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Intestinal polyps in children and adolescents--a review of 103 cases
1Department of Pediatrics, Veterans General Hospital-Kaohsiung, Taiwan, R.O.C.
Insights
Juvenile polyps are common pediatric gastrointestinal tumors causing rectal bleeding. Most cases are isolated and treated with colonoscopic polypectomy, though recurrence can occur.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Oncology
- Colorectal Surgery
Background:
- Juvenile polyps are the most frequent gastrointestinal tumors in children, often presenting as the primary cause of hematochezia.
- Intestinal polyps in pediatric patients encompass juvenile polyps, adenomatous polyps, and inherited polyposis syndromes.
Purpose of the Study:
- To analyze the clinical characteristics, management, and outcomes of pediatric intestinal polyps treated over a 33-year period.
- To evaluate the incidence and management of juvenile polyps and inherited polyposis syndromes in a pediatric population.
Main Methods:
- Retrospective review of 103 pediatric patients with intestinal polyps treated between 1961 and 1994.
- Diagnosis included colonoscopy, polypectomy, and genetic evaluation for inherited syndromes.
- Data analysis focused on polyp type, location, symptoms, treatment modalities, and recurrence rates.
Main Results:
- Juvenile polyps accounted for 84.5% of cases, predominantly in children aged 2-10 years, with rectal bleeding as the main symptom (97.7%).
- Most juvenile polyps were isolated (82.8%) and located in the rectosigmoid colon, treated successfully via colonoscopic polypectomy with a 10.2% recurrence rate.
- Inherited polyposis syndromes (Peutz-Jeghers, Familial Adenomatous Polyposis, Gardner's syndrome) were diagnosed in 14 patients, with some presenting with intussusception or malignancy.
Conclusions:
- Juvenile polyps are the most common pediatric intestinal polyps, typically benign and manageable with colonoscopic polypectomy.
- While generally benign, vigilance for complications like intussusception and malignant transformation in inherited polyposis syndromes is crucial.
- Colonoscopic surveillance and polypectomy are effective for managing juvenile polyps and associated conditions in children.
Abstract:
Juvenile polyps are the most common tumors of the gastrointestinal tract in children and are the principal cause of hematochezia. A total of 103 children and adolescents with intestinal polyps have been treated in Veterans General Hospital-Taipei from March 1961 to March 1994. The diagnosis included 87 cases (84.5%) of juvenile polyps, 2 cases of isolated adenomatous polyp and 14 cases of inherited polyposis syndrome. Juvenile polyps most often occur in children between 2 to 10 years old, with a male-to-female ratio of 1.4:1. Rectal bleeding was the main symptom (97.7%). Of the 87 patients, 82.8% had isolated polyps and 83.3% of those were located in rectosigmoid colon. After extensive use of colonoscopy, the reported incidence of multiple polyps substantially increased, and more polyps were found proximal to the rectosigmoid colon. Most juvenile polyps were removed by colonoscopic polypectomy. The recurrent rate was 10.2%. One of the two cases of juvenile polyposis coli suffered from intussusception demanding partial colectomy. Recurrent polyps were found in the remaining colon and were removed by colonoscopic polypectomy. Seven patients of Peutz-Jeghers syndrome came from five families. At initial diagnosis, one case had no polyps and two presented with intussusception. A 19-year-old girl was found to have bilateral ovarian cysts. One of the three familial adenomatous polyposis had adenocarcinoma at initial evaluation. Two cases of Gardner's syndrome received sulindac treatment, and no evidence of malignancy was found after three years of follow-up.