Endoscopic polypectomy is the first-line treatment for colorectal polyps. However, this procedure carries an increased risk of bleeding in patients with hemostatic disorders, particularly in the presence of a large pedunculated polyp. We report the case of a 52-year-old man with hemophilia A and associated von Willebrand factor deficiency, admitted for rectal bleeding evolving over the previous year. Laboratory investigations revealed severe iron-deficiency anemia and a reduced factor VIII level. Colonoscopy showed a large pedunculated sigmoid polyp located 50 cm from the anal verge, with a 15 mm stalk and a 30 mm head. A multidisciplinary approach involving gastroenterologists and hematologists allowed endoscopic polypectomy to be performed using a hot snare after hemostatic preparation with coagulation factor concentrates and tranexamic acid, together with prophylactic placement of an end loop. No periprocedural or postprocedural bleeding complications were observed. Histopathological examination revealed a tubulovillous adenoma with low-grade dysplasia, with complete resection and negative margins. This case highlights that endoscopic polypectomy can be safely performed in a hemophilic patient, provided that careful preparation, appropriate hemostatic prophylaxis, and preventive endoscopic techniques are used.

Introduction: Mucinous anal adenocarcinoma is a rare and often misleading entity, because its presentation may mimic suppurative perineal disease [abscess/fistula]. We report a case of fistulizing mucinous anal carcinoma diagnosed by endoscopic ultrasound and fine-needle aspiration, and discuss the diagnostic and therapeutic aspects. Case presentation: A 73-year-old man with a history of surgery for an anal fistula [2000] presented with purulent anal discharge associated with mild anal incontinence, without rectal bleeding or bowel habit disorders, and with preserved general condition. Proctological examination found fistulous openings and sphincter hypotonia. Pelvic MRI showed a mass in the left ischioanal fossa fistulizing toward the anal canal. Rectal endoscopic ultrasound showed a heterogeneous pararectal mass measuring 33 × 47 mm, with a fluid component and sparing the rectal wall; histological examination of the fine-needle aspiration sample confirmed mucinous adenocarcinoma. The staging work-up found no secondary lesions. A multidisciplinary decision was made to proceed with chemoradiotherapy, followed by reassessment and surgical discussion according to the clinical course. Conclusion: In the presence of a chronic, recurrent, or complex anal fistula, particularly when associated with a mass, induration, or functional impairment, malignant degeneration should be considered and documented by tissue sampling. MRI and endoscopic ultrasound with fine-needle aspiration/biopsy guide the diagnosis. Management is often multimodal and resembles that of rectal adenocarcinomas, with discussion of neoadjuvant treatment followed by radical surgery such as abdominoperineal resection.

Background: Ear infections rank among the most common health presentations in children attending clinics in Iraq and their microbiology continues to evolve. Staphylococcus epidermidis has transitioned from being disregarded as an innocuous commensal organism to a creeping opportunist drug-resistant pathogen, primarily due to its prolific biofilm-forming ability enabling the establishment of chronic and recurrent otitis media that are significantly more resistant to eradication. Objectives: The aim of this study was to identify the prevalence of S. epidermidis, evaluate biofilm genes carriage (icaA/icaD) and their associated factors among children with otitis media in Al-Diwaniyah. Methods: A total of 120 afresh suffering children age between 5-10 years with clinically diagnosed otitis media were enrolled in hospitals through the period between January and May 2024 in Al Diwaniyah City. Swab from the ear were cultured on blood agar and mannitol salt agar. Identification of isolates was performed by standard methods and confirmed with API Staph. Tubes were tested by PCR for icaA and icaD, and disk diffusion was performed to determine antibiotic susceptibility according to CLSI 2024. Results: Staphylococcus epidermidis was isolated from 76 out of the 120 children (63.3%). The predominant risk factor was poor nail hygiene; children with dirty nails had a much higher culture positivity (82.1% vs. 45.5%; OR = 5.42, 95% CI: 2.38–12.35, p <0·001). Bilateral ear involvement was also positively associated (p = 0.012). Conclusion: Staphylococcus epidermidis is an important pathogen in the pediatric otitis media in Al Diwaniyah and must be more than a contaminant. The close link with the bad hygiene of nails gives a very inexpensive and educable form of prevention for the ones who care for it. In addition, our antimicrobial data show that empirical penicillin therapy would otherwise be futile. Thus, it will be recommended that either ciprofloxacin or gentamicin is preferred concerning to the empirical therapy while waiting for definitive culture products.