Vanishing Cecal Polypoid Mass Lesion

Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia Correspondence: Dr Hugh J Freeman, Division of Gastroenterology, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, British Columbia V6T 1W5. Telephone 604-822-7216, fax 604-822-7236, email hugfree@shaw.ca Received for publication October 5, 2011. Accepted October 11, 2011 case presentation A 53-year-old man was referred because of colonoscopic identification by a surgeon of a large cecal polyp, possibly amenable to endoscopic removal. During the colonoscopic evaluation, no cecal lesion was seen by two expert gastroenterologists despite excellent visualization of the cecum. Ileal and appendiceal orifices appeared normal. After photographs were taken to document an apparently normal cecum (Figure 1), a large colonic polypoid mass appeared to partially, then subsequently fully prolapsed into the cecum during the procedure from the ileocecal orifice (Figure 2). This was later removed by laparoscopic resection and proved to be a villous adenoma of the cecum. Discussion A few reports have documented intussusception of benign and malignant polypoid lesions in the ileocecal area of adults (1,2). Usually, patients experience intermittent abdominal pain and distension, sometimes with nausea and vomiting, suggesting an obstructing lesion. In adults, a well-defined pathological abnormality is often evident and the intussusception is believed to be caused by a specific pathological lesion associated with a freely moving segment telescoping into an adjacent fixed or retroperitoneal segment. As a result, a relatively common site of intussusception is the ileocecal area (3). image of the month