Giant post-inflammatory polyposis in a child with ulcerative colitis: A case report

INTRODUCTION: Post-inflammatory pseudopolyps (PIPs) develop in connection with an inflammatory process in the bowel. Masses larger than 15 mm are classified as giant PIPs. They are very rare, especially in children. PRESENTATION OF CASE: A case of 13-year-old girl suffering from ulcerative colitis (UC) and treated with corticosteroids and azathioprine is reported. Colonoscopic examination after achieving clinical remission revealed multiple giant PIPs. During endoscopic surveillance subsequent spontaneous regression of pseudopolyps was documented. DISCUSSION: Patients with prolonged relapses of inflammatory bowel disease (IBD) are predisposed to PIPs. Giant PIPs may be related to post inflammatory mucosal regeneration or hyperplastic proliferation of the colonic mucosa between ulcerations after recurrent acute disease flares. Partial regression of giant polyps is uncommon, but has been reported. Some of these pseudopolyps are suitable for endoscopic polypectomy, but resection of PIPs is not generally advisable, because they usually regrow. Surgical intervention is advocated in symptomatic cases such as those with abdominal pain, severe hemorrhage or intestinal obstruction. CONCLUSION: The present case report of giant PIPs in an adolescent girl describes rare course of severe ulcerative colitis complicated by development of multiple giant PIPs. Due to asymptomatic course of the disease a conservative therapeutic approach was decided upon. Gradual regression of giant PIPs was observed during consecutive several year surveillance.