What Is a Juvenile Polyp?

Mucosal bulge-like lesions caused by local mucosal hyperplasia and hypertrophy caused by chronic mucosal inflammation can also be adenomas or hamartomas. It is mainly found in the large intestine (colon and rectum), while the small intestine (duodenum, jejunum, and ileum) is less common. Large intestinal polyps can occur singly, or several, dozens, or more. Most have pedicles, and few are broad-based. Most cases often have no noticeable symptoms and are only found incidentally during an intestinal X-ray examination, fiberscope, or autopsy for other diseases. Intestinal polyps are more common and their incidence can increase with age. More common in adults over 40 years of age, slightly more men than women. Some patients may have clinical manifestations such as blood in the stool, abdominal pain, and diarrhea. Most of the polyps are benign. After surgical resection or high-frequency resection via fiber endoscope, the prognosis is good, but it should be noted that some polyps can be malignant, and local bowel resection should be performed as soon as possible.

Chinese name: Intestinal polyps

Foreign name: polyp of intestine

Causes of intestinal polyps and common diseases

Common colorectal polyps include hyperplastic polyps, inflammatory polyps, child polyps, adenomas, and papillary adenomas. In addition, it is also common in familial polyposis and Petz-Jaggers syndrome.

Intestinal polyp hyperplastic polyp

It is more common in the large intestine, the cause of which is unknown, and it usually occurs after middle age. It can occur in 25 to 80% of autopsy specimens. Most manifested as a mound-like or semi-circular hump on the surface of the mucosa, generally smaller, about 0.5 cm in diameter. Often multiple. The pathological structure is hyperplasia of mucosa. Clinically asymptomatic, mostly accidentally found during endoscopic examination. This polyp does not become cancerous, so no treatment is required.

Intestinal polyp inflammatory polyp

Also called pseudopolyp. It is the fibrous tissue proliferation and submucosal edema between the ulcers of the large intestine during the healing process, which gradually forms the normal mucosal surface. Common intestinal diseases such as chronic ulcerative colitis, amoebic dysentery, schistosomiasis, and intestinal tuberculosis. Polyps are generally small, slender and curved, and irregular in shape. One end is free or both ends are attached to the intestinal wall and the middle is suspended like a bridge. Often multiple, clinical manifestations of blood in the stool or slime stool, combined with the history of intestinal inflammatory diseases, through fiber colonoscopy or X-ray barium enema examination, easier diagnosis. Treatment is mainly to control the primary lesion, and if necessary, to perform bowel resection. It is still difficult to conclude whether inflammatory polyps will become cancerous, but it is clinically found that patients with ulcerative colitis are more likely to have colorectal cancer than patients without ulcerative colitis. The longer the course, the higher the incidence of cancer.

Intestinal polyps

It mainly occurs in children, most of them are under 10 years old, and the most common is about 5 years old, which is more common among boys. Adults are rare. This shows that this polyp can fall off on its own. Polyps occur mainly in the rectum and the lower end of the sigmoid colon. They are usually single, and if they are multiple, they do not exceed 3 to 4. Polyps are spherical and most of them do not exceed 1 cm in diameter. Pathologically, it is strepoma. Because the polyp is brittle in texture and rich in blood vessels, blood in the stool or dripping blood from the stool is the main manifestation of the disease. This polyp does not become cancerous, and can be removed by endoscopic electrocautery treatment or it can fall off by itself.

Intestinal polyp adenoma

Benign tumors of the glandular epithelium. More common in various glandular organs and mucous membranes, etc., mostly round and nodular, often with a complete envelope. Adenoma grows out of the body and hangs in the cavity like a polyp. It is called a polypoid adenoma. Those with a papillary or villous appearance are called papillary adenomas or villous adenomas. An adenoma that expands into a sac by accumulation of its secretions is called a cystadenoma. According to the nature of the secretion, serous cystadenoma and mucinous cystadenoma can be divided. The cystic gland epithelium is highly proliferated, and most of the nipples protruding inside the cyst are called papillary cystadenoma. Glandular hyperplasia is the main type, and those with less interstitial hyperplasia are called simple adenomas. Glandular cavity and interstitial hyperplasia are also called fibroid adenomas. Under the microscope, the glands are increased, the size and shape of the glandular cavity are different, and the relationship between the normal glands and the drainage tube is lost. Some can be cancerous and can be treated surgically.

