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  • • Colorectal polyps are masses of tissue that project into the lumen

    • Heterogeneous group of sessile or pedunculated; benign or malignant; mucosal, submucosal, or muscular lesions

    • Types include:

    • -Neoplastic (adenomas/carcinomas)

      -Hamartomas

      -Inflammatory

      -Hyperplastic

    • Most adenomas are tubular, tubulovillous, or villous

    • Hyperplastic polyps are diminutive lesions most often found in the left colon

    • Hamartomas are uncommon (rarely malignant)

    • Adenomas are a premalignant lesion

    • Vast majority of adenocarcinomas of the large bowel in North America and Europe are believed to evolve from adenomas

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Epidemiology

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  • • Estimates of the incidence of colonic and rectal polyps in the general population range from 9% to 60%

    • Polypoid adenomas are found in about 25% of asymptomatic adults who undergo screening colonoscopy

    • Prevalence of adenomas is 30% at age 50 years, 40% at age 60, 50% at age 70, and 55% at age 80

    • Mean age is 55 years

    • 50% of polyps occur in the sigmoid or rectum

    • 50% of patients with adenoma have more than 1 lesion, and 15% have more than 2 lesions

    • Increased incidence of adenomas in breast cancer patients has been reported

    • Inflammatory polyps have no malignant potential

    • Cancer developing in association with hamartomas is rare

    • 25% of patients who have 5 or more adenomatous polyps have a synchronous colon cancer at the initial colonoscopy

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Symptoms and Signs

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  • • Most polyps are asymptomatic but the larger the lesion, the more likely it is to cause symptoms

    • Rectal bleeding most common symptom

    • Blood is bright red or dark red depending on the location of the polyp

    • Bleeding is usually intermittent

    • Altered bowel habits (constipation, increased frequency)

    • Crampy abdominal pain

    • Physical exam yields little information about the colonic polyps themselves

    • Polyp may be palpable by digital rectal exam

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Laboratory Findings

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  • • Anemia may be present with rectal bleeding

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Imaging Findings

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  • Barium enema: Rounded filling defect with smooth, sharply defined margins

    Colonoscopy: Most reliable means of diagnosis with biopsy; treatment with polypectomy

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  • • Malignant neoplasm

    • Artifacts seen on barium enema (such as fecal matter, air bubbles, appendices epiploicae, lymph nodes) may be confused with polyps

    • Diverticula

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Rule Out

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  • • Malignant neoplasm

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  • • History and physical exam

    • Digital rectal exam

    • Proctoscopy

    • Colonoscopy with biopsy/polypectomy

    • Barium enema

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When to Admit

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  • • Bleeding or other complications such as perforation, severe abdominal pain, obstruction

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  • • Polyps of the colon and rectum are treated because they produce symptoms, because they may be malignant when first discovered, or because they may become malignant later

    • Small polyps can be removed with an electrocautery snare

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Surgery

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Indications

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