EP744 - Inflammatory Cloacogenic Polyps in Crohn’s Disease: A Rare Entity With Malignant Potential

Purpose/Background: Inflammatory cloacogenic polyps are rare benign growths typically located in the anorectal transition zone and are thought to arise from chronic mucosal ischemia and regenerative changes. They are often associated with mucosal prolapse and chronic inflammatory disorders such as Crohn's disease, among others. However, due to the rarity of this pathology and limited literature available, a definitive causal relationship between these disorders remains unclear. Although generally benign, these lesions carry a potential risk for malignant transformation, particularly in the setting of HPV infection. Endoscopic or surgical resection remains the treatment of choice with continued surveillance recommended due to the risk of recurrence and neoplastic progression.

Methods/Interventions: We present a case of a 47-year-old asymptomatic female with Crohn's disease, diagnosed at 25 years of age and well-controlled on Adalimumab and Mesalamine, who was referred to colorectal surgery after an anal canal ulceration was identified on her most recent screening colonoscopy. Biopsy demonstrated histologic features consistent with an inflammatory cloacogenic polyp. Following extensive counseling regarding its malignant potential, she underwent transanal excision of the remaining lesion.

Results/Outcomes: Final pathology demonstrated mixed inflammatory and hyperplastic features consistent with an inflammatory cloacogenic polyp, with no evidence of dysplasia or malignancy. The patient's postoperative course was unremarkable, and she was advised to follow up with her outside gastrointestinal specialist for ongoing surveillance.

Conclusion/Discussion: Inflammatory cloacogenic polyps can closely mimic other pathologies, including solitary rectal ulcers, hemorrhoids, or anorectal carcinomas, making histopathologic evaluation essential for accurate diagnosis and exclusion of underlying dysplasia. This case highlights the importance of prompt recognition, definitive treatment, and continued surveillance of inflammatory cloacogenic polyps despite their seemingly benign appearance. Further studies are warranted to elucidate the pathophysiologic basis underlying the association between cloacogenic polyps and chronic inflammatory bowel disease, as this may improve our understanding of the etiopathologies of these rare lesions.

Endoscopic evaluation of the anal canal revealing a small ulceration without active bleeding