Kataoka F, Nakanishi T, Araki H, Ichino S, Kamei M, Makino H, Nagao R, Asano T, Tagami A, Moriwaki H. Adult juvenile polyp bleeding detected by extravascular contrast leakage and treated with endoscopic clipping: A case report. World J Gastrointest Endosc 2025; 17(2): 101135 [DOI: 10.4253/wjge.v17.i2.101135]
Corresponding Author of This Article
Fumiya Kataoka, MD, Department of Gastroenterology, Matsunami General Hospital, 185-1 Dendai, Kasamatsu, Hashima 501-6062, Gifu, Japan. a9mb1039@yahoo.co.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Fumiya Kataoka, Takayuki Nakanishi, Hiroshi Araki, Shoichi Ichino, Makoto Kamei, Hiroyuki Makino, Ryotaro Nagao, Takayuki Asano, Atsushi Tagami, Hisataka Moriwaki, Department of Gastroenterology, Matsunami General Hospital, Hashima 501-6062, Gifu, Japan
Co-first authors: Fumiya Kataoka and Takayuki Nakanishi.
Author contributions: Kataoka F and Nakanishi T wrote the first draft of the manuscript, they contributed equally as co-first authors; Kataoka F, Nakanishi T, Araki H, Ichino S, Kamei M, Makino H, Nagao R, Asano T, Tagami A, and Moriwaki H contributed to the patient consultation, commented on previous versions of the manuscript, and read and approved the final manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fumiya Kataoka, MD, Department of Gastroenterology, Matsunami General Hospital, 185-1 Dendai, Kasamatsu, Hashima 501-6062, Gifu, Japan. a9mb1039@yahoo.co.jp
Received: September 9, 2024 Revised: November 5, 2024 Accepted: January 11, 2025 Published online: February 16, 2025 Processing time: 159 Days and 18.1 Hours
Abstract
BACKGROUND
Juvenile polyps (JPs) are non-neoplastic polyps. In adults, JPs present with hematochezia in only approximately half the patients and are often found incidentally during endoscopic screening. JPs have no mucosal fascia at the tip, and spontaneous shedding and massive gastrointestinal hemorrhage may occur. Thus, the JP bleeding detected in this case by extravascular contrast leakage on computed tomography scans and treated with endoscopic clipping is rare.
CASE SUMMARY
A previously healthy 31-year-old male patient presented with a 2-day history of bloody stools. Upon hospital arrival, rectal examination revealed fresh blood, and abdominal computed tomography scans showed extravascular contrast leakage from the lower rectum’s left-side wall. His blood pressure was slightly low at 104/62 mmHg. However, his pulse rate (69 bpm) and oxygen level (99% on room air) were within normal limits. Emergency endoscopy revealed a pedunculated lesion in the rectum covered by a non-neoplastic mucosal epithelium. No neoplastic lesions were observed at the tip of the polyp; however, pulsatile bleeding was detected at the distal end. We performed endoscopic hemostasis by clipping the stem and then performed a polypectomy above the stem to examine the lesion tissue. Histopathological evaluation revealed a cystically dilated gland without neoplastic lesions. A subsequent total colonoscopy revealed two JPs with characteristic edematous, smooth, and reddish surfaces close to the hemorrhagic lesion. Subsequent histopathological evaluation indicated findings characteristic of JP, such as severe inflammatory cell infiltration of the stroma and cystic dilatation of the glandular ducts.
CONCLUSION
There are no reports of adult JPs presenting with contrast extravasation where endoscopic hemostasis was successful, as in this case.
Core Tip: A 31-year-old male presented with hematochezia lasting for 2 days. computed tomography scans showed extravasation, and endoscopy was used to confirm and stop bleeding from the stem of a juvenile polyp (JP). Emergency endoscopy revealed persistent bleeding from the base of the polyp, and diagnostic polypectomy and hemostasis was performed. JPs are often detected with bloody stools. However, there have been no reports of JPs with active bleeding seen on computed tomography scans as extravasation. In this rare case, an endoscopic video showed persistent bleeding, and successful endoscopic hemostasis was achieved, and captured on video.
