Colonic Polyps; Experience of 34 Cases in Two Hospitals

Kim, Seoung Joon; Kim, Sun Mi; Kim, You Jeong; Jeong, Dae Chul; Lee, Won Bae; Chung, Seung Yun; Kang, Jin Han

Abstract

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.