Clinical presentation

A 75-year-old male was referred to Gastroenterology under the 2-week wait service with a change in bowel habit and weight loss. He had a background of hypertension, inguinal scrotal hernia, suspected cognitive impairment and a cerebral meningioma resected in 1970. There was no history of abdominal surgery. A faecal immunochemical test performed in primary care was less than 10 µg Hb/g. He underwent a CT colonography (CTC) scan which reported a 22 mm polypoid lesion at the level of the hepatic flexure.

A colonoscopy was subsequently performed under conscious sedation for lesion assessment and possible polypectomy. Intubation was challenging due to recurrent looping within the inguinal hernia, but the procedure was completed to the caecum. The images of the polypoid lesion are seen below.

Question

What is the lesion identified in figure 1, and how would you manage it?

Answer

The lesion seen on the CTC and identified during colonoscopy demonstrated…