Adenoma - pedunculated 2 (thick and long pedicle)
This 75-year-old white male patient reported a history of blood in the stool for several months with occasional left lower abdominal pain. He was, however, initially reluctant to consult with his physician. Colonoscopy revealed a polyp 3 cm in diameter with a long pedicle in the middle sigmoid colon. Histological examination revealed a tubular adenoma with severe dysplasia but no infiltration of the pedicle.
The videoclip shows the pedunculated polyp. Following removal with the wire loop, the remaining pedicle stump was ligated with two clips.
Polyps of this size may bleed intermittently. The patient’s reported mild pain in the left lower abdomen could also have been due to the polyp. As a precaution, the short pedicle stump was ligated with two clips following removal of the polyp. A pedicle of this length can also be addressed with an endoloop prior to polyp removal to prevent bleeding.