Endoscopic Findings in Children with Isolated Lower Gastrointestinal Bleeding

BACKGROUND/AIMS: Colorectal polyps are a common cause of lower gastrointestinal bleeding in children. Our aim was to study the causes of isolated lower gastrointestinal bleeding and to analyze the characteristics of the colorectal polyps found in our cohort. METHODS: We retrospectively reviewed colonoscopic procedures performed between 2007 and 2015. Children with isolated lower gastrointestinal bleeding were included in the study. RESULTS: A total of 185 colonoscopies were performed for isolated lower gastrointestinal bleeding. The median patient age was 8 years, and 77 patients (41.6%) were found to have colonic polyps. Normal colonoscopy findings were observed and acute colitis was detected in 77 (41.6%) and 14 (7.4%) patients, respectively. Single colonic polyps and 2–3 polyps were detected in 73 (94.8%) and 4 (5.2%) patients with polyps, respectively. Of the single polyps, 69 (94.5%) were juvenile polyps, among which 65 (94.2%) were located in the left colon. CONCLUSIONS: Single left-sided juvenile polyps were the most common cause of isolated lower gastrointestinal bleeding in our study. It was rare to find multiple polyps and polyps proximal to the splenic flexure in our cohort. A full colonoscopy is still recommended in all patients in order to properly diagnose the small but significant group of patients with pathologies found proximal to the splenic flexure.

Progress of colorectal juvenile polyps in children / 国际儿科学杂志

Juvenile polyps are the most common colorectal polyps in children,usually present with painless,intermittent rectal bleeding.Colonoscopy is used to diagnose and juvenile polyps should be removed once found.The etiology and pathogenesis of juvenile polyps is still unclear.Histologically,the typical juvenile polyp is hamartoma with a prominent lamina propria,infiltration with inflammatory cells and cystic glands.This article reviewed the recent progress in the study of the clinical manifestation,histological characteristics,biological characteristics,diagnosis,treatment,pathogeny and molecular mechanisms of colorectal juvenile polyps in children.

Signet Ring Cell Carcinoma Arising from a Solitary Juvenile Polyp in the Colon

Juvenile polyps are relatively common polyps that affect predominantly young patients and may occur in isolated, multiple, and/or familial forms. They have been considered to be benign lesions without neoplastic potential, but for patients with multiple juvenile polyposis, the cumulative malignant risk is greater than fifty percents. In patients with a solitary polyp, the risks are minimal, and only a few cases of malignant change from a solitary juvenile polyp have been reported. We describe the case of a twenty one year old female with one solitary juvenile polyp, which contained a signet ring cell carcinoma in the mucosal layer.

Clinical Spectra of Auto-amputated Polyps:Comparison of Juvenile Polyps and Meckel's Diverticula / 대한소아소화기영양학회지

PURPOSE: The manner of rectal bleeding of auto-amputated polyps (AP) is similar to juvenile polyps (JP) or Meckel's diverticula (MD). We conducted this study to characterize the clinical spectrum of AP. METHODS: Fourteen patients were enrolled this study who were diagnosed AP due to painless rectal bleeding. The clinical data of AP was assessed and then compared with the clinical data of JP and MD retrospectively. RESULTS: The prevalence of AP was 10.4% (14/135) and high in younger patients compared with that of JP (p=0.042 below 2 years). Whereas JP was more common in patients aged 2 to 5 years (p=0.005). Male was predominant in AP (p=0.008 AP vs JP). The manner of rectal bleeding in AP group was sudden and transient. There was no significant difference in time interval between onset of rectal bleeding and diagnosis between the 3 groups. However AP was diagnosed in 9 patients (64.3%) within 7 days after onset of rectal bleeding, but JP was diagnosed in 5 patients (4.1%) in the same period (p<0.001). All of AP were located in the rectum and the sigmoid colon. The mean hemoglobin was 11.3+/-1.5 g/dL in AP, 11.8+/-1.3 g/dL in JP, and 8.4+/-1.2 g/dL in MD (p<0.001, only significant in MD). CONCLUSION: AP may be considered in male older than 1 year with transient and sudden onset or increase of painless rectal bleeding without drop of hemoglobin level.

