PEDBASE.org - The Pediatric Database - Detailed information of ISOLATED JUVENILE POLYPS

ISOLATED JUVENILE POLYPS

DEFINITION:

A disorder involving the colon characterized by isolated masses of benign inflammatory polyps.

EPIDEMIOLOGY:

incidence: accounts for > 90% of polyps in children
- present in 3-4% of population < 21 years
- most common tumor of the bowel in childhood
age of onset:
- 2 to 8 years with a peak between 3-4 years
- seldom seen in adolescents
risk factors:
- sporadic
- M > F (3:2)

PATHOGENESIS:

1. Etiology

controversial:
- inflammatory reaction to mechanical irritation of a redundant mucosal fold
- disturbance in colonic cell kinetics

CLINICAL FEATURES:

1. Gastrointestinal Manifestations

1. Painless Rectal Bleeding

occurs during or immediately after bowel movement
occult with iron deficiency anemia
blood per rectum with mucous
minimal with streaks of fresh blood on outside of stool
+/- bloody diarrhea

2. Others

abdominal pain (due to intussusception or traction of the polyp)

3. Complications

prolapse of polyp (dark, beefy, red mass)
sloughing of polyp (if > 2 cm)
diarrhea and obstruction are uncommon
no malignancy potential

INVESTIGATIONS:

1. Colonoscopy

procedure of choice
appear as smooth pedunculated reddish-brown tumors covered by normal colonic mucosa and may be ulcerated - number of polyps (% of cases):
- solitary (47%), multiple: <4 (28%), >4 (25%)
distribution of polyps (% of cases):
- rectosigmoid colon (40%), proximal to (60%)

2. Imaging Studies

barium enema with air contrast (Double Contrast)

3. Biopsy

inflammatory (not hamartomatous) polyps about 1-1.5 cm in diameter with a thin stalk
areas affected: colon

4. Serum

microcytic hypochromic anemia
reduced serum iron and ferritin with elevated transferrin

MANAGEMENT:

1. Supportive

iron supplementation for anemia
nutritional support

2. Surgical

1. Endoscopic Polypectomy

snare-loop polypectomy with diathermy

2. Transabdominal Polypectomy

if polyps above the peritoneal reflection

Pediatric Database - ISOLATED JUVENILE POLYPS

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