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.

Clinical Features of Symptomatic Meckel's Diverticulum / 대한소아소화기영양학회지

PURPOSE: The proper diagnosis of Meckel's diverticulum (MD) is difficult and delayed because of the variety of clinical manifestations. We reviewed clinical characteristics of symptomatic MD to facilitate early detection. METHODS: We analyzed retrospectively the clinical manifestations, diagnostic tools, histopathological findings, and operative findings in 58 patients with symptomatic MD. RESULTS: The male to female ratio was 2.8 : 1. The most common symptom of MD was bleeding. Others symptoms included: vomiting, abdominal pain, irritability, abdominal distension and fever in the order of frequency. The clinical manifestations of symptomatic MD were lower gastrointestinal bleeding, intestinal obstruction, perforation, diverticulitis and hemoperitoneum, in the order of frequency. The causes of intestinal obstruction were intussusception, internal hernia, band, volvulus, invagination, in the order of frequency. Seventy five percent of patient with MD were diagnosed prior to 5 years of age. The most frequently used diagnostic tool was the Meckel's scan. The diverticulum was located 2 cm to 120 cm proximal to the ileocecal valve. The length of the diverticulum ranged from 1 cm to 10 cm and 94% were less than 5 cm. The most common ectopic tissue found in the MD was gastric mucosa. Ileal resection was more frequently performed than diverticulectomy. CONCLUSION: In cases of unexplained gastrointestinal bleeding, obstruction and repeated intussusception, the meckel's scan, ultrasound and computed tomography shoud be considered to rule out MD, and if clinically necessary, an exploratory laparotomy when needed.