1579 Rare Finding of Incidental Ascending Colon Ganglioneuroma in the Setting of Hematochezia

INTRODUCTION: Ganglioneuromas are slowing growing tumors that are rarely found in the colon. Patients with colonic ganglioneuromas may present with nonspecific symptoms such as abdominal pain, bleeding, or change in bowel habits, but these patients are usually asymptomatic. We present a case of hematochezia where an ascending colon ganglioneuroma was incidentally found on diagnostic colonoscopy. CASE DESCRIPTION/METHODS: 84 year old male with a past medical history of hypertension, chronic atrial fibrillation on rivaroxaban, COPD, and prostate cancer S/P radiation presented with hematochezia of two days duration. He had three loose bowel movements on the day of presentation with bright red blood and clots. This was associated with nausea and diarrhea, but patient denied abdominal pain, vomiting, hematemesis, melena, and weight loss. Last colonoscopy, around 7 years ago, was normal. On presentation, patient's vital signs were within normal limits. Physical exam revealed an irregularly irregular rhythm. Abdominal exam was within normal range. Rectal exam revealed dark red stools. No external hemorrhoids were seen. Laboratory findings revealed hemoglobin of 12.5 g/dl and an INR of 1.4 Rivaroxaban was stopped on presentation. Hemoglobin dropped to 11 g/dl then became stable. Colonoscopy was performed five days later. It showed a 3 mm polyp in the ascending colon, a 4 mm polyp in the descending colon, and diverticulosis in the descending colon. The 3 mm polyp in the ascending colon was removed with a cold biopsy forceps. Histological examination of the specimen showed ganglioneuroma. DISCUSSION: Ganglioneuromas are hamartomatous tumors that are rarely seen in the gastrointestinal tract, and are usually found incidentally. There are three different subtypes of ganglioneuromas: polypoid ganglioneuroma, ganglioneuromatous polyposis, and diffuse ganglioneuromatosis. The most common type is polypoid ganglioneuroma which is usually a small single polyp arising from the mucosa and submucosa. Definitive diagnosis of ganglioneuroma can only be done through pathological and histological examination. Treatment depends on their size, location, and subtype in addition to the patient's clinical history. Polypoid ganglioneuroma, which is present in this patient, is a benign lesion, so endoscopic resection using a biopsy forceps or a snare is usually curative. It may also be useful to perform a follow up colonoscopy to ensure complete excision of the lesion.