who recently moved to the United States from Yemen presented complaining of change in bowel habits, fatigue and hematochezia. He denied any associated melena, weight loss, nausea, vomiting or abdominal pain. The patient denied any family history of cancer. The patient's laboratory values were significant for WBC of 4.4 Thous/mc L with an absolute eosinophil count of 691 Cells/mc L. The patient's basic metabolic panel and liver function tests were normal. Physical exam was only significant forheme positive brown stool. Colonoscopy was performed and revealed two large pedunculated polyps in the distal descending colon measuring 4 centimeters each. One polyp was removed successfully by snare cautery. The second polyp was removed partially by snare cautery with the intention to repeat the colonoscopy for completion of the polypectomy after the pathology results returned. Several random biopsies were obtained in the terminal ileum, cecum, ascending colon, transverse colon, descending colon and rectum. Microscopic examination of the random biopsies revealed intestinal colonic schistosomiasis with moderate chronic inflammation. The two descending colon polyps were diagnosed as inflammatory pseudopolyps due to extensive intestinal schistosomiasis. There was heavy egg burden noted in the mucosal vascular spaces associated with the presence of several adult worms in the submucosal vessels. The patient was started on praziquantel and noted clinical improvement. One month later, the patient presented for a follow-up colonoscopy which revealed complete resolution of the partially resected descending colon polyp. In addition, there was evidence of colitis in the rectum, rectosigmoid and descending colon which was biopsied. The biopsies revealed nonspecific chronic inflammation with occasional ova (mostly parasitic shells) of Schistosoma. There was no evidence of parasites in the terminal ileumorascending colon. Schistosomal colonic polyposis is a common complication of chronic Schistosoma mansoni infection in endemic areas, but it is rarely encountered in the United States. Colonoscopy typically shows primary involvement of the distal colon and polyps can be pedunculated or sessile, few or numerous. Our case demonstrates that colonoscopic polypectomy is safe and effective and may be required in combination with medical therapy for complete symptom relief and prevention of complications.

The histological diagnosis of dysplastic and neoplastic lesions in inflammatory bowel disease: A pathological perspective

Patients with inflammatory bowel disease (IBD), both ulcerative colitis (UC) and Crohn's disease (CD), are at an increased risk for developing colorectal carcinoma (CRC). The accurate diagnosis of dysplasia in biopsies taken during periodic surveillance of long-standing IBD patients is most important in prevention of UC and CD related cancer. Distinction of low from high grade IBD-related dysplasia and differential diagnosis between IBD-related dysplasia and dysplasia in sporadic adenoma as well as distinction from pseudodysplastic lesions in inflammatory pseudopolyps or reparative lesions is often very subtle and difficult and demands expertise of second experienced gastrointestinal pathologist. Although surveillance colonoscopy with multiple biopsies does not reduce the cancer mortality, it offers a reasonable chance of detecting precancer and performed prophylactic colectomy. Novel methods of detecting dysplasia are continuously being evaluated, including chromoscopy and molecular biology markers. In the future, one may expect, from these new markers to detect the dysplasia in IBD patients before development of histological evidence of neoplastic changes.

Seudoobstrucción intestinal crónica, hiperplasia nodular linfoide intestinal y endometriosis intestinal

Nodular lymphoid hyperplasia of the gastrointestinal tract associated to endometriosis is an uncommon cause of chronic pseudo-obstruction and malabsortion. The case of a 32-year-old woman who suffered from this syndrome for one a half years is described. Diagnosis was achieved by laparotomy, which disclosed swelling and inflammation of the 30 cm terminal yeyunal portion. Removal of the involved intestine and side-to-side anastomosis were performed. The pathological findings were: follicular lymphoid hyperplasia with mucosal ulcers an fissures inflammatory pseudo-polyps, chronic deep enteritis and areas of endometriosis. A favourable outcome followed surgery.