Obstructing giant post-inflammatory polyposis in ulcerative colitis: Case report and review of the literature

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Background: Post-inflammatory polyps > 15 mm in diameter or length are termed “giant”. This benign and rare sequel of ulcerative colitis or colonic Crohn's disease can mimic colorectal carcinoma.

Objective: To illustrate this rare complication of inflammatory bowel disease and outline the characteristic radiological, endoscopic and histopathological features, by reviewing all previously published cases of giant post-inflammatory polyps in the English literature.

Results: Reports of 81 giant post-inflammatory polyps in 78 patients were identified by systematic review of the literature. The incidence of giant post-inflammatory polyps is related to the extent of ulcerative colitis (incidence: 0%, 30%, and 70%, in proctitis, left-sided, and extensive disease, respectively). These lesions are typically located in the transverse or descending colon. Giant post-inflammatory polyps are as common in Crohn's disease (n = 36) as in ulcerative colitis (n = 42, 54%). Clinical presentations varies, including pain (n = 29), rectal bleeding (n = 20), diarrhoea (n = 19), luminal obstruction (n = 15), or a palpable mass (n = 11). Symptomatic presentation results in surgical resection. Clinical details and outcomes are comprehensively tabulated.

Conclusion: Recognition of this rare entity will prevent unnecessary radical surgical resection for presumed carcinoma. It highlights the need for clinical, radiological, endoscopic and histopathological correlation.

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