P0242 - A Case Presentation of Gout Tophus in the Ascending Colon

Alexandria Dennison, MD, Corbin Stephens, MD, Shruti Verma, MD, Ahmed Saeed, MD, Jay Helsel, MD
HCA, Overland Park, KS

Introduction: 49 yo male with a past medical history of hyperlipidemia and gout presented for planned endoscopic submucosal dissection (ESD) for a known colon, non-lifting, adenoma found on colonoscopy.

Case Description/Methods: 30 mm Paris IIa mixed lateral spreading lesion was found in the proximal ascending colon. The resection was planned with Dilumen stabilizing the overtube started with 15 mL Orise gel was injected with partial lift of the lesion from the muscularis propria. Dual knife was used to create circumferential mucosal incision. After partial dissection the submucosal layer was completely replaced with whitish/yellowish tissue that does not lift with injection or stain with dye. Clip and traction wire through the Dilumen did not help with submucosal exposure. Decision made to switch to piecemeal mucosal resection. A 20 mm braided snare was used. The snare required significant time to cut through the tissue. Pieces were then retrieved with a Roth net. A 4 mm muscle injury with no obvious perforation was noted. The defect was completely closed with one dual action tissue clip (DAT) and three hemostatic clips.

Discussion: Pathological final diagnosis for the ascending colon polyp was tubulovillous adenoma and submucosal nodular gout tophus. There were no high grade dysplasia or malignant features identified. It is important for all collected samples of endoscopic resection to be analyzed under a microscope to differentiate pathology and rule out malignancy such in this case.

Colonic submucosal gout tophus is extremely rare. Patients with a past medical history of gout are not commonly at risk for colonic lesions. A submucosal gout tophus can make endoscopic resection challenging due to non-lifting and replacing the submucosal layer like severe fibrosis. This can make ESD challenging but EMR and hybrid ESD are possible like this case.



Disclosures:


Alexandria Dennison, MD, Corbin Stephens, MD, Shruti Verma, MD, Ahmed Saeed, MD, Jay Helsel, MD. P0242 - A Case Presentation of Gout Tophus in the Ascending Colon, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.