Lower Gastrointestinal Bleeding In Children Research Articles

Etiological Profile of Lower Gastrointestinal Bleeding in Children and Adolescents from Kashmir; A Tale of 5 Years.

Background: Lower gut bleeding is an alarming sign among caregivers. Determining the etiology is of utmost importance for further management. This is the first study conducted in northernmost India. Methods: This cross-sectional study was conducted at the Department of Pediatrics, Government Medical College, Srinagar. This study aimed to describe the etiology of lower gastrointestinal bleeding in the age group of 1-18 years over the past 5 years from June 2017 to June 2022. Results: A total of 310 children presented with hematochezia (53.5%), blood mixed with loose stools for > 2 weeks (39.3%), melena (1.9%), and occult blood in stools (0.3%). The mean age was 5.12 years. The age group of 1-6 years was 73.5 %. The most common findings were rectosigmoid polyps n=104 (33.5%), anal fissure n=47 (15.1%), lymphoid nodular hyperplasia (LNH) n=38 (12.2%), trichuris dysentery syndrome n=30(9.7%), cow's milk protein allergy n=27(8.7%), non-specific colitis n=18(5.8%), solitary rectal ulcer syndrome n=14(4.5%), inflammatory bowel disease n=6 (1.9%),intestinal tuberculosis n=3(0.9%), duodenal dieulafoy lesion 1(0.3%), and blue bleb nevus rubber syndrome n=1(0.3%). 21 patients had a normal colonoscopy. The colonoscopy yield was 93.3 %. Among the colonoscopy-negative patients, 6(1.6%) had Meckel's diverticulum, and 1(0.3%) had a duodenal dieulafoy lesion. Conclusion: Lower GI bleeding most commonly presents as hematochezia, and the most common cause is a rectosigmoid polyp. Colonoscopy is the procedure of choice to evaluate the etiology of lower GI bleeding. Anal fissures, LNH, Trichuris trichiura, and cow's milk protein allergy are other common causes of lower gut bleeding in Kashmir, northernmost India.

Lower gastrointestinal bleeding in children: Clinical profile and outcome

Lower gastrointestinal bleeding in children: Clinical profile and outcome

Causes and Outcome of Children with Lower Gastrointestinal Bleeding (LGIB) Presenting at Tertiary Care Hospital

Background: One of the most potentially fatal pediatric events is gastrointestinal (GI) bleeding. Lower gastrointestinal bleeding children often have anemia, but determining the cause of the bleeding is crucial in developing a management plan. Objective: To assess the causes and outcome of children presenting with lower gastrointestinal bleeding. Methodology: The current study was prospective cross sectional study carried out at the pediatrics department of Fauji Foundation Hospital, Peshawar Cantt for duration of one year from June 2021 to July 2022. A total of 250 children with lower GI bleeding were enrolled in the current study. All the data was analyzed by IBM SPSS version 23. Results: In the current study, male children were 140 (56%) while female children were 110 (44%) with the mean age of 6.80 (± 1.50) years. The commonest complaint was abdominal pain in 105 (42%) patients whereas the commonest clinical observation was pallor observed amongst 115 (46%) patients. Juvenile colonic or rectal polyps were observed in 91 (36.4%) patients based on colonoscopy. Based on histo-pathological findings, polyps were observed in 93 (37.2%) patients, amongst whom 90 (96.77%) cases were Juvenile polyps and 3 (3.33%) cases were familial adenomatous polyposis. Conclusion: There are several underlying causes of lower gastrointestinal bleeding (LGIB). Abdominal pain was a common symptom in children with LGIB while the most typical cause of LGIB in children was a juvenile polyp in our study. Colonoscopy is a safe and effective diagnostic and therapeutic technique for children with LGIB. Keywords: Children; Lower gastrointestinal bleeding; Causes; Outcomes

Gastrointestinal Bleeds.

Gastrointestinal Bleeds.

Colonoscopic Diagnosis of Postoperative Gastrointestinal Bleeding in Patients With Hirschsprung's Disease.

