A case of pyogenic granuloma of the cecum treated by endoscopic resection.

by endoscopic resection A 45-year-old man presented with hematochezia during the 3 days prior to his admission. His past history included hemophilia without any major bleeding events. His vital signs were stable and his physical examination was unremarkable. Initial laboratory findings revealed a hemoglobin of 8.6g/dL, hematocrit of 40.3%, platelet count of 336×109/L, prothrombin time of 11.9 seconds, and activated partial thromboplastin time (aPTT) of 49.4 seconds. Esophagogastroduodenoscopy (EGD) showed no specific findings. Colonoscopy showed a pedunculated polyp of approximately 25mm, which had a lobulated contour, hypervascular appearance, and was covered with an adherent white exudate, and the surrounding mosaic-pattern mucosa with white spots (●" Fig.1a,b). It was difficult to exclude malignancy and biopsies were taken. Histopathology showed inflammatory granulation tissue and elective endoscopic snare polypectomy was performed. After the polyp had been resected, minor bleeding occurred (●" Fig.1c), which ceased after electrocoagulation (●" Fig.1d). Microscopic examination of the resected polyp showed a highly vascular proliferation that resembled granulation tissue and an inflammatory cell infiltrate with stromal edema, which was consistent with a pyogenic granuloma (●" Fig.2). After treatment, the patient’s hemoglobin improved gradually and he has remained in a stable condition with no further episodes of bleeding in the 6 months since his discharge. Fig.1 Colonoscopy views showing: a a pedunculated polyp (approximately 25mm) with a lobulated contour, hypervascular appearance, and covered with an adherent white exudate, and the surrounding mosaic-pattern mucosa with white spots close to the ileocecal valve (white arrow); b the same polyp and the nearby appendiceal orifice (black arrow); cminor bleeding after resection of the tumor with a polypectomy snare; d the resection site after the bleeding had been controlled by the application of electrocoagulation.