A 9-Month-Old Presenting With Rectal Prolapse

Abstract

Gastroenterology 2016;150:42–43 Question: A 9-month-old, previously healthy female infant presented with a 2-week history of watery diarrhea and tactile fevers. One day before admission, the mother noticed prolapsing rectal mucosa. The mother gave a history of amoxicillin treatment 2 weeks before the development of diarrhea. Mom denies any sick contacts. On physical examination, her weight was 7.35 kg, and height was 68 cm, plotting at the 10th percentile and 25th percentile, respectively, on the growth curve. Her abdomen was mildly distended, but no tenderness to palpation or guarding. While straining, prolapsed rectal mucosa was noted with raised white to yellow plaques (Figure A). The prolapse reduced spontaneously. Laboratory data revealed a white blood cell count of 15,100/mm, a hemoglobin count of 11.8 g/dL, and a platelet count of 130,000/mm. Stool culture was negative. Stool was sent for Clostridium difficile enzyme immunoassay (EIA) and was negative. Sweat test was negative. Computed tomography of abdomen revealed bowel wall edema, most pronounced at the rectosigmoid junction. Flexible sigmoidoscopy demonstrated raised yellow plaques scattered over rectosigmoid mucosa. (Figure B). What is the diagnosis? Look on page 43 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.