A CASE OF DIVERTICULITIS OF THE ASCENDING COLON WITH COLONIC MUCO-SUBMUCOSAL ELONGATED POLYPS

Abstract

We experienced a patient with diverticulitis of ascending colon who was operated on for stricture and abscess formation and found to have multiple colonic muco-submucosal elongated polyps (CMSEPs). This case is reported together with some bibliographical comments.
A 35-year-old man was seen at the hospital because of pain in the right abdomen. The patient was conservatively treated with a suspicion of colonic diverticulitis. Colonofiberscopy revealed a narrowing and multiple polyps in the cecum. Fluoroscopic study of the small intestine visualized a longitudinal ulcer on the ileum. Ileocecal stricture due to Crohn disease was suspected and the patient was operated on, when an inflammatory tumor about 7cm in size was confirmed in the region and ileocecal resection was performed. The resected material revealed a fistula between terminal ileum and the ascending colon and six polyps like tongue about 1.5-2.0cm in size in the cecum. Histopathological diagnosis was made as abscess formation due to diverticulitis. Crohn disease was negated by pathological findings. As for the multiple polyps, surfaces of the polyps were covered with normal mucosa and dilatation of submucosal veins and lymphatic vessels, proliferation of edematous connective tissue were seen. The polyps were clarified to be CMSEP. This is the first case report of juvenile colonic diverticulitis associated with multiple CMSEIs.