Clinical features, diagnosis, and treatment of colorectal cap polyposis

Authors:
  • LSLi-Na Shan
    Li-Na Shan
  • JSJin-Lin Shan
    Jin-Lin Shan
  • SYSi-Jie Yin
    Si-Jie Yin
  • BBBing-Jun Bai
    Bing-Jun Bai
  • KXKai Xu
    Kai Xu
  • SDSheng Dai
    Sheng Dai
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Abstract
BACKGROUND Cap polyposis (CP) is a rare benign colorectal disorder characterized by polyps capped with fibrinopurulent exudate and is frequently misdiagnosed as inflammatory bowel disease because of overlapping clinical and histological features. No consensus exists regarding optimal management strategies. The aim of this study was to establish a standardized stepwise management algorithm for CP based on lesion distribution, number, size, and symptom severity, with the hypothesis that such an approach will optimize therapeutic outcomes while minimizing unnecessary interventions. AIM To clarify the clinical features, endoscopic findings, treatments and short-term outcomes of colorectal CP and provide clinical information for the diagnosis and treatment of this rare disease. METHODS We retrospectively collected data from seven consecutive patients with histologically confirmed CP who were treated at our center between January 2022 and January 2025. RESULTS The cohort comprised six males and one female (median age 36 years). Hematochezia was the main symptom (n = 3), and two patients had hypoalbuminemia. Five patients had solitary lesions and two patients had multiple lesions. All the polyps had a characteristic “cap-like” appearance with white fibrinous exudate covering the surface. Histology revealed elongated, dilated crypts and mucosal hyperplasia covered by granulation tissue. One patient with small, asymptomatic lesions was kept under surveillance. Three patients underwent endoscopic mucosal resection, and three underwent transanal excision. Symptoms resolved in all treated patients. During a median follow-up of 18 months (range 10-30 m), no recurrence was detected. CONCLUSION In this small series, CP affected mainly males and resulted in rectal bleeding. Both endoscopic and transanal resection relieved symptoms, but larger studies with longer follow-up periods are needed to confirm long-term efficacy.

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