Bleeding from the rectum is attributed to hemorrhoids in young patients even by doctors. The golden rule is to check and make sure that it is nothing but hemorrhoids.
Here is a case of a 38-year old with bleeding from the rectum which looked like hemorrhoidal bleeding. She was found to have a 6-cm diameter giant polyp.
Only portions of this giant polyp could be seen in one view at this stage. There is a large head (first picture) and then there are portions hidden behind it.
Ordinarily, most endoscopist recommend an operation for removal of such polyp. But with skill, methodical approach and patience, Dr. Shah removed it without an operation.
The polyp was blocking the lumen. First, the stalk which connects the tumor part of the polyp to the colon wall was identified. It was very thick and contained large blood vessels. So metal clips were applied to compress and block them.
The polyp was so big that it had two such stalks and both were given two clips each to make sure that when cut, they do not bleed.
The shiny metal objects are the clips.
The head of the polyp is seen turning blue already before the cutting begins.
The 'brain' like pattern portion is the one that has real tumor. The paler stalk does not contain tumor. The thick stalk attaching polyp head to colon has large blood vessels which can bleed. 4 clips are skillfully applied to squeeze the blood vessels in two different stalks so that they do not bleed.
The third picture shows all the four clips reducing the blood supply to the large polyp in different portions.
A snare is passed and with electrocautery a large piece is cut. It is seen laying loose and disconnected from the wall is seen.
Removal of smaller pieces one by one with the help of an electrocautery is undertaken. The last picture shows that lonmg process.
The first row shows several small portions containing tumor hanging on to the stalks along with the clips. They need to be removed.
The irregular stalk was difficult to lasso, but this was accomplished. All the portions of a 6cm diameter polyp were sent to the pathology department for microscopic exam to determine the nature of the polyp.
The second row of pictures shows that there is no tumor tissue remaining. The stalk along with clips placed on it is also removed. The site of polyp removal shows as a crater with burnt edges.
In spite of the size of the polyp, no active bleeding is seen. Time taken to put clips in appropriate places paid off. The patient will not need surgery. She had no complications.
An inexperienced or less skilled endoscopist can recommend surgery easily. If he attempts to do what is shown in this series here, the risk of complications is real and emergency surgery may be needed.
The bottom line: This is why experience matters.