What is your diagnosis?

Discussion

Juvenile polyps resulting in lower gastrointestinal bleeding or prolapse require polypectomy. In this case, surgery consisted in pedicle cerclage and mass excision. The procedure was uneventful and the child was successfully discharged after eight hours of surveillance. Histologic examination confirmed the diagnosis of a 2.9-cm juvenile polyp (hamartoma). Total colonoscopy was planned to exclude multiple or proximal polyps, documented to occur in 24% and 15% of cases, respectively.¹

Gastrointestinal polyps are common in children and usually benign.^1-4 The diagnosis is most often established during the first decade of life, with a peak incidence between the ages of two and six years.^2-3 The condition is predominant in the male gender.¹ Gastrointestinal polyps may occur anywhere in the alimentary tract.^1-4 In preschool children and adolescents, 85% of polyps are juvenile, 10% are adenomas, and 3% are hyperplasic.² Most juvenile polyps are unique and located in the rectum and sigmoid and sometimes can be accessible by rectal touch.^1-3 The most common symptom of juvenile polyps is intermittent mild hematochezia.^1,2 Rarely, they may be accompanied by hemodynamic or hematologic alterations, as stool passing through the polyp may cause bleeding.^2,3 Most polyps are pedunculated and can prolapse when located in rectum, as in the present case.² Usually no pain is described, but polyp traction can cause discomfort. Although the risk of malignancy associated with a solitary juvenile polyp is very small, excision is recommended to confirm benignity. The recurrence rate was considered rare in older series, but more recent studies report recurrence in 17% of patients with single juvenile polyps.^1,2 Patient surveillance depends of the number of identified polyps and family history.²