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Hydrosonography in the evaluation of colorectal polyps
U P Ling1, J Y Chen, C J Hwang
1Department of Paediatrics, Chung Shan, Taichung, Taiwan, Republic of China.
Insights
Transabdominal ultrasound (hydrosonography) effectively identifies colonic polyps in children with rectal bleeding. This radiation-free method complements colonoscopy, offering a valuable alternative pre-procedural examination.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
Background:
- Rectal bleeding in children often necessitates endoscopic evaluation.
- Colonoscopy, while effective, carries risks and may not always be feasible.
Purpose of the Study:
- To evaluate the utility of pre-colonoscopy transabdominal ultrasound (hydrosonography) in diagnosing colonic polyps in children presenting with rectal bleeding.
- To compare the diagnostic yield of hydrosonography with colonoscopy in this pediatric population.
Main Methods:
- Seventeen children with rectal bleeding underwent pre-colonoscopy evaluation using prewarmed saline enemas and transabdominal ultrasound (hydrosonography).
- Findings from hydrosonography were compared with subsequent colonoscopy results.
Main Results:
- Hydrosonography identified polyps in 10 out of 12 patients diagnosed with polyps (83% sensitivity).
- Ultrasound detected 11 polyps, characterizing them as hyperechoic ovoid masses; colonoscopy identified finer mucosal details and smaller polyps.
- Colonoscopy was superior for detecting subtle mucosal abnormalities and smaller polyps.
Conclusions:
- Hydrosonography is a simple, non-invasive, and radiation-free imaging modality for evaluating the pediatric colon before colonoscopy.
- It serves as a complementary tool, aiding in the pre-procedural assessment of children with rectal bleeding and suspected polyps.
Abstract:
Prewarmed saline enemas and transabdominal ultrasound (hydrosonography) were used to evaluate 17 consecutive children with rectal bleeding before colonoscopy. Twelve patients with polyps were identified (10 by ultrasound, 10 by endoscopy): these included multiple hyperplastic polyps (1), multiple polyps (1), solitary polyps (9), and pseudopolyps (1). Ultrasound identified 11 polyps in 10 patients, missing two patients with small polyps less than 0.5 cm in diameter. The polyps were hyperechoic ovoid masses fixed to the colonic wall, with a stalk (7), submucosal infolding (5), and intraluminal floating (5). There was one false positive. Colonoscopy was refused by one patient and failed to reach beyond the distal sigmoid in another following previous surgery for malrotation. Colonoscopy was superior in identifying finer mucosal detail (colitis, ulcers, proctitis, anal fissure) and in detecting smaller polyps (sessile polyps, hyperplastic polyps). Hydrosonography of the colon is a simple, relatively non-invasive procedure that provides an alternative, radiation-free examination of the whole colon before colonoscopy. It is complementary to colonoscopy in the management of rectal bleeding in children.