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Citrullus vulgaris: another cause of colon pseudopolyps
2. Barone RM, Byfield JE, Goldfarb PB, Frankel S, Ginn C, Greer S. Intra-arterial chemotherapy using an implantable infusion pump and liver irradiation for the treatment of hepatic metastases. Cancer 1982;50:850-62. 3. Shepard KV, Levin B, Karl RC, Faintuch J, DuBrow RA, Hagle M, Cooper RM, Beschorner J, Stablain D. Therapy for metastatic colorectal cancer with hepatic artery infusion chemotherapy using a subcutaneous implanted pump. J Clin Oncol 1985;3:161-9. 4. Hohn D, Stagg R, Ignoffo R, Friedman M, Melnick J, Altman D, Lewis B. Incidence and prevention of complications of cyclic hepatic artery infusion (HAl) of floxuridine (FUDR): severe biliary sclerosis, gastritis and ulcer. ASCO Proceedings 1984;3:148. 5. Gillin JS, Kemeny N, Daly JM, Balis MB, Kurtly RS, Shike M. Severe gastroduodenal ulcerations complicating hepatic artery infusion chemotherapy for metastatic colon cancer. Gastroenterology 1983;34:116. 6. Chuang VP, Wallace S, Stroehlein J, Yap HY, Patt YZ. Hepatic artery infusion chemotherapy: gastroduodenal complications. Am J Roentgenol 1981;137:347-50.
Citrullus vulgaris: another cause of colon pseudopolyps To the Editor: Pseudopolyps are usually found in inflammatory bowel disease.! We recently observed a polypoid lesion which so closely resembled a true polyp that an attempt to remove it by electrocautery was made. A 45-year-old woman presented with a 14-month history of left upper quadrant pain and pencil-shaped stools. There was a strong family history of colon carcinoma. Her physical examination was unremarkable. A CBC and urinalysis were within normal limits. Stools were guaiac negative. At colonoscopy a lobulated polypoid lesion measuring 3 em in diameter at the level of the mid-sigmoid colon was found. The instrument was then advanced to the cecum, and no other abnormalities were noted. Upon withdrawing the colonoscope, a wide-loop snare was passed over the polyp, at which point it became detached from the overlying mucosa, which was of normal character. It was obvious that the polyp was in fact, a foreign body. A small Fleet's enema was given, and the foreign body was recovered and identified as a piece of Citrullus vulgaris (watermelon). On questioning the patient, she stated that she had eaten a light supper consisting of rice, chicken, and watermelon 2 hours prior to taking the Golytely@ solution the evening before the procedure. Certain features are of interest in this case. The colon was completely clean, with the exception of the small piece of watermelon. The watermelon looked like a polypoid lesion and was essentially undigested. In spite of advancing the instrument to the cecum, and manipulation of the instrument, the pseudopolyp remained attached to the mucosa at the same level where it was originally found. Another experienced endoscopist was called to observe the "lesion" and agreed that it corresponded to a lobulated benign adenomatous polyp. Other polyp-like formations include focal polypoid hyperplasia,2 lipid granulomas,3 everted diverticula, and pneumatosis cystoides intestinalis, but in general, these can be easily distinguished from true adenomatous polyps. David S. Cantor, MD Huntington Memorial Hospital Pasadena, California
VOLUME 33, NO. 2, 1987
REFERENCES 1. Haubrich WS, Berk EJ. Benign tumors of the colon and rectum In: Bockus HL, ed. Gastroenterology. Philadelphia: WB Saunders, 1976:1059. 2. Crocker DW, Veith FW. Focal primary mucosal hyperplasia of the colon: the case for its importance in the pathogenesis of cancer. Ann Surg 1964;160:215-25. 3. Wittoesch JH, Jackman RJ, McDonald JR. Lipoid granulomas of the rectum. Proc Staff Meet Mayo Clinic 1956;31:265-71. 4. Bass DD, Schuster MM. Proctoscopic diagnosis of pneumatosis cystoides coli. Gastrointest Endosc 1970;16:164-6.
