Yield of Colonoscopy in Children with Rectal Bleeding

Rectal bleeding is a common complaint in children and is the most common indication for colonoscopy. The aim of this study is to report the yield of this procedure in children. Analysis of the medical records of all children below 18 years of age, who underwent colonoscopy from 1993 to 2002, in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia for the evaluation of rectal bleeding. Eighty-nine children presented with bleeding per rectum, accounting for 49% of the indications for colonoscopy. The majority [92%] was Saudi nationals, the age range was from 5 months to 18 years, and the male to female ratio was 1.1: 0.9. There were 22 children between 0-12 years and 35 between 13-18 years. The overall yield of colonoscopy was 57/89 [64%]; however, the yield was slightly better 22/32 [69%] for children 0-12 years. In a subset of children [22 patients, 21 of them were in the age group 0-12 years] where rectal bleeding was associated with diarrhea, the yield was 22/23 [97%]. The causes of bleeding per rectum are presented in the table indicating that colitis was the most common cause 30/57 [36%], followed by polyps in 15 [27%]; whereas rectal ulcers, chronic anal fissures and hemorrhoids accounted for 5% each. However, age-related analysis shows that colitis occurred more commonly in older children and polyps were found almost with equal frequency in both age groups. The diagnostic yield of colonoscopy is very high especially in children presenting with bloody diarrhea

Coeliac disease in Saudi-Arab children

The clinicopathological features of 19 children with coeliac disease seen at King Khalid University hospital, Riyadh, over a 5-year period are described. Their mean age at presentation, introduction to cereals and onset of symptoms were 4.5 years, 0.7 years and 2.0 years respectively. The main symptoms were diarrhoea in 1 7 patients [89%] and failure to thrive in 13 [68%]. The main physical signs at admission were abdominal distension in 16 patients [86%], wasting in 15 [78%], pallor in 12 [63%], oedema in 5 [27%], and short stature in one [5%]. The mean haemoglobin, serum folate level and 1 h blood D-xylose were 9.1 g/dl, 1.4 ng/ml and 0.9 mmol/l respectively. The initial Jejunal] biopsy showed subtotal villous atrophy in every patient. Repeat biopsy showed normal villi in 10 patients while on gluten-free diet and subtotal villous atrophy on gluten challenge in four patients. There was considerable delay in establishing the diagnosis. All improved on a gluten-free diet

Congenital chloride-losing diarrhea in Saudi children

Four Saudi patients with congenital chloride-losing diarrhea [CCD] are described. The disease was characterized by polyhydramnios, chronic diarrhea, abdominal distention, growth failure, and delay in diagnosis. In only one patient, the brother of a known case, was the diagnosis made at birth. The first patient had laparotomy at the age of five days for suspected intestinal obstruction, and CCD was not diagnosed until seven weeks of age. The second patient had chronic diarrhea since birth, but the correct diagnosis was delayed until 11 months of age when he was seen because of chronic diarrhea and severe marasmus. The third patient was a sibling of the second patient, and diagnosis was made on the first day of life. The fourth patients had symptoms since birth, and was kept in her local hospital for 9 months because of electrolyte abnormalities, but correct diagnosis was not made until she was referred to another hospital. The possibility of CCD should be considered in any infant with persistent watery stools beginning in the first days of life, particularly if there was polyhydramnios during pregnancy