Familial polyposis is an autosomal dominant disease, occasionally seen in people without family history, mostly accumulating in the whole colon and rectum, with the number of polyps ranging from about 100 to thousands, from the size of a soybean to several centimeters in diameter, often densely arranged. The common clinical manifestations are blood in the stool, diarrhea, sometimes abdominal pain, mucus stool, and even anemia and weight loss. The age of prevalence is 20 to 40 years old. The diagnosis is usually confirmed by clinical presentation, e-colonoscopy and biopsy.
Familial polyposis is a recognized precancerous lesion that will almost certainly become cancerous if left untreated. Therefore, once diagnosed, it should be promptly treated by surgery. Surgery mainly includes traditional open surgery and laparoscopic surgery. Traditional laparoscopic surgery requires both left and right hemicolectomy and rectal surgery, large abdominal incision, large intra-abdominal organ interference and trauma, and is prone to complications such as incisional infection, incisional dehiscence, intestinal adhesion and intestinal obstruction, which prolong patients’ hospital stay. With the development of laparoscopic technology and its wide application, it can completely avoid the above-mentioned disadvantages, and with less injury, faster postoperative recovery and significantly shorter hospital stay, laparoscopy has become a treatment procedure routinely performed by us. A typical case of familial colonic polyposis treated with the aid of laparoscopy is reported below.
Patient Sun**, male, 51 years old. He was admitted to the hospital with “blood in the stool for more than 1 month”. The patient had persistent blood in the stool with no obvious cause 1 month ago, with a small amount, occasional abdominal pain and distension, which could be relieved by itself, without nausea and vomiting. Stool routine showed positive fecal occult blood test (+), e-colonoscopy suggested multiple polyps in the colon (Figure 1), and pathological examination suggested tubular adenoma with low-grade intraepithelial neoplasia in the ascending colon. The patient came to our hospital for surgical treatment. During the course of the disease, the patient was mentally well, with no significant changes in weight, normal appetite and diet, normal urine and irregular stools. After the diagnosis was clear, the patient underwent laparoscopic assisted total colectomy, ileostomy and rectal mucosal debridement (see Figure 2) on 2012-05-08 in our hospital, and was discharged after postoperative treatment with rehydration, anti-infection and nutritional support.
Figure 1. colonoscopic labeling of multiple polyps in the colon Figure 2. resection of the whole colon Figure 3. abdominal appearance