Clinical presentation

A 39 year old man with a known history of tuberous sclerosis complex (TSC) presented with haematuria due to haemorrhagic changes of a large renal angiomyolipoma. Selective transcatheter arterial embolisation of the lesion was performed. Haematuria resolved but the patient experienced postembolisation syndrome with fever, and presented with bowel obstructive symptoms. Abdominal radiographs showed marked dilatation of the colon. An acute colonic pseudo-obstruction (Ogilvie’s syndrome) was suspected and colonoscopic decompression was performed. Colonoscopy showed dilatation of the colon without mechanical obstruction and multiple sessile polyps localised in the rectum (fig 1A). One polyp was biopsied and fig 1B shows the microscopic features.

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Figure 1

 (A) Endoscopy of the colon. (B) Microscopic examination of a biopsied polyp.

Question

What is the diagnosis?

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