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Endoloop-Assisted Polypectomy for a Symptomatic Giant Colonic Polyp in a Pediatric Patient. CHILDREN 2022; 9:children9020222. [PMID: 35204942 PMCID: PMC8870706 DOI: 10.3390/children9020222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/13/2022] [Accepted: 01/25/2022] [Indexed: 11/28/2022]
Abstract
Colonic polyps are a common cause of persistent bloody stools in pediatric patients. Such polyps are easily diagnosed by a barium study of the lower gastrointestinal tract or by colonoscopy. Polypectomies utilizing electric ligators are generally performed on pediatric patients, and such patients can be easily operated on. However, giant colonic polyps have been reported in pediatric patients. In the past, a laparotomy or laparoscopy would have been performed in some pediatric patients diagnosed with a giant colonic polyp; however, the large size, location, or position of the polyp would sometimes be too large or the location or position of the polyp would make successful operation difficult. In general, larger stumps with large feeding arteries are associated with larger colonic polyps. Therefore, if such a polyp is removed via electric polypectomy alone, there may be a higher risk of post-polypectomy bleeding from its stump. We report a case of a 14-year-old male patient who presented with a 2-month history of bloody stools. A giant juvenile colonic polyp was detected by colonoscopy in the transverse colon. Finally, we successfully removed the giant polyp by using endoloop-assisted polypectomy.
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Stampfer L, Deutschmann A, Dür E, Eitelberger FG, Fürpass T, Gorkiewicz G, Heinz-Erian P, Heller I, Herzog K, Hopfer B, Kerbl R, Klug E, Krause R, Leitner E, Mache C, Müller T, Pansy J, Pocivalnik M, Scheuba E, Schneditz G, Schweintzger G, Sterniczky E, Zechner E, Hauer AC, Högenauer C, Hoffmann KM. Causes of hematochezia and hemorrhagic antibiotic-associated colitis in children and adolescents. Medicine (Baltimore) 2017; 96:e7793. [PMID: 28816966 PMCID: PMC5571703 DOI: 10.1097/md.0000000000007793] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Diseases causing hematochezia range from benign to potentially life-threatening. Systematic pediatric data on the causes of hematochezia are scarce. We studied the underlying causes and long-term outcome of hematochezia in children. We further investigated the relevance of antibiotic-associated hemorrhagic colitis in children, especially if caused by Klebsiella oxytoca.Infants, children, and adolescents with hematochezia were recruited prospectively. Patients were grouped according to age (<1 year, 1-5 years, 6-13 years, >14 years). In addition to routine diagnostics, K oxytoca stool culture and toxin analysis was performed. We collected data on history, laboratory findings, microbiological diagnostic, imaging, final diagnosis, and long-term outcome.We included 221 patients (female 46%; age 0-19 years). In 98 (44%), hematochezia was caused by infectious diseases. Endoscopy was performed in 30 patients (13.6%). No patient died due to the underlying cause of hematochezia. The most common diagnoses according to age were food protein-induced proctocolitis in infants, bacterial colitis in young children, and inflammatory bowel disease in children and adolescents. Seventeen (7.7%) had a positive stool culture for K oxytoca. Antibiotic-associated colitis was diagnosed in 12 (5%) patients: 2 caused by K oxytoca and 2 by Clostridium difficile; in the remaining 8 patients, no known pathobiont was identified.Infections were the most common cause of hematochezia in this study. In most patients, invasive diagnostic procedures were not necessary. Antibiotic-associated hemorrhagic colitis caused by K oxytoca was an uncommon diagnosis in our cohort. Antibiotic-associated colitis with hematochezia might be caused by pathobionts other than C difficile or K oxytoca.
