Successful Polypectomy & Sphincterotomy for Colonic Polyp with Anal Fissure
PACE Hospitals
PACE Hospitals’ expert gastroenterology team successfully performed Upper Gastrointestinal (UGI) Endoscopy and Colonoscopy with Polypectomy, along with Laser-Assisted Sphincterotomy (LAS), on a 42-year-old male patient diagnosed with anal fissure, colonic polyp (Paris Is type), erosive gastroduodenitis, MASLD, dyslipidemia, systemic hypertension, and type 2 diabetes mellitus. The aim of the procedure was to evaluate the upper and lower gastrointestinal tract and identify the extent of disease involvement. It also aimed to remove the colonic polyp, treat the anal fissure, and manage gastrointestinal pathology to prevent complications and improve overall digestive health.
Chief Complaints
A 42-year-old male patient with a body mass index (BMI) of 21 presented to the Gastroenterology Department at PACE Hospitals, Hitech City, Hyderabad, with a seven-year history of perianal pain and swelling, associated with intermittent rectal bleeding. The patient also reported severe pain in the perianal region, constipation characterised by hard stools and straining.
Past Medical History
The patient had a known history of systemic hypertension and type 2 diabetes mellitus and was on regular treatment for both conditions.
On Examination
On examination, the patient was conscious, coherent, and oriented. General physical examination revealed a stable condition, and systemic examination showed a soft, non-tender abdomen. Vital parameters were within normal limits, and there were no acute cardiorespiratory abnormalities detected.
Diagnosis
Upon admission to PACE Hospitals, following a detailed clinical assessment, the Gastroenterology team evaluated the patient’s complaints of long-standing perianal pain and swelling associated with intermittent bleeding per rectum, constipation with hard stools and straining, and abdominal discomfort. A comprehensive review of his medical history and a full diagnostic workup were performed.
Clinical examination and endoscopic evaluation revealed a colonic polyp (Paris Is) and fissure in ano, along with erosive gastroduodenitis. Imaging with USG of the abdomen and pelvis showed mild hepatomegaly with Grade II fatty liver changes, while liver elastography demonstrated mild to moderate hepatic fibrosis. Laboratory investigations included complete blood picture (CBP), fasting and post-prandial blood sugar, HbA1c, lipid profile, liver function tests (LFT), renal function tests (RFT), electrolytes, thyroid profile, coagulation profile (PT, INR, APTT, CT, BT), urine analysis including microalbumin-creatinine ratio and protein-creatinine ratio, viral markers (HIV, HBsAg, HCV), blood group and Rh typing, and serological studies. Cardiac evaluation with ECG and 2D echocardiography showed preserved cardiac function, and the chest X-ray was normal.
Based on the confirmed diagnosis, the patient was advised to undergo
Anal Fissure and Colonic Polyp Treatment in Hyderabad, India, under the expert care of the Gastroenterology Department.
Medical Decision Making (MDM)
After a detailed consultation with consultant gastroenterologists, Dr. Govind Verma, Dr. M. Sudhir, and Dr. Padma Priya, along with cross consultations with Dr. Tripti Sharma (Endocrinology, Diabetes & Metabolism), Dr. Suresh Kumar S (Surgical Gastroenterology), Dr. Krishna Prasad Chowdary MB (Advanced Surgical Gastroenterology), and Dr. Seshi Vardhan Janjirala (Cardiology), a comprehensive evaluation was performed to determine the most appropriate diagnostic and therapeutic approach.
Considering the patient’s history of chronic perianal pain with bleeding per rectum due to anal fissure and presence of colonic polyp, along with significant comorbidities including type 2 diabetes mellitus, systemic hypertension, dyslipidemia, and MASLD, a multidisciplinary decision was taken after appropriate anesthesia and cardiology fitness. The patient was planned for endoscopic evaluation and simultaneous therapeutic intervention to address both upper and lower gastrointestinal pathology safely and effectively.
Based on clinical assessment, endoscopic findings, and cross-specialty input, it was determined that colonoscopic hot snare polypectomy was the most appropriate and definitive management for complete excision of the colonic polyp with histopathological confirmation.
Additionally, the Laser-Assisted Sphincterotomy (LAS) procedure was chosen as the optimal minimally invasive treatment for chronic anal fissure to provide symptomatic relief, promote healing, and avoid surgical morbidity. This combined endoscopic and laser approach was selected considering the patient’s comorbid status and to ensure faster recovery with reduced procedural risk.
