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Acute lower gastrointestinal bleeding from a polyp: An unusual etiology

An 81-year-old woman, without relevant pathologies or usual medication, presented with 3-day history of hematochezia. She denied diarrhea, fever, abdominal pain, similar prior episodes, and previous colonoscopy. No consumption of nonsteroidal anti-inflammatory drugs, antiplatelet agents, or anticoagulants. No family history of colorectal cancer or polyposis syndrome. She was hemodynamically stable. The laboratory examination revealed normal blood urea nitrogen (7 mg/dL), normal creatinine (0.55 mg/dL) and coagulation factors, and an anemia of 10.2 g/dL, normocytic and normochromic. A colonoscopy was performed identifying a 30-mm pedunculated polyp with active bleeding in the proximal descending colon (Figure 1A). An endoloop-assisted polypectomy technique was performed (Figure 1B). Since the stalk had more than 1 cm, hemostasis was reinforced with two hemoclips (Figure 1C) and the polyp recovered for histological evaluation (Figure 2). The patient was hospitalized for a short period of time and there was no hemorrhagic recurrence. Anatomopathological evaluation was compatible with an inflammatory pseudopolyp (Figure 2). Polyps usually induce chronic blood loss being the source of acute lower gastrointestinal bleeding in only a small percentage of patients. However, the exact frequency of this event is not known. In literature, only two cases of acute lower gastrointestinal bleeding due to polyps in adults were found and both patients were under anticoagulants. Risk factors for polyp's bleeding are size greater than 10 mm, presence of a stalk and a cherry-red color. The usual histopathological findings include marked vascular congestion and intramucosal blood lakes and these features can be seen in inflammatory pseudopolyps. This non-neoplastic polyps usually are found in regenerative and healing phases of inflammation so any form of severe colitis as inflammatory bowel disease, ischemic colitis, or infection colitis can originate them. However, inflammatory pseudopolypsmay develop sporadically in up to one third of the cases as happened in this situation.