Colonic Polyps; Experience of 34 Cases in Two Hospitals / 소아과

PURPOSE: Colonic polyps are among the most common causes of rectal bleeding in children. We studied the clinical spectrum, histology, malignant potential and treatment of colonic polyps in our cases. METHODS: We reviewed hospital charts of all patients with colonic polyps, seen over a 15-year period from January 1988 to November 2002. Colonoscopy and/or barium enema were done for diagnosis of colonic polyps. Thirty-four children, aged one to 18 years old with colonic polyps, were enrolled in this study. Clinical spectrum, gross appearance, histologic appearance, malignant potential, treatment and prognosis of the colonic polyps were evaluated. RESULTS:The mean age of these patients was 6.4 years, with a male predominance(M:F=1.9:1). All patients had symptoms of rectal bleeding of a mean duration of five months. Solitary polyps were seen in 82.4%(28/34), more than on polyp(all had two polyps) in 11.8%(4/34), juvenile polyposis syndrome in 2.9%(1/34), and Peutz-Jegher syndrome in 2.9%(1/34) of the cases. All but one of the 36 polyps had typical features of a juvenile polyp on histological examination. Adenomatous change was observed in 2.8%(1/36) of juvenile polyps. 94.4%(34/36) of juvenile polyps were located in the rectosigmoid region, 2.8%(1/36) were in the distal colon, and 2.8%(1/36) were in the proximal colon. False negative result of barium enema alone without colonoscopy were found in 25%(2/8), and rectosigmoidscopy alone could miss proximal polyps. Colonoscopic polypectomy or surgical transrectal polypectomy were performed in all cases without major complications. Surgical polypectomy needed general anesthesia in 100%(11/11) of children compared to colonoscopic polypectomy which needed general anesthesia in 23.8%(5/21) of children. Recurrence of polyps was observed only in 2.9%(1/34) of the children. CONCLUSION: Juvenile polyps may be the most common colonic polyps in children. Juvenile polyps should be removed even if asymptomatic because of their neoplastic potential. Because some cases of colonic polyps may be multiple and proximally located, pancolonoscopic polypectomy is recommended in all cases. Surgical polypectomy is less recommended, because general anesthesia is required in all cases and proximal polyps could be missed.

Solitary Juvenile Polyps and Colonoscopic Polypectomy in Children

PURPOSE: This study was performed to know the clinical profile and effectiveness of colonoscopic polypectomy in patients with solitary juvenile polyp. METHODS: This study included 19 children, aged 1.8 to 11.4 years, who underwent colonoscopic polypectomy and histologically proven solitary juvenile polyps between March 1998 and August 2002. We analyzed their detailed history, clinical manifestations, colonoscopic examination, method of anesthesia and results of colonoscopic polypectomy. RESULTS: The mean age of the 19 cases was 4.7+/-2.8 year. The male to female ratio was 1 : 1.1.Hematochezia, the main indication of colonoscopy, was present in all cases. Combined symptoms were mucoid stool or diarrhea(42%), abdominal pain(26%), constipation(11%) and anal fissure(11%). Anemia(Hb <10 g/dL) in four cases recovered spontaneously after polypectomy. Complications associated with premedication, sedation and colonoscopy itself did not occur. Bleeding developed in two cases(11%) after polypectomy. One of them was controlled with hemoclipping. The main site of polyps was the rectosigmoid colon in 15 cases(79%). The size of the polyps ranged from 0.5 to 3.5 cm. The interval between the onset of symptoms and polypectomy was from 0.1 to 42 months. CONCLUSION: Juvenile polyps are a common cause of benign, chronic and recurrent rectal bleeding. Colonoscopic polypectomy is a simple, safe and effective therapeutic method. So earlier colonoscopy might avoid uneffective treatment and prevent untoward problems such as fear of parents and anemia.