Medical and surgical management of intestinal Malacoplakia
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. 4 patients had unresectable tumors, all of whom also had hydronephrosis. Of these patients who were all handled by ileosigmoidostomy 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 of 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.