A Case Of Serrated Polyposis Syndrome, Highlighting The Importance Of Awareness, Diagnostic And Surveillance criteria.
Butler J, Ireland A.
Depatment of general surgery, South infirmary Victoria Hospital, Cork City
Serrated Polyposis syndrome (SPS) is characterized by multiple serrated polyps in the large colon and is recognised as a risk factor for CRC. Where previously serrated polyps were thought to be benign entities, they have now been shown to have pre-malignant potential and are implicated in 15-30% of colorectal cancers. As the aetiology of SPS is unkown, diagnosis at present is based on the WHO definition of serrated polyposis syndrome 2019
I wish to submit the case of a 35 year old male current smoker who presented with a 3/12 hx of acute onset diarrhoea and was referred for colonoscopy by his general practitioner. He had no prior history of any bowel complaints. There was no family history of CRC or bowel issues. His TFT’S, IGA ANTI TTG and stool analysis were all negative. His first colonoscopy identified numerous colonic polyps, their locations were noted for future endoscopic resection. Over the course of four colonoscopies, there were twenty two polyps removed by cold snare and cold biopsy.
Four colonoscopies perfomed over a nine month timeframe.
On histological analysis, 21 of the polyps were shown to be SSP’S and one polyp showed normal colonic mucosa. Based on the above histology, our patient met the criterion for SPS. As the surveillance for SPS is continually evolving with figures of between one year and three years quoted. Our patient is scheduled for surveillance colonoscopy in three years.
This case highlights a diagnosis of serrated polyposis syndrome discovered on routine endoscopy in a previously well male. This case highlights SPS, its diagnostic criteria and the need for more established guidelines regarding surveillance requirements