Abstract
Purpose
Cap polyposis is a benign disease of the colon, characterized by inflammatory polyps with a “cap” of inflammatory granulation tissue. Its prevalence is very low, especially in children.
Methods and results
A 16-year-old girl presented with frequent bowel movements with mucous discharge and bloody stool, leading to the initial suspicion of chronic inflammatory bowel disease. Results of further investigation by endoscopy and histological examination were consistent with a diagnosis of cap polyposis. Treatment with systemic steroids resulted in symptom improvement.
Conclusion
A review of the literature shows that cap polyposis can occur at any age, including childhood, with a slight predilection for the male gender. Rectal bleeding and rectal polyps are consistent features in all reported cases. Other typical symptoms include constipation, diarrhea, and abdominal pain. Symptoms may be very similar to those of chronic inflammatory bowel disease, the most important differential diagnosis. The cause of cap polyposis is still unclear, and specific therapy has not as yet been established. Conservative therapeutic measures should be preferred, especially in children.
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References
Williams GT, Bussey HJR, Morson BC (1985) Inflammatory “cap” polyps of the large intestine. Br J Surg 72:133–s134. https://doi.org/10.1002/bjs.1800721355
Campbell AP, Cobb CA, Chapman RW, Kettlewell M, Hoang P, Haot BJ, Jewell DP (1993) Cap polyposis--an unusual cause of diarrhoea. Gut 34:562–564. https://doi.org/10.1136/gut.34.4.562
Suzuki H, Sato M, Akutsu D, Sugiyama H, Sato T, Mizokami Y (2014) A case of cap polyposis remission by betamethasone enema after antibiotics therapy including Helicobacter pylori eradication. J Gastrointestin Liver Dis 23:203–206
Shimizu K, Koga H, Iida M, Yao T, Hirakawa K, Hoshika K, Mikami Y, Haruma K (2002) Does metronidazole cure cap polyposis by its antiinflammatory actions instead of by its antibiotic action? A case study. Dig Dis Sci 47:1465–1468
Ng KH, Mathur P, Kumarasinghe MP, Eu KW, Seow-Choen F (2004) Cap polyposis: further experience and review. Dis Colon Rectum 47:1208–1215. https://doi.org/10.1007/s10350-004-0561-8
Li JH, Leong MY, Phua KB, Low Y, Kader A, Logarajah V, Ong LY, Chua JH, Ong C (2013) Cap polyposis: a rare cause of rectal bleeding in children. World J Gastroenterol 19:4185–4191. https://doi.org/10.3748/wjg.v19.i26.4185
Batra S, Johal J, Lee P, Hourigan S (2018) Cap polyposis masquerading as inflammatory bowel disease in a child. J Pediatr Gastroenterol Nutr 67(3):e57. https://doi.org/10.1097/MPG.0000000000001343
Kim SC, Kang MJ, Jeong YJ, Hwang PH (2017) A case of cap polyposis with epidermal nevus in an infant. J Korean Med Sci 32(5):880–884. https://doi.org/10.3346/jkms.2017.32.5.880
Papaconstantinou I, Karakatsanis A, Benia X, Polymeneas G, Kostopoulou E (2012) Solitary rectal cap polyp: case report and review of the literature. World J Gastrointest Surg 4:157–162. https://doi.org/10.4240/wjgs.v4.i6.157
Konishi T, Watanabe T, Takei Y, Kojima T, Nagawa H (2005) Cap polyposis: an inflammatory disorder or a spectrum of mucosal prolapse syndrome? Gut 54:1342–1343
Yang SY, Choi SI (2010) Can the stomach be a target of cap polyposis? Endoscopy 42(Suppl 2):E124–E125. https://doi.org/10.1055/s-0029-1214863
Singh B, Mortensen NJ, Warren BF (2007) Histopathological mimicry in mucosal prolapse. Histopathology 50:97–102
Kreisel W, Ruf G, Salm R, Lazaro A, Bengsch B, Globig AM, Fisch P, Lassmann S, Schmitt-Graeff A (2017) Protein-losing pseudomembranous colitis with cap polyposis-like features. World J Gastroenterol 23(16):3003–3010. https://doi.org/10.3748/wjg.v23.i16.3003
Oriuchi T, Kinouchi Y, Kimura M, Hiwatashi N, Hayakawa T, Watanabe H, Yamada S, Nishihira T, Ohtsuki S, Toyota T (2000) Successful treatment of cap polyposis by avoidance of intraluminal trauma: clues to pathogenesis. Am J Gastroenterol 95:2095–2098. https://doi.org/10.1111/j.1572-0241.2000.02277.x
Géhénot M, Colombel JF, Wolschies E, Quandalle P, Gower P, Lecomte-Houcke M, Van Kruiningen H, Cortot A (1994) Cap polyposis occurring in the postoperative course of pelvic surgery. Gut 35:1670–1672. https://doi.org/10.1136/gut.35.11.1670
Bookman ID, Redston MS, Greenberg GR (2004) Successful treatment of cap polyposis with infliximab. Gastroenterology 126:1868–1871. https://doi.org/10.1053/j.gastro.2004.03.007
Maunoury V, Breisse M, Desreumaux P, Gambiez L, Colombel JF (2005) Infliximab failure in cap polyposis. Gut 54:313–314. https://doi.org/10.1136/gut.2004.053686
Ohkawara T, Kato M, Nakagawa S, Nakamura M, Takei M, Komatsu Y, Shimizu Y, Takeda H, Sugiyama T, Asaka M (2003) Spontaneous resolution of cap polyposis: case report. Gastrointest Endosc 57:599–602. https://doi.org/10.1067/mge.2003.166
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Brunner, M., Agaimy, A., Atreya, R. et al. Cap polyposis in children: case report and literature review. Int J Colorectal Dis 34, 363–368 (2019). https://doi.org/10.1007/s00384-018-3192-6
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DOI: https://doi.org/10.1007/s00384-018-3192-6