POLYPS
OF THE COLON AND RECTUM
A
polyp is a mass of tissue that protrudes into the lumen of the bowel. Polyps
can occur anywhere in the intestinal tract and rectum. They can be classified
as neoplastic (ie, adenomas and carcinomas) or non-neoplastic (ie, mucosal and
hyperplastic). Non-neoplastic polyps, which are benign epithelial growths, are
common in the Western world. They occur more commonly in the large intestine
than in the small intestine. Although most polyps do not develop into invasive
neoplasms, they must be identified and followed closely. Adenomatous polyps are
more common in men. The proportion of these polyps arising in the proximal part
of the colon increases with age (after 40 years of age). Prevalence rates vary
from 25% to 60%, depending on age. Non-neoplastic polyps occur in 80% of the
population, and their frequency increases with age (Wolfe, 2000).
Clinical
manifestations depend on the size of the polyp and the amount of pressure it
exerts on intestinal tissue. The most common symptom is rectal bleeding. Lower
abdominal pain may also occur. If the polyp is large enough, symptoms of
obstruction occur. The diagnosis is based on history and digital rectal
exam-ination, barium enema studies, sigmoidoscopy, or colonoscopy.
After
a polyp is identified, it should be removed. There are sev-eral methods:
colonoscopy with the use of special equipment (ie, biopsy forceps and snares),
laparoscopy, or colonoscopic excision with laparoscopic visualization. The
latter technique enables im-mediate detection of potential problems and allows
laparoscopic resection and repair of the major complications of perforation and
bleeding that may occur with polypectomy. Microscopic examina-tion of the polyp
then identifies the type of polyp and indicates what further surgery is
required.
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