Medical and surgical management of intestinal malacoplakia

ABSTRACT

During the last 7 years diagnosis of intestinal malacoplakia [MP] has been confirmed in 5 children and one adult, either by colonoscopy with tissue biopsy or fine needle aspiration [FNA]. All children had chronic abdominal pain, bloody diarrhea, low grade fever and irregular abdominal mass with signs of partial intestinal obstruction. The adult patient had the same symptoms with no mass. Complete resection was possible in only one child with no evidence of recurrence. The adult patient developed recurrence in the ileum and rectum 2 years after total colectomy and ileo-proctostomy. Four patients had unresectable tumors, all of whom also had hydronephrosis. Of these patients who were all handled by ileo-sigmoidostomy as a bypass, ileostomy or right transverse colostomy, 2 died 1-3 months later. In the presence of abdominal mass, diagnosis is feasible by FNA. However, colonoscopy is mandatory for appropriate decision and management. Intestinal MP should be managed seriously because of its aggressive nature. If diagnosed early, MP may be cured by medical therapy alone or by resection with or without adjuvant medical therapy. An underlying immunosuppressive disorder should also be looked for