Filiform polyposis (FP) is a rare entity that is associated with inflammatory bowel disease. It is present in 10-20% of cases, especially in patients with ulcerative colitis, and is characterized by the presence of soft and elongated “worm-like” or “finger-like” polyps that can measure up to 9 cm in length and form mucosal bridges. A 44-year-old man with ulcerative colitis had abdominal pain of 15-day progression and leukocytosis. The computed tomography (CT) scan identified thickening of the descending colon, with atypical morphology, and intraluminal content associated with pneumoperitoneum. Emergency sigmoidectomy and Hartmann procedure were performed, revealing purulent peritonitis secondary to the perforation of a large mass with an inflammatory aspect in the left colon (Fig. 1). The pathology study showed countless digitiform polypoid formations that fused together, constituting bridges (Fig. 2). Histologic study reported acute and chronic inflammation with abscesses, consistent with perforation, and no dysplasia (Fig. 3). A later endoscopic examination showed the presence of filiform polyposis in the remaining colon (Fig. 4). Filiform polyposis should be suspected in patients with ulcerative colitis that present with clinical obstruction. Perforation is a rare complication.

Figure 1.

Surgical specimen, after the sigmoidectomy and Hartmann procedure, with multiple worm-like polyps.

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Figure 2.

Surgical specimen fixed in formol.

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Figure 3.

Pathologic image showing digitiform, polypoid formations, no dysplasia, and the presence of acute and chronic inflammation, with focal abscesses, consistent with perforation.

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Figure 4.

Endoscopic image, showing polyps forming mucosal bridges.

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