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

Background: We report two rare cases of inflammatorycloacogenic polyps of the anorectum. The first case involves a 50year old white female who presented with chronic diarrhea,prolapse, and rectal bleeding. The second case presents a 67 year oldwhite male who presented with hemorrhoids and rectal bleeding. Itis hypothesized that correction of prolapse will resolve thepathologic changes. In these two patients, at one year follow-up,there has been gradual resolution of pathologic changes followingresection of lesions and correction of prolapse with stapledtechnique.Investigation: Physical examination, colonoscopy, andhemorrhoidectomy with correction of prolapseDiagnosis: The pathologic findings of these lesions are presented.A review of the literature in relation to this colonic lesion ispresented.Management: Inflammatory cloacogenic polyps (ICPs) are benignlesions arising from the transitional zone of the anorectal junctionand may macroscopically resemble anorectal malignancies. ICPsare being recognized lately with increasing frequency and treatmentoptions are similar as to those for other submucosal lesions of thecolon and may include conservative therapy, and endoscopicresection for small lesions. Surgical resection for larger lesions canbe used as treatment if there is a threat of obstruction, a question ofunderlying malignancy, or if they are prolapsed induced. Surgery isthe most common path for treatment. Surveillance is necessary withpatients that show severely dysplasic ICPs since they have beenassociated with anal neoplasias as well as squamous cellcarcinomas. It is hypothesized that correction of the prolapse willresolve the pathologic changes.