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Clinical characteristics of colorectal polyp in Thai children: a retrospective study
Satawan Waitayakul1, Jesda Singhavejsakul, Nutthapong Ukarapol
1Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Insights
Pediatric colorectal polyps are often juvenile polyps in the rectosigmoid colon, but some occur higher up. Colonoscopy is recommended for accurate diagnosis and to monitor for potential malignancy in polyposis coli.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
- Diagnostic Endoscopy
Background:
- Historically, colorectal polyps in children were presumed to be single, rectosigmoid lesions, treated with sigmoidoscopy.
- The widespread adoption of pediatric colonoscopy has challenged this traditional view.
Purpose of the Study:
- To characterize the clinical presentation of colorectal polyps in Thai children.
- To compare clinical features between children with polyposis coli and those with fewer than five polyps.
Main Methods:
- Retrospective review of medical records for pediatric patients diagnosed with colorectal polyps.
- Analysis included patient demographics, symptoms, examination findings, endoscopic investigations, polyp location, and histopathology.
Main Results:
- 93 children (average age 5.1 years) presented with lower GI bleeding and rectal polyp prolapse as common symptoms.
- Juvenile polyps constituted 95% of histopathological diagnoses.
- While 88.2% of polyps were in the rectosigmoid colon, 11.8% were proximal, with 50% of colonoscopies identifying polyps above this region.
Conclusions:
- Most pediatric colorectal polyps are juvenile polyps located in the rectosigmoid colon.
- A notable proportion of polyps occur proximal to the rectosigmoid, potentially missed by sigmoidoscopy alone.
- Routine colonoscopy is advised for initial investigation of pediatric colorectal polyps, especially given the risk of malignancy in polyposis coli.
Background:
It was believed that more than 90 per cent of children with colorectal polyp had a single lesion, located in the rectosigmoid colon, therefore, sigmoidoscopy with polypectomy was the treatment of choice. After a wide use of pediatric colonoscopy, this concept has been changed.
Material And Method:
This study was aimed to describe clinical characteristics of colorectal polyp in Thai children. Medical records of children with colorectal polyp were retrospectively reviewed. Comparison between polyposis coli and children with less than 5 polyps were also analyzed.
Results:
There were 93 patients, 43 females and 50 males. The average age was 5.1 years. Lower GI bleeding and prolapse of rectal polyp comprised the two most common presentations, 93.5 and 39.8 per cent, respectively. The mean duration of symptoms was 5.6 months. Only 50.6 per cent had rectal polyp noted by digital examination. Investigations included sigmoidoscopy (n = 77), colonoscopy (n = 16), and barium enema (n = 16). Eight per cent of the cases had more than 5 polyps. Location of the polyps was noted in the rectosigmoid colon (88.2%), descending colon (4.3%), right-sided colon (4.3%), and pancolonic (3.2%). Of all the patients, 11.8 per cent had the polyp above the rectosigmoid region, whereas 50 per cent of those who underwent colonoscopy (n = 16) had the polyps noted proximal to this region. Older age, lower hematocrit, and more frequent right-sided polyps were significantly associated with polyposis coli (p < 0.05). Only 2 patients with polyposis coli were treated by colectomy. Histopathology included juvenile polyp (95%), inflammatory pseudopolyp (2.5%), and hyperplastic polyp (2.5%).
Conclusion:
Most of the children with colorectal polyp had juvenile polyp that is commonly found in the rectosigmoid colon. However, a significant number of patients had carrying polyps proximal to the rectosigmoid region, which would be easily missed by sigmoidoscopy. With the concern of malignancy change particularly in children with polyposis coli, routine colonoscopy should be considered as an initial investigation in children with colorectal polyp.
