1. GastroCloud
  3. Case of the month
  5. 2022
  7. February

The two towers

Adrian Săftoiu1, 2
Codruța Constantinescu3
1. Spitalul Universitar de Urgență Elias, UMF Carol Davila București, ROMÂNIA
2. Regina Maria - Ponderas Academic Hospital București, ROMÂNIA
3. Centrul de Cercetare în Gastroenterologie și Hepatologie, UMF Craiova, ROMÂNIA

History :

A 48-year-old patient with a positive fecal occult blood test (FOBT) was referred for colonoscopy as part of the screening program.

 

Clinical & biological :

No symptoms.

Imaging :

Two pedunculated polyps (Paris Ips) were visualised in the sigmoid with iSCAN 1,2 aspect and OE (optical enhancement) revealing a gtyrus-like pattern (J-NET2A / Kudo IIIL) (Figure 1-2, Video 1). At the base of the polyps edema is observed (chicken skin appearance) due to traction in the colonic mucosa.
Polyps were resected by endoscopic polypectomy after injection of 5 mL 1:10 000 epinephrine diluted in Gelofusine + methylene blue (MB), without complications (Figure 3-4, Video 2). Two hemostatic clips were placed at the end of the procedure (Figure 5-6, Video 3).

Diagnostic :

Tubular adenomas with low dysplasia.

Discussion :

Rare case of polyps located in the proximal colon.

Conclusion :

The detailed examination allows to establish the correct polypectomy technique.

References :

1. Bianchi M, Clemente V, Koch M. The “Siamese twins” polyps. Dig Liver Dis 2015; 47(4): 346.
2. Benatta MA, Desjeux A, Grimaudb JC. A double-headed polyp. Ann Gastroenterol 2013; 26(1): 72.
3. Olson MR, Govil YK. Two polyps on a common stalk. Gastrointest Endosc 2011; 74(3): 692.

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