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Endoscopy
Inside View
Pedunculated polyp of the ileum protruding from a large diverticulum
  1. Yugo Iwaya1,
  2. Corwyn Rowsell2,
  3. Teodor Grantcharov3,
  4. Norman E Marcon1
  1. 1 Division of Gastroenterology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
  2. 2 Division of Laboratory Medicine, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
  3. 3 Division of General Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Yugo Iwaya, Division of Gastroenterology, St Michael’s Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada; yiwaya{at}shinshu-u.ac.jp

Abstract

Introduction A 52-year-old woman presented with iron deficiency anaemia and postprandial right lower quadrant pain. Abdominal examination was unremarkable and laboratory results showed mild anaemia (haemoglobin 11.3 g/dL). Upper and lower endoscopies did not reveal any source of bleeding. Video capsule endoscopy was performed which showed a large polypoid lesion in the mid-ileum (figure 1). Abdominal contrast enhanced CT demonstrated a heterogeneously enhancing pedunculated polyp measuring approximately 6 cm (figure 2). Retrograde double-balloon enteroscopy was performed which revealed a large pedunculated polyp with hyperplastic-like mucosa protruding from a large diverticulum located approximately 70 cm proximal to the ileocaecal valve (figure 3A). The stalk appeared to arise from the base of the diverticulum (figure 3B). A technetium-99m pertechnetate scintigraphy revealed no ectopic gastric mucosa.

Figure 1
Figure 1

Video capsule endoscopy shows a large polypoid lesion.

Figure 2
Figure 2

CT shows a heterogeneously enhancing pedunculated polyp (arrow).

Figure 3
Figure 3

Retrograde double-balloon enteroscopy images. (A) Large pedunculated polyp protruding from a large diverticulum. (B) The stalk appears to arise from the base of the diverticulum.

Question What is the diagnosis?

  • small bowel
  • small bowel disease
  • small bowel enteroscopy
  • polyp
  • diverticular disease

https://doi.org/10.1136/flgastro-2017-100931

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    Footnotes

    • Contributors YI wrote the paper. YI, TG and NEM treated the patient. CR carried out a pathological assessment of the case. YI, CR, TG and NEM gave final approval of the version to be published.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.