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Affiliation(s)
- Laura Stampfer
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz
| | - Andrea Deutschmann
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz
| | - Elisabeth Dür
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz
| | - Franz G. Eitelberger
- Division of General Pediatrics and Adolescent Medicine, Hospital Wels-Grieskirchen, Wels
| | - Theresia Fürpass
- Microbiologic Laboratory, Institute of Pathology, General Hospital Hochsteiermark, Leoben
| | | | | | - Ingrid Heller
- Institute of Microbiology, Medical University Innsbruck, Innsbruck
| | - Kathrin Herzog
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz
| | - Barbara Hopfer
- Division of Pediatrics and Adolescent Medicine, General Hospital Hochsteiermark, Leoben
| | - Reinhold Kerbl
- Division of Pediatrics and Adolescent Medicine, General Hospital Hochsteiermark, Leoben
| | - Evelyn Klug
- Institute of Pathology, Hospital Oberwart, Oberwart
| | - Robert Krause
- Department of Internal Medicine, Medical University Graz
| | - Eva Leitner
- Institute of Hygiene, Microbiology and Environmental Medicine
| | - Christoph Mache
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz
| | | | - Jasmin Pansy
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University Graz
| | - Mirjam Pocivalnik
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz
| | - Eva Scheuba
- Division of General Pediatrics and Adolescent Medicine, Hospital Wels-Grieskirchen, Wels
| | - Georg Schneditz
- Institute of Molecular Biosciences, Karl-Franzens University Graz, Graz
| | - Gerolf Schweintzger
- Division of Pediatrics and Adolescent Medicine, General Hospital Hochsteiermark, Leoben
| | - Edith Sterniczky
- Division of Pediatrics and Adolescent Medicine, Hospital Oberwart, Oberwart
| | - Ellen Zechner
- Institute of Molecular Biosciences, Karl-Franzens University Graz, Graz
| | - Almuthe C. Hauer
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz
| | - Christoph Högenauer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Karl Martin Hoffmann
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz
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de Ridder L, van Lingen AV, Taminiau JAJM, Benninga MA. Rectal bleeding in children: endoscopic evaluation revisited. Eur J Gastroenterol Hepatol 2007; 19:317-20. [PMID: 17353696 DOI: 10.1097/meg.0b013e328080caa6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Rectal bleeding is an alarming event both for the child and parents. It is hypothesized that colonoscopy instead of sigmoidoscopy and adding esophago-gastro-duodenoscopy in case of accompanying complaints, improves the diagnostic accuracy in children with prolonged rectal bleeding. STUDY DESIGN All pediatric patients undergoing colonoscopy because of prolonged rectal bleeding over an 8-year period at the Emma Children's Hospital/Academic Medical Centre were reviewed. Patient demographics, clinical features, number and extent of endoscopic examinations and the endoscopic and histopathological findings were assessed. RESULTS A total of 147 colonoscopies were performed in 137 pediatric patients (63 boys) because of prolonged rectal bleeding. Inflammatory bowel disease and polyp(s) were the most prevalent diagnoses. In 72% of patients diagnosed as Crohn's disease, focal, chronically active gastritis was seen on histology, giving support to the diagnosis Crohn's disease. In 22% of the cases polyps would have been missed in the case where only sigmoidoscopy was performed. No complications after endoscopic intervention were seen. CONCLUSIONS Colonoscopy is the investigation of choice in children with prolonged rectal bleeding. In patients presenting with accompanying complaints such as abdominal pain or diarrhea, it is advisable to perform ileocolonoscopy combined with esophago-gastro-duodenoscopy. This combines a high diagnostic yield with a safe procedure.
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Affiliation(s)
- Lissy de Ridder
- Department of Pediatric Gastroenterology, VU University Medical Centre, Amsterdam, The Netherlands.
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Abstract
Although uncommon in children, haemorrhoids are one of the causes of a protruding anal lesion and may be confused with rectal prolapse or prolapse of a rectal polyp. The lesions may not be obvious when the child is anaesthetised because of lack of straining. This may prevent accurate diagnosis and impede identification of the lesion if surgery is being attempted. The authors report 3 cases where a 20 F Foley catheter with 30 ml balloon was inserted rectally and gentle traction applied to reproduce the raised venous pressure generated during straining. On each occasion external haemorrhoids could be demonstrated as the underlying pathology.
