Clin Endosc.  2019 May;52(3):258-261. 10.5946/ce.2018.046.

Endoscopic Findings in Children with Isolated Lower Gastrointestinal Bleeding

• Silbermintz A
• Matar M
• Assa A
• Zevit N
• Glassberg
• Shamir R

• KMID: 2449766
• DOI: http://doi.org/10.5946/ce.2018.046

Abstract

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.

Keyword

Colitis; Colonic polyps; Colonoscopy; Juvenile polyps; Rectal bleeding

MeSH Terms

Child*
Cohort Studies
Colitis
Colon
Colon, Transverse
Colonic Polyps
Colonoscopy
Hemorrhage*
Humans
Pathology
Polyps
Retrospective Studies

Figure

• 

  Fig. 1. Endoscopic and histologic findings in our cohort.

• 

  Fig. 2. Distribution of juvenile polyps in the colon.

Reference

1. Torres P, Rossomando A, Delpretti F, et al. [The usefulness of endoscopic polypectomy of rectosigmoid and colon in childhood]. G E N. 1991; 45:51–54.

2. El-Shabrawi MH, El Din ZE, Isa M, et al. Colorectal polyps: a frequently-missed cause of rectal bleeding in Egyptian children. Ann Trop Paediatr. 2011; 31:213–218.

3. Lee HJ, Lee JH, Lee JS, Choe YH. Is colonoscopy necessary in children suspected of having colonic polyps? Gut Liver. 2010; 4:326–331.

4. Thakkar K, Fishman DS, Gilger MA. Colorectal polyps in childhood. Curr Opin Pediatr. 2012; 24:632–637.

5. Lin CH, Wu RS, Lin WC, Wu SF, Chen AC. Colonoscopic polypectomy of colorectal polyps in children under general anesthesia. Kaohsiung J Med Sci. 2009; 25:70–76.

6. Mandhan P. Sigmoidoscopy in children with chronic lower gastrointestinal bleeding. J Paediatr Child Health. 2004; 40:365–368.

7. Sahn B, Bitton S. Lower gastrointestinal bleeding in children. Gastrointest Endosc Clin N Am. 2016; 26:75–98.

8. Haghi Ashtiani MT, Monajemzadeh M, Motamed F, et al. Colorectal polyps: a clinical, endoscopic and pathologic study in Iranian children. Med Princ Pract. 2009; 18:53–56.

9. Tam YH, Lee KH, Chan KW, Sihoe JD, Cheung ST, Mou JW. Colonoscopy in Hong Kong Chinese children. World J Gastroenterol. 2010; 16:1119–1122.

10. Brugnara C, Oski FA, Nathan DG. Disorders of erythrocyte production. In : Orkin SH, Nathan DG, Ginsburg D, Look AT, Fisher DE, Lux SE, editors. Nathan and Oski’s hematology of infancy and childhood. 7th ed. Philadelphia (PA): WB Saunders;2009. p. 455–520.

11. Fox VL, Perros S, Jiang H, Goldsmith JD. Juvenile polyps: recurrence in patients with multiple and solitary polyps. Clin Gastroenterol Hepatol. 2010; 8:795–799.

12. Poddar U, Thapa BR, Vaiphei K, Singh K. Colonic polyps: experience of 236 Indian children. Am J Gastroenterol. 1998; 93:619–622.

13. Campbell AM, Sugarman I. Does painless rectal bleeding equate to a colonic polyp? Arch Dis Child. 2017; 102:1049–1051.

14. Kleinman RE, Goulet OJ, Mieli-Vergani G, Sanderson IR, Sherman PM, Shneider BL IV. Walker’s pediatric gastrointestinal disease. 6th ed. Raleigh (NC): People’s Medical Publishing House USA;2018.