The management of familial gastrointestinal polyposis involving stomach and colon

1. 1. The problems inherent in the treatment of children with familial polyposis involving both the stomach and colon have been presented. 2. 2. The authors base their therapeutic approach upon 6 premises and facts expressed in the literature. First, polyposis involving the stomach and colon is more common than diffuse involvement of the gastrointestinal tract. Second, polyposis of the colon has a malignancy potential approaching 100 per cent. Third, polyposis of the stomach has a malignancy potential, but of an undetermined degree. Fourth, polyposis of the stomach is often localized enough to permit extirpation by partial gastrectomy. Fifth, carcinoma in polyposis of the colon has occurred in patients as young as 12 years of age. Sixth, growth and development of children after subtotal gastrectomy or colectomy have been good. 3. 3. The course described is recommended when the presence of polyposis in the colon and stomach is established. Definitive operation is suggested in children at whatever age the diagnosis is made. Exploratory laparotomy is performed and the small bowel explored endoscopically through multiple enterotomies. If polyps are found eradication of disease is impossible and no resection is indicated. If no polyps are found in the small bowel, a gastrotomy is performed to evaluate the involvement of the stomach. Extirpation of the polyps by partial gastrectomy is performed if feasible, and if not, simple excision of as many polyps as possible is carried out. Four to 6 weeks later, after preliminary fulguration of the rectal polyps, subtotal colectomy and ileoproctostomy are performed. The retained rectum is examined every 3 months and new polyps fulgurated. 4. 4. Two cases of polyposis of the stomach and colon in which the suggested course of therapy was employed are presented.