Familial Adenomatous Polyposis
Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 1 of 30.

Familial Adenomatous Polyposis of the Colon.

A colonoscopy performed in retroflexed maneuver from the cecum to the rectum. We have found nobody in the medical literature ever performed a complete colonoscopy in retroflexed maneuver from the cecum to the rectum in this fashion. Therefore we are claiming this achievement as a record.

Update, in the familial polyposis II chapter also, we performed a full colonoscopy in in retroflexed maneuver from the cecum to the rectum. As well as in the melanosis coli chapter


The image above reveals an enormous tubular and stalked
polyp at the hepatic angle.

A Case of Familial polyposis of the colon with two
adenocarcinomas are in colonic carcinoma chapter

Familial Adenomatous Polyposis of the Colon

Click on the endoscopic images to download the video clips. All endoscopic images shown in this Atlas contains video clips. 

 

 

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 2 of 30.

Endoscopy of Familial Adenomatous Polyposis of the Colon.

Our patient is a 27 year-old man from the republic of Nicaragua. His father died of colon carcinoma at the age of 36. Two brothers had colectomies due to similar familial polyposis. His sister did not have the disease.

The patient underwent a colectomy. The image of the sigmoid show a stalked polyp where multiple smaller polyps are seen nearby.

 

Endoscopy of Familial Adenomatous Polyposis of the Colon

Video Endoscopic Sequence 3 of 30.

Endoscopy of Familial Adenomatous Polyposis of the Colon

Retroflexed view of the enormous stalk of the biggest tumor at hepatic angle. There are several tiny polyps. Findings are indicative of Familial Adenomatous Polyposis (APC), an autosomic dominantly inherited disease characterized by the presence of 100 or more colorectal adenomatous polyps. The development of colon carcinoma is unavoidable if left untreated.

This disease is inherited as an autosomal dominant disorder with a 80% to 100% penetrance. Adenocarcinoma is the inevitable consequence of APC unless the colon is removed. Multiple colon malignancies can occur.

Colon Cancer has been reported as early as 9 years of age, although the occurrence of malignancy before adolescence is unusual. 

 

 

 

 

Endoscopy of Familial Adenomatous Polyposis of the Colon

Video Endoscopic Sequence 4 of 30.

The cecum.

The right colon is affected only with some tiny polyps.

 

Endoscopy of Familial Adenomatous Polyposis of the Colon

Video Endoscopic Sequence 5 of 30.

The ileocecal valve.

Tiny polyps are observed.
The video clip displays the beginning of the retroflexed
maneuver. 

 

Endoscopy of Familial Adenomatous Polyposis of the Colon

Video Endoscopic Sequence 6 of 30.

Endoscopy of Familial Adenomatous Polyposis of the Colon

Ascending Colon:

The beginning of a special way to explore the colon by
viewing it from cecum to rectum in retroflexed maneuver
We have not come across any prior experience with a total
retroflexed colonoscopy in the world´s literature.
We recommend that you look at the complete video
sequence to appreciate the advantages of this retroflexed
procedure.

 

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 7 of 30.

Retroflexed view of ascending colon near the hepatic angle.

 

Video Endoscopic Sequence 8 of 30.

Retroflexed view of hepatic angle, the biggest polypoid
tumor of the series is starting to appear. 

 

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 9 of 30.

Retroflexed view of hepatic angle. The largest tumor of
this case is seen here.

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 10 of 30.

Retroflexed view of the same case at the hepatic angle.
The view of this colonoscopy is different from a regular
colonoscopy.
The image displays an enormous pedicle of the biggest
polyp.

Some tiny polyps are observed nearby.

 

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 11 of 30.

Retroflexed view of the hepatic flexure.
A large twisted stalk and the polyps are seen.

 

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 12 of 30.

After overcoming some difficulties at the hepatic angle
the endoscope was advanced to the transverse colon.

 

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 13 of 30.

The transverse colon is seen in retroflexed view.

The video clip displays the long trajectory across the
transverse colon.

