RESUMEN
Objective: to evaluate the role of colonoscopy in the diagnosis and management of bleeding per rectum in children
Material and Methods: it was descriptive type of study conducted at Department of Pediatrics, Services Hospital, and Lahore including 50 patients of either sex with age range of 5-15 years in whom colonoscopy was performed for bleeding PR. The patients with acute dysentery, melena and rectal prolapse were excluded from study. Gut preparation was started forty-eight hours before procedure. The children were given clear liquids without any milk and fiber containing diet. Liquid paraffin was given orally as laxative and two doses of kleen enema were given, 12 hours and 1 hour before procedure. Colonoscopy was performed under deep sedation [Midazolam 0.25-0.5mg/kg] using fiber optic pediatric colonoscopy in Medical Unit-1 of Services Hospital, Lahore. Polypectomy was done in patient with pedunculated polyps and colonic biopsy was taken where indicated. The samples were sent for histopathology in the Department of Pathology of the same hospital. After procedure all patients were kept under observation for4-6 hours in pediatric ward
Results: colorectal polyps were the most common cause of bleeding per rectum [56%] followed by ulcerative colitis [12%], solitary rectal ulcer [8%], non-specific colitis [8%] and hemorrhoids in 2%. There was suspicion of malignancy in 2 children on colonoscopy. Biopsy was taken and it was confirmed as adenocarcinoma on histopathology in one child. Among patients with polyps [n=28], 22 [78.6%] have single polyp and 6 [21.4%] have more than one. Main site of polyps was rectum [20 patients] while it was sigmoid/recto sigmoid junction in 5 and descending colon in 2 children. Polypectomy was performed in 21 children while it was not possible in 7 due to sessile polyps in 6 and polyp size larger than snare in 1 child
Conclusion: colons-copy is safe and very useful tool in the diagnosis and management of bleeding per rectum in pediatric patients and juvenile polyps are the commonest cause of bleeding per rectum in this age group
RESUMEN
Background: upper gastrointestinal [GI] bleeding refers to bleeding occurring above the ligament of Treitz. Esophagogastroduodenoscopy [EGD] is the most important tool to evaluate upper GI tract for a source of bleeding. The objective of the study was to evaluate the yield of upper gastrointestirial endoscopy and different causes of upper gastrointestinal bleeding in a tertiary care pediatric unit
Methods: the study was conducted at Department of pediatrics, Services Institute of Medical Sciences/Services Hospital Lahore from January 2005 to December 2008. The study included 74 patients1hwhom upper GI endoscopy was performed for hematemesis
Results: out of 74 children who underwent upper GI endoscopy, 50 were boys with a male to female ratio of 2:1. Age range of studied patients was 6 months to 15 years with a mean age of 7.6 +/- 0.32 years Out of 74 with hematemesis, 24 [32.4%] patients had gastric mucosal lesions. In this group 22 patients had superficial gastric mucosal lesions [SGML] and 2 had gastric ulcers. 21 [28.4%] patients had esophageal° varices _and out of these 13 patients had prehepatic portal hypertension due to portal vein thrombosis [PVT], 6 patients had chronic liver disease and 2 patients had post hepatic portal hypertension. 8 patients were diagnosed esophagitis and 2 as esophageal ulcers. One patent had gastric hemangiomas as the cause of hematemesis. The cause of bleeding could not be ascertained in 21.6% of patients
Conclusion: this study concludes that upper GI endoscopy is -an important diagnostic tool in children with hematemesis: Mucosal lesson followed by esophageal varices are the commonest cause of hematemesis in children in our tertiary care hospital Which is concordant with 'that of other centers in the world