Correction of anal prolapse associated with resolution of cloacogenic polyp lesions. Implications to anorectal cancer

Background: We report two rare cases of inflammatory cloacogenic polyps of the anorectum. The first case involves a 50 year old white female who presented with chronic diarrhea, prolapse, and rectal bleeding. The second case presents a 67 year old white male who presented with hemorrhoids and rectal bleeding. It is hypothesized that correction of prolapse will resolve the pathologic changes. In these two patients, at one year follow-up, there has been gradual resolution of pathologic changes following resection of lesions and correction of prolapse with stapled technique. Investigation: Physical examination, colonoscopy, and hemorrhoidectomy with correction of prolapse Diagnosis: The pathologic findings of these lesions are presented. A review of the literature in relation to this colonic lesion is presented. Management: Inflammatory cloacogenic polyps (ICPs) are benign lesions arising from the transitional zone of the anorectal junction and may macroscopically resemble anorectal malignancies. ICPs are being recognized lately with increasing frequency and treatment options are similar as to those for other submucosal lesions of the colon and may include conservative therapy, and endoscopic resection for small lesions. Surgical resection for larger lesions can be used as treatment if there is a threat of obstruction, a question of underlying malignancy, or if they are prolapsed induced. Surgery is the most common path for treatment. Surveillance is necessary with patients that show severely dysplasic ICPs since they have been associated with anal neoplasias as well as squamous cell carcinomas. It is hypothesized that correction of the prolapse will resolve the pathologic changes. Keywords: Inflammatory Cloacogenic Polyps, lesions of the colon, mucosal prolapse, cancer. Received: 25 February 2009 / Received in revised form: 25 February 2009, Accepted: 25 February 2009, Published online: 12 March 2009