 

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 14 of 30.

The transverse colon in retroflexed maneuver.

 

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 15 of 30.

Splenic flexure in retroflexed view

There are several tiny polyps.
The entire colon looks somewhat different in retroflexed
view. Observe this angle view that is different of normal
forward view.

 

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 16 of 30.

Splenic angle is seen in a different view from a
conventional colonoscopy.

 

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 17 of 30.

Descending colon in retroflexed view is seen.
There are several and some pediculated adenomas.

Download the video clip.

 

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 18 of 30.

Adenomas of different sizes, stalked and sessile.

 

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 19 of 30.

Descending-Sigmoid junction.
Several tiny polyps are appreciated.

 

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 20 of 30.

Rectum seen in retroflexed maneuver.

Finally, we got to the end. A complete colonoscopy in
retroflexed maneuver from the cecum to the rectum.
The colonoscopy in retroflexed maneuver offers additional
views of the colon which increases the sensitivity of the
procedure in some cases. The retroflex maneuver, which
is commonly utilized within the stomach and esophagus,
where it is of great benefit to detect small lesions, had not
been utilized within the colon either because it was
deemed unnecessary, because of its technical difficulty or
because of the fear of perforation. We believe that, as part
of the development and evolution of endoscopic technique,
the complete retroflexed colonoscopy maneuver has its
place as a special endoscopic procedure in selected cases. 

 

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 21 of 30.

Post surgical status, patient underwent surgery.
The image and the video display the scar of the Ileorectal
Anastomosis.
Ablation of rectal adenomas every 6 to 12 months should
be done.

 

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 22 of 30.

Terminal ileum.

The image and the video terminal ileum is observed
which has been jointed with the rectum, hyperplasia
linfoide is observed which is normal in the terminal ileum.

 

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 23 of 30.

Papilla of Vater.

A small adenoma is observedin the same patient above. A carefully inspection of the papilla of Vater should be done removing any adenoma to avoid adenocarcinoma of the duodenum and the papilla of Vater, occurs in as many as 12% of patients.

Patients with familial adenomatous polyposis (FAP) have a high prevalence of duodenal adenomas, and the region of the ampulla of Vater is the predilection site for duodenal adenocarcinomas.

The average age at diagnosis of periampullary cancer in patients with polyposis is 46 years, compared with 39 years for the age of colon cancer diagnosis. fifty percent of patients with polyposis exhibit adenomatous histology of the papilla, although the polyps are often small and difficult to appreciate without a side-viewing endoscope.

More than one third of the duodenal cancers reported occur at the papilla, and obstruction of the pancreatic duct has been observed from benign and malignant neoplasia of the papilla.

 

 

 

 

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 24 of 30.

Minor papilla.

The video clip displays both papillas.

Argon Plasma Coagulator.

Video Endoscopic Sequence 25 of 30.

Argon Plasma Coagulator.

APC has a useful application in the fulguration of small
rectal polyps in FAP.

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 26 of 30.

Status post argon plasma coagulator APC.

More endoscopic details download the video clip by
clicking on the endoscopic image.

 

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 27 of 30.

Two weeks after the therapy with Argon Plasma
Coagulator. 
The image and the video display several rectal ulcers
some of them with visible vessels.

 

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 28 of 30.

The patient also has multiple gastric polyposis

There are several hyperplastic small polyps in the gastric body and fundus.

Hyperplastic polyposis in the stomach is not an infrequent
finding in Familial Polyposis. These hyperplastic polyps do
not cause any symtoms and do not need any treatment.

 

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 29 of 30.

Patients with Familial Polyposis should be examined by an
upper gastrointestinal endoscopy at time of diagnosis, and
at regular intervals, mainly because of a risk of malignant
changes in the duodenum. The hyperplastic polyposis often
seen is probably not associated with any significant risk of
malignancy.

 

Familial Adenomatous Polyposis of the Colon.

Video Endoscopic Sequence 30 of 30.

There are several polyps in the fundus seen with methylene blue.

 

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