Colonic stricture with filiform polyposis in Crohn's disease.

To cite: Hokama A, Nagahama M, Kishimoto K, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014204710 DESCRIPTION A 41-year-old man with a 5-year history of Crohn’s disease presented with abdominal distention, right lower quadrant pain and weight loss for 4 weeks. On physical examination, the abdomen was distended with right lower quadrant tenderness. Plain radiograph of the abdomen disclosed marked dilation of the ascending colon due to a stricture at the hepatic flexure and intraluminal polypoid filling defects that suggested the presence of postinflammatory polyps (figure 1). Colonoscopy failed to disclose the precise cause of the stricture. CT scan could not rule out neoplasms at the stricture. He thus underwent right hemicolectomy. Gross examination showed a colonic stricture with filiform polyposis at the hepatic flexure and the ileocaecal region (figure 2). Only oedematous fine holds were noted on the dilated ascending colon. Pathological examination confirmed no evidence of calcification, adenoma or adenocarcinoma. The postoperative course was uneventful and he remains well. Filiform polyposis is an uncommon entity characterised by numerous slender and finger-like polyps. It is usually associated with a history of ulcerative colitis, Crohn’s disease and intestinal tuberculosis. Filiform polyposis develops as a postinflammatory reparative process in response to the altering ulceration and healing cycles during chronic luminal inflammation. Filiform polyposis itself is not considered precancerous and thus does not require surgical resection except in complications including bowel obstruction, as in this case.