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Affiliation(s)
- R Babu
- Department of Paediatric Surgery, Southampton General Hospital, Tremona Road, SO16 6YD Southampton, UK.
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Abstract
Gastrointestinal (GI) bleeding is an alarming problem in children. Although many causes of GI bleeding are common to children and adults, the frequency of specific causes differs greatly, and some lesions, such as necrotizing enterocolitis or allergic colitis, are unique to children. This article reviews the spectrum of GI bleeding in infants and children. The causes, diagnostic evaluation, and management are discussed, and differences with adult medicine are highlighted.
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Affiliation(s)
- V L Fox
- Harvard Medical School, Boston, Massachusetts, USA
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Abstract
STUDY OBJECTIVES To describe the presumptive diagnoses in an unselected, ambulatory, pediatric population complaining of rectal bleeding; to determine how often those diagnoses changed with follow-up; and to determine how often the bleeding represented an acutely life-threatening condition. DESIGN Retrospective case series. SETTING Urban, tertiary care pediatric emergency department. PARTICIPANTS One hundred four patients with 109 visits with a chief complaint of blood in the stool. INTERVENTIONS None. MAIN RESULTS Follow-up was available on 95 of 109 visits (87.1%), with a mean duration of 7.5 months. A specific presumptive etiology was established for 73 of 109 patients (67%) at the initial ED visit and for 74 of 95 patients (77%) at follow-up. The etiologies varied markedly by age. Four patients (4.2%; 95% confidence interval, 0.2% to 8.2%) presented with a life-threatening condition (requiring an RBC transfusion or operative intervention): intussusception (three patients) and Meckel's diverticulum (one patient). Concordance between the ED diagnosis and the follow-up diagnosis was 81%. CONCLUSION A complaint of rectal bleeding is typically not life threatening in children. Emergency physicians normally are able to establish a presumptive diagnosis, which usually remains the same with follow-up.
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Affiliation(s)
- S J Teach
- Division of Emergency Medicine, Children's Hospital, Boston, MA
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Walter DF, Govil S, Korula A, William RR, Chandy G. Pedunculated colonic polyp diagnosed by colonic sonography. Pediatr Radiol 1992; 22:148-9. [PMID: 1501950 DOI: 10.1007/bf02011322] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A solitary hamartomatous polyp of the colon in a four year old boy was diagnosed by colonic sonography while barium enema and colonoscopy were non-diagnostic. Colonic sonography provides an additional simple, relatively non-invasive modality for evaluation of the colon.
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Affiliation(s)
- D F Walter
- Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India
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Holmquist L, Rudic N, Ahren C, Fällström SP. The diagnostic value of colonoscopy compared with rectosigmoidoscopy in children and adolescents with symptoms of chronic inflammatory bowel disease of the colon. Scand J Gastroenterol 1988; 23:577-84. [PMID: 3399830 DOI: 10.3109/00365528809093915] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Seventy-eight young patients with symptoms of chronic inflammatory bowel disease (IBD) of the colon have been investigated to determine to what degree colonoscopy adds important information for the diagnosis of IBD in addition to results of the routine procedures, including rectosigmoidoscopy carried out at the same time. After colonoscopy IBD was established in 4 of 12 patients classified as non-IBD after the routine procedures. Eleven of 18 patients with the routine diagnosis indeterminate colitis (IC) could after colonoscopy be differentiated into UC or probable CC. In 30 of 31 cases classified as UC the routine diagnosis was confirmed by colonoscopy. Routine diagnosis as probable CC was changed to definite CC in 3 of 10 cases. In all cases but one with previously established IBD it was possible to confirm the diagnosis. Thirty-seven of 70 patients with established IBD of the colon had no radiologic evidence of colitis.
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Affiliation(s)
- L Holmquist
- Dept. of Pediatrics II, University of Gothenburg, Sweden
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