A non-surgical approach to colonic polyposis syndrome: a case of early detection and endoscopic intervention to prevent malignancy.

Introduction and Importance: Colonic polyposis syndrome, characterized by multiple colorectal adenomatous polyps, presents significant diagnostic and therapeutic challenges. This case emphasizes the importance of early detection, histopathological evaluation, and endoscopic management in colonic polyposis in a young patient. Case Presentation: We report the case of a 45-year-old male who presented with chronic diarrhea, generalized weakness, and severe anemia. Initial investigations revealed a hemoglobin level of 4.2 g/dL and a positive stool occult blood test, suggestive of gastrointestinal blood loss. Upper gastrointestinal endoscopy shows no active bleeding, while colonoscopy identified multiple pedunculated polyps extending from the distal sigmoid colon to the right colon. Histopathology confirmed tubulovillous adenomas with focal high-grade dysplasia, but no invasive carcinoma. Management involved serial surveillance colonoscopies with polypectomies initially at 2-month intervals, resulting in the resolution of anemia and symptomatic improvement, with hemoglobin increasing to 11.0 g/dL. Surveillance colonoscopy with polypectomy relieved symptoms, resulting in the avoidance of major destructive surgery. Genetic testing could not be performed due to financial constraints. Clinical Discussion: The patient showed marked symptomatic and hematological improvement with endoscopic management alone, avoiding colectomy. This highlights the importance of early detection and regular surveillance in resource-limited settings. Conclusion: This case highlights the need for accessible screening and ongoing endoscopic evaluation to prevent adenomatous polyps from progressing to colorectal cancer.