Aim: Postoperative lower gastrointestinal bleeding in children with Hirschsprung's Disease (HSCR) is a non-specific symptom, which may be caused by various etiologies. Our current study aims to utilize colonoscopy to diagnose the causes of postoperative hematochezia and to analyze its feasibility, accuracy, and safety.Methods: Twenty-four patients with HSCR with postoperative lower gastrointestinal bleeding or occult blood in the stool were enrolled in this study. The postoperative onset duration, age at examination, accompanied anomalies were recorded. After bowel preparation, all patients underwent colonoscopy. According to visual findings, mucosal biopsy was performed, followed by pathological diagnosis. Further treatment was determined according to the visual findings and pathological diagnosis. All patients were followed up for 6 months including therapeutic outcomes and recurrence of symptoms.Results: The mean onset duration was (221.3 ± 216.8) days postoperatively (ranging from 25 to 768 days). The mean age at examination was (41.0 ± 29.4) months. There was no significant difference in the onset days among each group (all, p > 0.05). Based on visual and pathological findings, there were 11 cases of HSCR associated enterocolitis (HAEC), 4 cases of anastomotic leakage, 7 cases of anastomotic inflammation, 1 case of juvenile polyp, and 1 case of inflammatory pseudopolyp. Intraluminal saline irrigation, thrombin treatment or colorectal polyp electrocision was performed according to intraoperative diagnosis. Patients with HEAC and anastomotic inflammation underwent antibiotics therapy and colorectal irrigation. Patients with leakage underwent reoperation. The highest incidence of accompanied symptoms of diarrhea existed in HEAC group (p = 0.02) and fever in leakage group (p = 0.02), respectively. No perforation or aggravated bleeding occurs in any patients. All patients gained uneventful recovery during follow-up period.Conclusions: Colonoscopy is a safe, accurate and timely examination for HSCR patients with postoperative lower gastrointestinal bleeding. The visual findings and biopsy may provide accurate diagnosis and guide treatment for this subset of patients.

Endoscopic Findings in Children with Isolated Lower Gastrointestinal Bleeding.

Background/AimsColorectal polyps are a common cause of lower gastrointestinal bleeding in children. Our aim was to study the causes of isolated lower gastrointestinal bleeding and to analyze the characteristics of the colorectal polyps found in our cohort. MethodsWe retrospectively reviewed colonoscopic procedures performed between 2007 and 2015. Children with isolated lower gastrointestinal bleeding were included in the study. ResultsA total of 185 colonoscopies were performed for isolated lower gastrointestinal bleeding. The median patient age was 8 years, and 77 patients (41.6%) were found to have colonic polyps. Normal colonoscopy findings were observed and acute colitis was detected in 77 (41.6%) and 14 (7.4%) patients, respectively. Single colonic polyps and 2–3 polyps were detected in 73 (94.8%) and 4 (5.2%) patients with polyps, respectively. Of the single polyps, 69 (94.5%) were juvenile polyps, among which 65 (94.2%) were located in the left colon. ConclusionsSingle left-sided juvenile polyps were the most common cause of isolated lower gastrointestinal bleeding in our study. It was rare to find multiple polyps and polyps proximal to the splenic flexure in our cohort. A full colonoscopy is still recommended in all patients in order to properly diagnose the small but significant group of patients with pathologies found proximal to the splenic flexure.

Chronic Lower Gastrointestinal Bleeding: Etiological Profile and Role of Colonoscopy among Children from sub‑Himalayan Ranges of North India

