Pediatr Gastroenterol Hepatol Nutr.  2019 Nov;22(6):613-618. 10.5223/pghn.2019.22.6.613.

Juvenile Polyp associated with Hypovolemic Shock Due to Massive Lower Gastrointestinal Bleeding

• Kim DY
• Bae JY
• Ko KO
• Cheon EJ
• Lim JW
• Song YH
• Yoon JM

• KMID: 2462104
• DOI: http://doi.org/10.5223/pghn.2019.22.6.613

Abstract

Juvenile polyps are the most common types of polyps in children, and patients usually present with lower gastrointestinal (GI) bleeding as the predominant symptom. These lesions, which are referred to as hamartomas, usually measure approximately 2 cm in size and are benign tumors located mainly in the rectum and sigmoid colon. The most common symptom of a juvenile polyp is mild intermittent rectal bleeding. It is rare for anemic patients because the amount of blood loss is small and often not diagnosed immediately. We present the case of a 6-year-old girl with a juvenile polyp in the distal transverse colon, who developed hypovolemic shock due to massive lower GI bleeding. Pediatricians must perform colonoscopy for thorough evaluation of polyps, because their location and size can vary and they can cause massive bleeding.

Keyword

Polyp; Children; Anemia; Colonoscopy

MeSH Terms

Anemia
Child
Colon, Sigmoid
Colon, Transverse
Colonoscopy
Female
Hamartoma
Hemorrhage*
Humans
Hypovolemia*
Polyps*
Rectum
Shock*

Figure

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  Fig. 1 Colonoscopy image showing the mass (A) and stalk (B). The mass was identified as a pedunculated solitary juvenile polyp with a smooth bright red and friable.

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  Fig. 2 (A) Heterogeneous polyp that has no calcification (arrow). (B) Stalk of polyp in the distal transverse colon (arrow).

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  Fig. 3 A 4.5 cm polyp after polypectomy.

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  Fig. 4 Microscopic photograph revealing a cystically dilated gland, excess lamina propria, and dense infiltration of inflammatory cells (H&E, ×75).

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