P4144 - The Show Must Go On: Endoscopic Removal of Cloacogenic Polyp in an Opera Singer

Miguel Martins, MD, Francisco Mendes, MD, Rui Morais, MD, Guilherme Macedo, MD, PhD, FACG
Centro Hospitalar Universitário de São João, Porto, Porto, Portugal

Introduction: We present a case of a 34-year-old opera singer presented with chronic fecal obstruction and intermittent rectal bleeding.

Case Description/Methods: Apart from a history of childhood urinary incontinence, she had no other significant medical history. These symptoms persisted form months, causing a bothersome sensation of protrusion during bowel movements that significantly affected her singing career. The patient underwent colonoscopy which revealed multiple sessile serrated polyps (Paris 0-Isp) ranging from 5 to 20 millimeters in size, located in the distal rectum just above the anorectal junction. Biopsies revealed the presence of inflammatory stroma, along with dilated glands and an ulcerated surface, with absence of dysplasia, consistent with inflammatory cloacogenic polyps. The patient underwent endoscopic mucosal resection, using a piecemeal hot snare technique. Oozing bleeding for several large vessels occurred during procedure, but was effectively controlled with a grasper. Histopathological analysis confirmed the inflammatory cloacogenic polyps identified on prior biopsy. Following this, the patient underwent pelvic floor MRI, which revealed incomplete stool evacuation despite straining, with no evidence of anatomical prolapse.

Discussion: Cloacogenic polyps, though uncommon, can present as benign, typically sessile lesions, although pedunculated forms exist, with 1-5 cm. They usually arise in the anorectal transition zone and can rarely transform into malignant tumors. This case adds to the limited data on managing these rare polyps and underscores the potential association with pelvic floor dysfunction.


Disclosures:


Miguel Martins, MD, Francisco Mendes, MD, Rui Morais, MD, Guilherme Macedo, MD, PhD, FACG. P4144 - The Show Must Go On: Endoscopic Removal of Cloacogenic Polyp in an Opera Singer, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.