Intestinal Polypoid Adenomas Clinical Presentation

Updated: Feb 05, 2018
  • Author: Swati G Patel, MD, MS; Chief Editor: BS Anand, MD  more...
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Presentation

History & Physical Examination

History

Most adenomas are asymptomatic and are identified primarily by colorectal cancer (CRC) screening tests or by colonic imaging tests ordered for unrelated reasons.

The most common symptoms and signs, usually occurring from large adenomas, include the following:

  • Rectal bleeding, overt and occult

  • Change in bowel habits

  • Abdominal pain

  • Rectal prolapse

  • Occasional bowel obstruction from a large adenoma

  • Intussusception

  • A large villous adenoma causing profuse watery diarrhea (rare)

Most patients have no symptoms and adenomas are found during routine colon cancer screening.

Rarely, patients, primarily Ashkenazi Jews, may have hereditary mixed polyposis syndrome, in which duplication of a noncoding sequence near the gremlin 1, DAN family BMP antagonist gene (GREM1) occurs. [34]  Clinical features include the presence of extracolonic tumors, onset of polyps in adolescence, and the rapid progression of some polyps to advanced adenomas. [34]

Physical examination

Physical examination findings are usually benign. A large rectal polyp or a flat adenoma can sometimes be detected on digital rectal examination.