Colorectal Inflammatory Pseudopolyps: A Retrospective Analysis of 70 Patients

Introduction: Inflammatory pseudopolyps (IPs) are a well-recognized entity in patients with inflammatory bowel disease (IBD), most likely developing from long-standing chronic inflammation. Similarly, IPs have been associated with ischemic and infectious colitis, intestinal ulcers, and mucosal anastomoses. This study aimed to analyze inflammatory pseudopolyps without a history of these known associated pathologies. Materials and Methods: A database search was conducted for patients who underwent biopsies at Thomas Jefferson University Hospital from 2003-2013 for the presence of colorectal IPs. Exclusion criteria consisted of patients with a history of IBD, mucosal anastomoses, ischemic and infectious colitis. Spatial and temporal associations between colonic pathologies and IPs were assessed via Fisher’s exact and chi-square test, respectively. Results: Seventy-five polyps from 70 patients fulfilled the database search criteria. Forty-one pseudopolyps (55%) arose from the rectosigmoid region. Twenty-two patients had no associated colon pathology (31%); 35 patients had epithelial polyps (50%), such as tubular adenomas, serrated adenomas, and hyperplastic polyps; 10 patients had colonic adenocarcinoma (16%), and 18 patients had diverticulosis (26%). Epithelial polyps were significantly associated with IPs in the same region. However, diverticulosis was independent of IPs in regard to space and time. Conclusion: Colorectal inflammatory pseudopolyps may develop sporadically in up to one third of the cases while others frequently arise in the background of non-IBD colonic pathology. The increased presence of these polyps in the left colon raises the possibility that a subset of them may arise in predisposed mucosa. These polyps need to be differentiated from other morphologically similar colonic polyps.