Villous Adenoma Clinical Presentation

Updated: Sep 21, 2022
  • Author: Alnoor Ramji, MD, FRCPC; Chief Editor: Burt Cagir, MD, FACS  more...
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History and Physical Examination


Note that the vast majority of patients are asymptomatic and have unremarkable laboratory findings. Approximately two thirds of colorectal polyps are asymptomatic. Any nonspecific intestinal symptoms are more likely to be coincidental. For example, bright red rectal bleeding in a patient in whom a small colonic polyp is eventually found is still most likely to be hemorrhoidal in origin. Polyps greater than 1 cm are more likely to produce symptoms, usually rectal bleeding, abdominal pain, and a change in bowel habits. Note the following:

  • The most common presenting symptom is occult/overt bleeding (hematochezia) with an anemia, which may be microcytic. Polyps may bleed only intermittently into the stromal component, thus accounting for inconsistent findings.

  • Nonspecific symptoms include diarrhea, constipation, and flatulence. A change in stool caliber (ie, the classic pencil-thin stools), although still described in older textbooks, is an entirely nonspecific and unreliable symptom. Pencil-thin stools, if truly present, would be secondary to large distal adenomas or frank carcinomas.

  • When intense cramping occurs, torsion or episodic intussusception due to larger adenomas may be considered.

  • Villous adenomas rarely cause a secretory diarrhea syndrome. The tumor usually is located at the rectosigmoid or rectum and often is 3-4 cm in diameter. Stool volumes of 350-3000 mL are reported and may cause hypovolemia and metabolic imbalances.

  • Patients may have a family history of polyps and colon cancer. Using data obtained from the prospective Health Professionals Follow-Up Study, in which men underwent endoscopy between 1986 and 2004, Wark et al examined whether a family history of colorectal cancer is associated with advanced adenoma stage, defined as 1 cm or larger and a histology with villous component or carcinoma in situ, or adenoma multiplicity. [15] Twenty-one percent of 3881 patients with adenoma and 13.9% of 24,959 adenoma-free men had a first-degree relative with colorectal cancer. The investigators found a number of positive associations with a family history of colorectal cancer including advanced and advanced adenomas, with the possibility of potential differences due to adenoma location, as well as the number of adenomas and presence of multiple distally located adenomas. [15] Wark et al suggested that at the population level, their findings may demonstrate a greater significance of heritable factors in earlier stages of adenoma formation than at stages of adenoma advancement for at least distally located adenomas. [15]

  • Patients with villous adenomas of the ampulla usually present with intermittent or progressive jaundice, abdominal pain, intestinal hemorrhage, or pancreatitis.

Physical examination

Patients often have no findings on bedside physical examination.

Occasionally, a palpable mass is present upon digital rectal examination.

Jaundice may be present with villous adenoma of the ampulla.