Skip to Main Content

+

  • • 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

++

Epidemiology

+

  • • 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

++

Symptoms and Signs

+

  • • 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

++

Laboratory Findings

+

  • • Anemia may be present with rectal bleeding

++

Imaging Findings

+

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

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

+

  • • Malignant neoplasm

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

    • Diverticula

++

Rule Out

+

  • • Malignant neoplasm

+

  • • History and physical exam

    • Digital rectal exam

    • Proctoscopy

    • Colonoscopy with biopsy/polypectomy

    • Barium enema

++

When to Admit

+

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

+

  • • 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

++

Surgery

++

Indications

+

  • • ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.