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Colonic polyps in children: frequently multiple and recurrent
1Division of Gastroenterology, Wayne State University School of Medicine, Detroit, MI, USA.
Insights
Colorectal polyps in children are often diagnosed via rectal bleeding and successfully removed endoscopically. Full colonoscopy is recommended due to potential for multiple polyps and recurrence, especially with a family history of juvenile polyposis.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
- Diagnostic Imaging
Background:
- Colorectal polyps in children are uncommon but require thorough investigation.
- Understanding presenting symptoms and diagnostic methods is crucial for timely management.
Purpose of the Study:
- To review the clinical presentation, diagnosis, and outcomes of colorectal polyps in pediatric patients.
- To assess the efficacy of endoscopic removal and recurrence rates.
- To inform diagnostic and management strategies for pediatric colorectal polyps.
Main Methods:
- Retrospective chart review of 77 children and adolescents with colorectal polyps over 15 years (1980-1994).
- Analysis of presenting symptoms, demographics, diagnostic methods (including air contrast barium enema and rectal examination), pathological findings, and treatment outcomes.
- Assessment of polyp location, number, and recurrence rates.
Main Results:
- Rectal bleeding was the most common symptom (71/77 patients), with 66.2% presenting under age six.
- Air contrast barium enema confirmed polyps in 76% of cases; 16% were palpable on rectal exam.
- Endoscopic removal was successful in 97.3% of cases. 83.1% of polyps were in the rectosigmoid.
- Recurrence was observed in 7.9% of juvenile polyps. Multiple polyps occurred in 35% of children without polyposis syndromes.
Conclusions:
- Full colonoscopic evaluation is recommended for all suspected pediatric colorectal polyps to identify multiple lesions.
- Parents should be counseled on the potential for recurrence and increased malignancy risk in cases of multiple polyps or positive family history of juvenile polyposis.
Abstract:
A retrospective chart review on 77 children and adolescents (45 males and 32 females) with colorectal polyps seen over a 15-year period (1980-1994) was undertaken. Their presenting symptoms, demographic data, methods of diagnosis, pathologic diagnosis, and outcome were assessed. The age at presentation varied from 6 months to 19 years (mean age 77 months), 66.2% presenting under 6 years of age. The presenting symptoms were rectal bleeding in 71 patients, mass per rectum in 12, abdominal pain in nine, diarrhea in nine, vomiting in two, and one patient was asymptomatic. Air contrast barium enema was confirmatory in 41/54 patients (76%). Polyps were palpable in 16 patients during the rectal examination. A single polyp was present in 50 patients, whereas two to five polyps were present in 20 patients, and more than five in seven patients. Successful endoscopic removal was accomplished in 71/73 patients (97.3%). In 83.1% of patients polyps were located in the rectosigmoid area and in 32.5% polyps occurred proximal to the sigmoid colon. However, multiple polyps in the same location or at other locations were also present simultaneously. Recurrence was observed in five of 63 patients (7.9%) with juvenile polyps, in one patient with infantile polyposis, and in one with solitary adenomatous polyp. We conclude that a full colonoscopic evaluation should be performed in all patients with suspected polyps if feasible, for multiple polyps occurred in 35% of children without polyposis syndromes in this series. Parents of patients with more than three polyps and/or a family history of juvenile polyposis should be warned regarding the possibility of an increased risk of malignancy in future if polyps continue to recur.