Endoscopic elastic band ligating device, pneumatically released To the Editor: Stiegmann et aI., in their article in the June 1986 issue,! describe a new method of elastic band ligation using flexible endoscopes. In 1978 we used a similar method. A cylindric metal tube was attached to the endoscope (Fig. 1). Using a conical loading device, an a-ring was stretched over the tube. By means of endoscopic suction, mucosa could be aspirated into the tube (Fig. 2A). The a-ring could be released pneumatically (Fig. 2, B and C). Figure 3 shows a vascular malformation immediately after ligation (A) and 1 week later (B). We have used the device in the stomach of five patients without complications.
Figure 1
INSTlUeJTAT ICN
OWI'JEL
B
MXlJ5'I_ L1CATID
c Figure 2 129
Citrullus vulgaris: another cause of colon pseudopolyps To the Editor: Pseudopolyps are usually found in inflammatory bowel disease.! We recently observed a polypoid lesion which so closely resembled a true polyp that an attempt to remove it by electrocautery was made. A 45-year-old woman presented with a 14-month history of left upper quadrant pain and pencil-shaped stools. There was a strong family history of colon carcinoma. Her physical examination was unremarkable. A CBC and urinalysis were within normal limits. Stools were guaiac negative. At colonoscopy a lobulated polypoid lesion measuring 3 em in diameter at the level of the mid-sigmoid colon was found. The instrument was then advanced to the cecum, and no other abnormalities were noted. Upon withdrawing the colonoscope, a wide-loop snare was passed over the polyp, at which point it became detached from the overlying mucosa, which was of normal character. It was obvious that the polyp was in fact, a foreign body. A small Fleet's enema was given, and the foreign body was recovered and identified as a piece of Citrullus vulgaris (watermelon). On questioning the patient, she stated that she had eaten a light supper consisting of rice, chicken, and watermelon 2 hours prior to taking the Golytely@ solution the evening before the procedure. Certain features are of interest in this case. The colon was completely clean, with the exception of the small piece of watermelon. The watermelon looked like a polypoid lesion and was essentially undigested. In spite of advancing the instrument to the cecum, and manipulation of the instrument, the pseudopolyp remained attached to the mucosa at the same level where it was originally found. Another experienced endoscopist was called to observe the "lesion" and agreed that it corresponded to a lobulated benign adenomatous polyp. Other polyp-like formations include focal polypoid hyperplasia,2 lipid granulomas,3 everted diverticula, and pneumatosis cystoides intestinalis, but in general, these can be easily distinguished from true adenomatous polyps. David S. Cantor, MD Huntington Memorial Hospital Pasadena, California
VOLUME 33, NO. 2, 1987
REFERENCES 1. Haubrich WS, Berk EJ. Benign tumors of the colon and rectum In: Bockus HL, ed. Gastroenterology. Philadelphia: WB Saunders, 1976:1059. 2. Crocker DW, Veith FW. Focal primary mucosal hyperplasia of the colon: the case for its importance in the pathogenesis of cancer. Ann Surg 1964;160:215-25. 3. Wittoesch JH, Jackman RJ, McDonald JR. Lipoid granulomas of the rectum. Proc Staff Meet Mayo Clinic 1956;31:265-71. 4. Bass DD, Schuster MM. Proctoscopic diagnosis of pneumatosis cystoides coli. Gastrointest Endosc 1970;16:164-6.
Endoscopic elastic band ligating device, pneumatically released To the Editor: Stiegmann et aI., in their article in the June 1986 issue,! describe a new method of elastic band ligation using flexible endoscopes. In 1978 we used a similar method. A cylindric metal tube was attached to the endoscope (Fig. 1). Using a conical loading device, an a-ring was stretched over the tube. By means of endoscopic suction, mucosa could be aspirated into the tube (Fig. 2A). The a-ring could be released pneumatically (Fig. 2, B and C). Figure 3 shows a vascular malformation immediately after ligation (A) and 1 week later (B). We have used the device in the stomach of five patients without complications.
Figure 1
INSTlUeJTAT ICN
OWI'JEL
B
MXlJ5'I_ L1CATID
c Figure 2 129