A tubular polyp in the cecum during colonoscopic examination

Question

A 48-year-old woman came to our hospital for a health examination. She had no known medical conditions, but underwent cesarean section due to malpresentation about 20 years ago. Physical and laboratory findings were unremarkable. Colonoscopy disclosed a 0.5 cm × 5 cm tubular lesion within the cecum (Fig. 1 ).

Figure 1. A tubular lesion measuring 0.5 cm × 5 cm within the cecum.

Which is not the next proper procedure for this case?

• Polypectomy
• Biopsy
• Arrange other imaging studies, such as barium enema or CT colonography.

Answer

At first, a cecal polyp was considered and intervention procedures such as biopsy or polypectomy were to be performed. Further close observation at the base of the oblong polyp found a circular ring that could be the orifice of appendix. Furthermore, the mucosal feature of the polyp was similar to normal colonic mucosa. A lower gastrointestinal series using barium contrast medium delineated a tubular filling defect in the lumen of the cecum, whereas normal barium contrast medium filling in the lumen of the appendix was absent (Fig. 2 ). Inverted appendix was confirmed.

Figure 2. Lower gastrointestinal series using barium contrast revealed a tubular filling defect (arrows) in the lumen of the cecum.

Take-home message

Inverted appendix may be seen, though rarely, during routine colonoscopic examination. A neoplastic lesion is probably the only indication of performing polypectomy at colonoscopy. If a narrow band image or chromoendoscopy is available, non-neoplastic lesions could be confirmed, and unnecessary and potentially harmful polypectomy can be avoided in this clinical setting. Prior to polypectomy, careful observation of the mucosal pattern of the lesion to differentiate neoplastic or non-neoplastic lesions is important.

Conflicts of interest

All authors declare no conflicts of interest.