Intestinal polyp papillary adenoma

Also called lichen-like adenoma or villous adenoma. Rare, but prone to cancer. This kind of adenoma accounts for about 4 to 10% of large intestinal polyps. It is more common in the elderly and rarely occurs under the age of 40. The average age is more than 60 years. More men than women, about 90% of cases occur in the rectum and sigmoid colon. The tumors are large, most of which are broad-based, with purple fluff or velvet surface. There is usually only one, and occasionally several. The main symptoms are diarrhea and bleeding. Diarrhea occurs because the tumor is large and stimulates intestinal peristalsis; due to the loss of large amounts of water, salt and protein, weakness, weight loss and even electrolyte disturbances can occur. Examination by sigmoidoscopy or fiber colonoscopy and X-ray barium enema is easier to find. Treatment is generally advocated for surgical removal. If there is malignant change, local intestinal segment resection should be done as soon as possible.

Intestinal polyps familial polyposis

Also known as familial adenoma disease, hereditary multiple polyps. A relatively rare hereditary disease, with autosomal dominant inheritance, 50% of the children of the affected may also get the same disease. There is not much difference in gender. Polyps often appear after the age of 10 and generally do not exceed the age of 40. The occurrence of polyps is limited to the colon and rectum. Multiple. It is a tumor-like polyp that will eventually become cancerous. Clinical manifestations are blood in the stool, diarrhea, weight loss and other symptoms. The main treatment is surgical removal of the colon and rectum.

There is still a variant of this disease, characterized by multiple colon polyps with small intestine, stomach, bone and skin tumors. This disease is called Gardner's syndrome.

Intestinal polyps Petz-Jaggers syndrome

Also known as melanin plaque-gastrointestinal polyposis syndrome. A rare genetically related disease. There is no significant difference in gender. In addition to polyps that are widely distributed in the gastrointestinal tract, brown, blue, or black pigmented spots may appear around the mouth, lips, buccal mucosa, hands and feet, etc. Pigmented spots can appear after birth, and most of the polyps are in adult Appears, involving the entire gastrointestinal tract, more common in the stomach and small intestine. Polyps are hamartomas. There may be no clinical symptoms, and some cases may have abdominal pain, diarrhea, bleeding and other symptoms, which can sometimes cause intestinal obstruction. If there is no comorbidity, surgery is generally not required. This syndrome is rarely cancerous. Recently, 2 to 3% of the risk of gastrointestinal cancer was found, often involving the duodenum.

Differential diagnosis of intestinal polyps

1. Blood in the stool may be blood in the stool or blood in the stool as the most common first symptom. Blood in the stool is generally small and recurrent intermittently. Blood can also cover the surface of the stool or drip after the stool, and it is sometimes easily mistaken for hemorrhoid bleeding.

2. The degree of diarrhea is mild, and the stool often has mucus.

3. Other symptoms include abdominal pain, weight loss, anemia, and intussusception.

Intestinal polyps

Sigmoidoscopy and fiber colonoscopy often show a single, sometimes multiple red-banded pedicles or wide-based polyps, of varying sizes and shapes, soft to the touch and prone to bleeding.

Double contrast angiography of barium enemas and barium enema shows a round or oval filling defect with clear and smooth edges.

Pathological examination can determine the type of polyp.

V. Principles of treatment

(1) Large polypoid adenomas are mainly surgically removed, or removed by electrocautery under a colonoscope. Non-pedicled polyps can also be directly burned.

(2) Symptoms of inflammatory polyps, juvenile polyps, and other hamartomas that are symptomatic can be removed by colonoscopy microwave or electrocautery, and can also be locally excised, with a good prognosis.

(3) Familial colonic polyposis is mostly adenoma-like and susceptible to canceration, and colonectomy is often advocated.