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[Colorectal prolapse in a child with a severe form of juvenile polyposis]
V Martins1, M Gonçalves, M J Leal
1Cirurgia Pediátrica, Hospital de Santa Maria, Lisboa.
Insights
Severe juvenile polyposis in a child required surgical intervention when endoscopic resection proved insufficient. This case highlights the need for surgical treatment in extensive colorectal juvenile polyposis.
Area of Science:
- Pediatric Gastroenterology
- Surgical Oncology
Background:
- Juvenile polyps are common in infancy, typically isolated and treated endoscopically.
- Severe, diffuse colorectal juvenile polyposis is rare and presents significant management challenges.
Observation:
- An 8-year-old child presented with a 4-year history of severe digestive bleeding, abdominal pain, anemia, and hypoproteinemia due to diffuse colorectal juvenile polyposis.
- The polyps extensively coated the colon, particularly the rectum and sigmoid, rendering standard endoscopic resection unfeasible.
Findings:
- Surgical resection of the rectum and descending colon with transanal pull-through (Soave technique) was performed.
- Histopathology confirmed juvenile polyps, and the postoperative period was uneventful with satisfactory follow-up.
- Complementary endoscopic resection addressed residual scattered polyps.
Implications:
- This case underscores the necessity of surgical resection for severe, diffuse juvenile polyposis unresponsive to endoscopic methods.
- Aggressive surgical management may be required for extensive juvenile polyposis to prevent complications and improve patient outcomes.
Abstract:
Colon polyps are very common in infancy, most cases are unique, seldom exceeding ten; as a rule, the treatment is endoscopic resection. The AA present a case of a severe diffuse colorectal juvenile polyposis in an 8-year-old black child, with a 4-year evolution of serious digestive bleeding, abdominal pains, anemia and hypoproteinemia. The disease scattered throughout the colon with a great density at the rectum and sigmoid level, coating fully the mucous membrane, making the classic treatment by endoscope unworkable. A resection of the rectum and descendent colon with transrectal pullthrough by the Soave technique with anal demucosization was performed. The post operative without incidents and the follow-up period was considered satisfactory. Complementary endoscopic resection of the remaining and scattered polyps followed. The result of the histopathological examination of all elements studied was juvenile polyps. This case demonstrates the necessity of surgical treatment with resection in cases of severe diffuse juvenile polyposis, in which endoscopic resection alone is not deemed to be sufficient.