Video Endoscopic Sequence 1 of 7.

Cap polyposis that resemble a adenocarcinoma of the rectum.

This 22 year-old lady, has been presented with rectal bleeding and mucus discharge, also has been suffering of Bulimia Nervosa.

Digital rectal examinations revealed polypoidal masses in the rectum.

Download the video clips by clicking on the endoscopic images, if you wish to observe in full screen, wait to be downloaded complete then press Alt and Enter for Windows media, Real Player Ctrl and 3.

Configure the windows media in repeat is optimal.
All endoscopic images shown in this Atlas contain video clips. We recommend seeing the video clips in full screen mode.

Video Endoscopic Sequence 2 of 7.

Cap polyposis is characterized by the presence of inflammatory polyps with a "cap" of granulation tissue. It may represent one end of a spectrum of conditions caused by chronic straining.

Polyps have an erythematous and inflamed appearance and are capped with a purulent fibrin exudate.

The pathogenesis is not well known although many affected individuals have long standing colonic dysmotility manifested by chronic constipation.

It is hypothesized that recurrent mucosal trauma due to chronic straining can result in the clinical spectrum of mucosal prolapse syndrome which includes solitary rectal ulcer syndrome and the more dramatic finding of cap polyposis.

Video Endoscopic Sequence 3 of 7.

The findings here are of cap polyposis, a rare condition thought to be related to chronic constipation and straining causing prolapse of mucosa in the rectum and sigmoid.

Often mistaken for pseudopolyps, the polyps seen can range from sessile to pedunculated in morphology and can be found anywhere from the rectum to the cecum although the vast majority are found in the rectosigmoid region as in this example.

Video Endoscopic Sequence 4 of 7.

Chromoendoscopy with indigo carmin.

Cap polyposis is characterized by rectosigmoid polyps that have tortuous elongated crypts and are covered by a cap of fibropurulent exudate.

The pathogenesis is unknown, but the histology suggests that mucosal prolapse may play a role.

The current therapy often used for inflammatory bowel diseases has frequently been ineffective.

Overall infliximab lead to symptomatic improvement and histologic resolution of the polyps.

Video Endoscopic Sequence 5 of 7.

Argon Plasma Coagulation was used as ablative therapy.

Video Endoscopic Sequence 6 of 7.

Recently, there was a case report published, on a patient with cap polyposis who was treated with a single infusion of infliximab 5 mg/kg and who demonstrated dramatic symptomatic improvement.

Video Endoscopic Sequence 7 of 7.

Status after the polyps were considered successfully ablated with argon plasma coagulation.

Three different session of argon plasma coagulator were used.

Cap Polyposis.

Another Case.

This 47 year-old female, who has been suffering of rectal discharge with mucoid secretion.