Colonoscopy has the great advantage of early diagnosis of precancerous colonic lesions, including adenomatous polyps. Adenomatous polypoid lesions may occur anywhere throughout the colonic mucosa. Compared to the incidence rates in other portions of the colon, they are rarely seen in the cecum (8%) (3, 4). They may be broad-based or pedunculated and vary in size and may cause obstruction. Interestingly, even though the polypoid lesion in our case reached obstruction size, it did not cause any clinical sign that might be related to intestinal obstruction. Also of interest is that the major complaint of our patient was swelling and recurrent hernia of the right inguinal region.
Inguinal hernia may occur at any age. However, it is important to recall that any pathologic condition that causes increased intraabdominal pressure may cause an inguinal hernia. In our clinic, to rule out any neoplastic lesion, we routinely use ultrasonography and, if necessary, abdominal CT in older patients with inguinal hernia.
Villous adenoma may cause two important complications, namely obstruction and electrolyte imbalance. In our case, villous adenoma did not cause electrolyte imbalance or intestinal obstruction, despite its macroscopic appearance and significant dimensions. In addition to its complete histopathologic benign nature on LM examination, these were the most interesting aspects of the present case. These features of our case are not in line with previous reports (5-7).
There are some reports in the literature that indicate that local giant polyposis occurs as a consequence of chronic inflammatory bowel disease (1, 3, 8). Also, giant pseudopolyposis occurring in 10%-20% of ulcerative colitis cases mimics villous adenoma (9, 10). However, in our case, histopathological examination of the lesion did not reveal any sign of inflammatory bowel disease.
In conclusion, we believe that in older patients with inguinal hernia, presence of an intraabdominal mass should be considered. Also, villous adenomas may reach significant dimensions without causing any signs of obstruction or electrolyte imbalance and they may mimic colon carcinoma.