The patient and his family members were counselled regarding the procedures performed, their outcomes, and the need for follow-up.
Surgical Procedure
Following the decision, the patient was scheduled to undergo Laser-Assisted Sphincterotomy (LAS) and Colonoscopy with Hot Snare Polypectomy Procedure in Hyderabad at PACE Hospitals, under the specialized care of the Gastroenterology Department.
The following steps were carried out during the procedure:
Surgical Procedures Performed (Step-wise Details)
- Pre-procedure Evaluation and Clearance: The patient was evaluated for procedural fitness in view of comorbid conditions including diabetes mellitus and hypertension. Pre-anaesthetic assessment and cardiology clearance were obtained. Surgical Gastroenterology opinion was taken, and the patient was deemed fit for endoscopic and minimally invasive procedures.
- Colonoscopic Assessment and Lesion Identification: Diagnostic colonoscopy was performed, which revealed a Paris Is colonic polyp located at approximately 14–17 cm from the anal verge. The lesion was assessed endoscopically for morphology and suitability for removal.
- Hot Snare Polypectomy (Colonic Polyp Removal): Endoscopic hot snare polypectomy was performed, and the colonic polyp was completely excised under colonoscopic guidance using electrocautery. Adequate hemostasis was achieved, and the specimen was retrieved for histopathological examination.
- Laser Treatment for Fissure in Ano: Laser Anal Sphincterotomy (LAS) was performed for fissure in ano. Laser energy was used to reduce internal sphincter spasm, promoting healing of the fissure with minimal tissue injury and improved postoperative comfort.
- Completion of Procedures: Both endoscopic polypectomy and laser procedure were completed successfully without intra-procedural complications, and the patient tolerated the procedures well.
Postoperative Care
The procedures were completed uneventfully and the patient tolerated them well without any intra-procedural complications. Endocrinology referral was done in view of diabetes mellitus, and the patient was advised medical management for glycemic control along with lifestyle modifications including diet regulation and regular physical activity.
During the course of hospital stay, the patient was managed with intravenous fluids for hydration and maintenance of fluid balance, medications for prevention of infection in the post-procedural period, medications for reduction of gastric acidity and protection of gastric lining, and other supportive care measures for symptomatic improvement and recovery. The patient showed significant clinical improvement with stabilization of condition and was discharged in a stable state with advice for regular follow-up.
Discharge Medications
Upon discharge, the patient was prescribed short-term medication for infection prevention for a few days, therapy for gastric acid suppression and mucosal protection for one month, long-term treatment for glycemic control, lipid-lowering therapy for dyslipidemia, medications for blood pressure control, additional cardiac rate and blood pressure control therapy, stool softening treatment for constipation to be continued, and short-term pain relief medication for symptomatic use as needed.
Advice on Discharge
The patient was advised to follow a low-salt, strict diabetic diet along with a high-fiber diet. Lifestyle modification was strongly recommended, including regular physical activity for at least 150 minutes per week on a minimum of five days, in order to improve overall metabolic control and cardiovascular health.
Emergency Care
The patient was advised to contact the emergency ward at PACE Hospitals immediately in case of any emergency or development of symptoms such as fever, severe abdominal pain, vomiting, rectal bleeding, or passage of black or altered stools, or any other worsening of general condition.
Review and Follow-up Notes
The patient was advised to return for follow-up with the Gastroenterologist in Hyderabad at PACE Hospitals, after 1 week with a prior appointment. He was also advised follow-up with the Surgical Gastroenterologist after 1 week and with the Endocrinologist after 1 month with prior appointments for further evaluation and continued management.
Conclusion
This case highlights a patient with a colonic polyp and fissure in ano presenting with perianal symptoms and bleeding per rectum. He underwent a successful colonoscopic polypectomy and laser treatment for a fissure in ano with an uneventful procedure and good clinical recovery. The patient was discharged in stable condition with advice for follow-up and further evaluation as needed.
