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CASE REPORT Table of Contents   
Year : 2012  |  Volume : 9  |  Issue : 2  |  Page : 169-171
Colonoscopic examination of rectal bleeding in children: A report of two cases


1 Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
2 Department of Medicine, Irrua Specialist Teaching Hospital, Edo State, Nigeria
3 Department of Histopathology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
4 Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria

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Date of Web Publication6-Aug-2012
 

   Abstract 

Rectal bleeding in children is a frightening and cause of great concern, and of parental anxiety. In this report, we present the value of colonoscopy to unravel the diagnostic conundrum often associated with rectal bleeding in children.

Keywords: Children, colonoscopy, juvenile polyps, rectal bleeding

How to cite this article:
Olokoba AB, Obateru OA, Bojuwoye MO, Ibrahim OK, Babalola OM. Colonoscopic examination of rectal bleeding in children: A report of two cases. Afr J Paediatr Surg 2012;9:169-71

How to cite this URL:
Olokoba AB, Obateru OA, Bojuwoye MO, Ibrahim OK, Babalola OM. Colonoscopic examination of rectal bleeding in children: A report of two cases. Afr J Paediatr Surg [serial online] 2012 [cited 2019 Sep 20];9:169-71. Available from: http://www.afrjpaedsurg.org/text.asp?2012/9/2/169/99410

   Introduction Top


Rectal bleeding is a relatively uncommon but important occurrence in children. [1] When it occurs it could be a source of great anxiety for both the child and parents. Rectal bleeding in children occurs in 1% of pre-school and school children. [2] Fortunately, most cases in children are due to aetiologies that have little morbidity. [3] A vast majority of rectal bleeding in children is benign. [2]


   Case Reports Top


0Case 1

A 9-year-old girl presented with 6 months history of recurrent painless rectal bleeding occurring as streaking of blood mixed with stools. There was no associated haematemesis, abdominal pain, constipation, diarrhoea or instrumentation. There was no similar history in the family. Stool microscopy culture and sensitivity showed only the presence of red blood cells. All other haematologic and biochemical results were within normal limits. Digital rectal examination confirmed the presence of blood in the rectum. Colonoscopy using a flexible paediatric video colonoscope, showed a pedunculated polyp with necrotic surface at the recto-sigmoid area, about 8 cm from the anal verge [Figure 1].
Figure 1: Showing pedunculated colonic polyp (arrowed)

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The polyp was snared and sent for histology, which diagnosed juvenile polyps [Figure 2].
Figure 2: Photomicrograph of Juvenile polyp in a 9 year old girl

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The patient has not had any episode of bleeding per rectum since then and she is being followed up in the last eighteen months.

Case 2

A 4-year-old girl presented with 2 months history of painless recurrent passage of blood mixed with stool. There was occasional protrusion of a mass from the rectum while defaecating. She has no history of haematemesis, abdominal pain, constipation, diarrhoea or instrumentation. She has no family history of polyps. Digital rectal examination revealed a mass in the rectum. Stool examination done showed only the presence of red blood cells.

All other haematologic and biochemical results were within normal limits. Colonoscopy revealed a pedunculated polyp with a necrotic surface [Figure 3] and a small sessile polyp in the rectum [Figure 4], about 4 cm from the anal verge. The pedunculated polyp was removed and sent for histological examination, which confirmed juvenile polyp [Figure 5]. She has remained symptom free and has been followed up in the clinic for about 4 months.
Figure 3: Shows a rectal polyp (long arrow), with its pedicle (short arrow)

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Figure 4: Shows a small polyp (arrowed)

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Figure 5: Photomicrograph of Juvenile polyp in a 4 year old girl

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   Discussion Top


Colorectal bleeding is one of the numerous causes of bleeding in children. [1] Bleeding from colonic polyps range from spotting to a severe life threatening condition necessitating resuscitation, [1] as was our experience in this report. Colonic polyp may be single or multiple. [2]

Most colorectal polyps are located on the left side of the colon, particularly at the rectosigmoid area, but can be located anywhere in the colon. [4] Both patients had their polyps located at the right side of the colon. Reassurance of both parent and child is necessary. Endoscopic polypectomy with its low morbidity and mortality has revolutionized the management of polyp and now regarded as the modality of treatment for this condition. [5] For those not amenable to endoscopic removal or found to have malignant potential at histological examination, open or laparoscopic colectomy is required. [6] Colonoscopy has advantage over open colectomy as it allows for direct visualisation without surgical incision, thus less traumatising to the patient. However, colonoscopy may not be readily available and affordable to patients in a poor resource setting. The complications these patients could have with ulcerated polyps include life threatening bleeding, perforation and peritonitis. Following endoscopic snaring of polyps, the patients would require long time follow-up and repeat colonoscopy in future, because of the possibility of reoccurrence and later malignancy potential. [7]

In conclusion, this report further re-emphasizes the value of colonoscopy in the evaluation of children who present with rectal bleeding.

 
   References Top

1.Haghighat M, Geramizadeh B. The Clinical presentation and outcome of infants with nodular lymphoid hyperplasia: Experience with 34 cases from Southern Iran. Iran J Med Sci 2003;28:176-9.  Back to cited text no. 1
    
2.Lee HJ, Lee JH, Lee JS, Choe YH. Is colonoscopy necessary in children suspected of having colonic polyps? Gut Liver 2010;4:326-31.  Back to cited text no. 2
[PUBMED]    
3.Lawrence WW, Wright JL. Causes of rectal bleeding in children. Pediatr Rev 2001;22:394-5.  Back to cited text no. 3
[PUBMED]    
4.Keyur P, Neville EH. The anatomical distribution of colorectal polyps at colonoscopy. J Clin Gastroenterol 2001;33:222-5.  Back to cited text no. 4
    
5.Hauroto M, Lozano R, Beteta O, Hauman C, Salazar G. Paediatric colonoscopic polypectomy. Rev Gastroenterol Peru 1994;14:204-8.  Back to cited text no. 5
    
6.Cruz RA, Ragupathi M, Pedraza R, Pickron TB, Le AT, Haas EM. Minimally invasive approaches for management of "Difficult" Colonic polyps. Diagn Ther Endosc 2011;2011:682793.   Back to cited text no. 6
[PUBMED]    
7.Robertson DJ. Colonoscopy for colorectal cancer prevention. "Is it fulfilling the promise"? Gastrointest Endosc 2010;71:118-20.  Back to cited text no. 7
[PUBMED]    

Top
Correspondence Address:
Abdulfatai B Olokoba
Division of Gastroenterology, Department of Medicine, University of Ilorin Teaching Hospital, Ilorin
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0189-6725.99410

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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