Role of Gastroenterology in Colorectal Disease Management
Colorectal diseases commonly present with symptoms such as bleeding per rectum, altered bowel habits, and abdominal or anorectal discomfort, requiring timely clinical evaluation. Endoscopic assessment remains the cornerstone of diagnosis, allowing direct visualization of the gastrointestinal tract and enabling therapeutic intervention when required. Minimally invasive endoscopic techniques have significantly reduced the need for open surgical procedures while improving patient outcomes and recovery time. Early assessment by a Gastroenterologist / Gastroenterology doctor helps in accurate diagnosis and timely management of both benign and potentially serious colorectal conditions. Consideration of overall patient health and associated medical factors is essential for safe and individualized treatment planning. Structured follow-up and surveillance are important to monitor recovery and prevent recurrence. Overall, early specialist evaluation and endoscopic management form the foundation of effective colorectal care.
Frequently Asked Questions (FAQs)
What is the significance of the polypectomy procedure in this case?
The patient had a polyp removed during a colonoscopy. This procedure is important because it removes growths that could turn into cancer over time. By getting rid of these polyps, the risk of developing cancer is lowered. It's important to check for new polyps regularly after this procedure. Follow-up colonoscopies help ensure no new growths develop.
What role does liver elastography play in diagnosing liver conditions?
Liver elastography is a test that measures how stiff the liver is. If the liver is stiff, it could mean there’s damage, like from fatty liver disease or scarring. In this case, the test showed mild to moderate liver damage, which helps doctors decide how to treat the liver. It’s important to keep checking the liver's condition over time to prevent further damage.
Why was the patient referred for a cardiology evaluation?
The patient was sent to a heart specialist because of his high blood pressure and diabetes, which can cause heart problems. Before surgery, it’s important to make sure the heart is healthy enough for the procedure. The heart specialist helps reduce the risk of any heart issues during surgery. This evaluation helps the doctors make sure everything is safe before proceeding.
What is the importance of dietary modifications post-discharge?
After leaving the hospital, the patient needs to follow a strict diet to control his diabetes and high blood pressure. Eating foods that help manage blood sugar and reduce salt is key to staying healthy. A good diet can also help prevent other health problems, like heart disease. Eating high-fiber foods will also help with digestion and prevent constipation.
How does the treatment of erosive gastroduodenitis contribute to recovery?
The patient had a stomach issue called erosive gastroduodenitis, which was treated with medicine that lowers stomach acid. This helps the stomach lining heal and reduces pain. By treating this condition, doctors prevent further damage to the stomach. The treatment also helps the patient feel better and recover faster from stomach problems.
What are the implications of the patient’s lipid profile?
The patient’s cholesterol levels were higher than normal, which can increase the risk of heart problems. The doctor prescribed medicine to lower the bad cholesterol and reduce the risk of heart attacks and strokes. Keeping cholesterol under control is especially important for people with high blood pressure and diabetes. Regular tests are needed to make sure the treatment is working.
Why was the endocrinology referral necessary in this case?
The patient was referred to an endocrinologist to manage his diabetes. The endocrinologist will help adjust the patient’s medication and recommend changes in lifestyle, like diet and exercise. Proper diabetes management is important to avoid complications such as heart disease or kidney problems. The endocrinologist will monitor the patient’s blood sugar levels and help make sure diabetes is under control.
What follow-up care is essential after this discharge?
After being discharged, the patient should see several specialists for regular check-ups. This includes visits to the gastroenterologist to make sure the digestive system is doing well after the polyp removal. The patient should also see the endocrinologist to manage diabetes and the surgical specialist to check for any issues from the surgery. These follow-ups help catch any problems early and ensure the patient stays healthy.
How does laser LAS surgery aid in perianal disease treatment?
Laser LAS surgery was done to treat a painful condition near the anus called a fissure. The laser helps remove or shrink the fissure, which makes it heal faster and with less pain than traditional surgery. It also reduces the chance of infection and makes recovery easier. After this procedure, the patient should experience less pain and discomfort.
What precautions should be taken to avoid recurrence of colonic polyps?
After removing the polyps, the patient should have regular colonoscopies to check for new ones. Eating a healthy diet, avoiding too much fat, and getting enough fiber can help prevent new polyps from forming. It’s also important to keep taking any prescribed medications, like those for cholesterol, to help reduce the risk. Regular check-ups with the doctor will help detect any new growths early.
Share on
Request an appointment
Fill in the appointment form or call us instantly to book a confirmed appointment with our super specialist at 04048486868
Appointment request - health articles
Recent Articles