Background: Most patients with chronic lower gastrointestinal (GI) bleeding warrant endoscopic examination of the lower GI tract. This study was done to determine the etiological profile of chronic lower GI bleeding and the role of colonoscopy in its diagnosis, as well as the prognosis among children from sub‑Himalayan ranges of North India. Methods: In this study, we did a retrospective review of the clinical notes of children between 2 and 15 years of age who presented with chronic lower GI bleeding and underwent diagnostic and therapeutic colonoscopy in the Department of Gastroenterology, Indira Gandhi Medical College and Hospital, Shimla, from January 2012 to October 2017. Patient demographics, clinical features, and endoscopic and histopathological findings were recorded. Results: Of the total 57 patients reviewed, 22 (38.59%) were female and 35 (61.40%) were male, with a male‑to‑female ratio of 1.62:1.0. The highest incidence of lower GI bleeding was between the ages of 6 and 10 years (43.85%). The presenting symptoms were hematochezia in 50 (87.71%), bloody diarrhea in 5 (8.77%), and positive stool occult blood test in 2 (3.50%) patients. The most common accompanying symptom was constipation in 16 (28.07%), abdominal pain in 14 (24.56%), fever in 5 (8.77%), and weight loss in 5 (8.77%) patients. The most common colonoscopy finding was rectosigmoid polyps (36 cases, 63.15%) followed by internal hemorrhoids (9 cases, 15.78%), rectal ulcers (5 cases, 8.77%), findings suggestive of colitis of left colon (5 cases, 8.77%), and findings suggestive of ileocecal tuberculosis (2 cases, 3.50%). The most common histopathological finding was juvenile colorectal polyps (35 cases, 61.40%) followed by solitary rectal ulcer (5 cases, 8.77%), ulcerative colitis (5 cases, 8.77%), tuberculosis (2 cases, 3.50%), and Peutz–Jegher polyp (1 case, 1.75%). Conclusion: Juvenile colorectal polyps constitute the most common cause of chronic lower GI bleeding in children from sub‑Himalayan ranges of North India followed by hemorrhoids, solitary rectal ulcer, inflammatory bowel disease, and ileocolonic tuberculosis. Colonoscopy remains a useful and safe procedure in children for evaluation of lower GI bleeding both from the diagnostic and therapeutic points of view.

Clinico-etiological pattern of lower gastrointestinal bleeding in children (5-18 years age group) at a tertiary care center in central India

Background: Lower gastrointestinal bleeding (LGIB), defined as bleeding occurring distal to the ligament of Treitz, is a common presenting symptom in pediatric patients. Objective: To understand the clinico-etiological pattern of LGIB in children in the age group 5-18 years. Materials and Methods: This prospective study was carried out at a tertiary health-care center in central India between January 2011 and August 2012. We consecutively enrolled all patients in the age group 5-18 years who came to our center with gross LGIB or two consecutive positive occult blood tests with at least 1-week interval between tests. All patients underwent colonoscopy (small, flexible Olympus PCF-20 colonoscope) and the findings were recorded. The procedure was done only after proper informed consent from the parents. Results: Total 38 patients were included in the study with above-mentioned inclusion and exclusion criteria, during the study period. Male to female ratio in LGIB was 2.16:1. LGIB was most common in children aged 5-10 years (63.1%), followed by 10-14 years (26.3%). Hematochezia was the most common presenting symptom (78.9%) followed by melena (21.1%). The most common causes of LGIB were colitis and colorectal polyp (31.6% each) followed by anal fissures (21.1%). Anemia was present in 68.4% patients at the time of presentation. Recurrence of LGIB was noted in 18 (47.4%) patients. Conclusion: We conclude that LGIB is most common in 5-10 years of children (school age) with hematochezia as the most common presenting symptom. Causes of LGIB in children in developing countries are same as developed countries (polyps and colitis being most common, followed by anal fissure), but further studies are required to determine the significant correlation between findings.

Colonoscopic findings in children with lower gastrointestinal bleeding

Objective: The aim of our work was to assess the clinical manifestations and to determine the colonoscopic findings of children with lower gastrointestinal bleeding (LGIB) attending to hospital. Background: Colonoscopy is used for both diagnostic and therapeutic purposes in patients with lower gastrointestinal symptoms. LGIB in children has many different etiologies and is a serious problem that warrants careful diagnostic work-up. Patients and methods: This study was conducted on 75 patients (51 male and 24 female with age ranging from 3 to 12 years) presented with LGIB. We divided the patients into three age groups to find the relationship between the age and the causes of rectal bleeding in the studied patients. These groups were: group 1, which included patients from 3 to 6 years; group 2, which included patients from 6 to 9 years; and group 3, which included patients from 9 to 12 years. Results: Colon polyps were the most common colonoscopic finding among children (44%), followed by linear ulcerations and edema (25.3%), diffuse nonspecific inflammation (24%), and normal cases (6.6%). Juvenile polyps were the most common pathological finding among children. We found polyps common in patients between 3 and 6 years of age. Conclusion: Colonoscopy was performed for children with LGIB; we found that the most common causes of bleeding were polyps, ulcerative colitis, nonspecific colitis, and infectious colitis.

An assessment of the causes of lower gastrointestinal bleeding in a children’s hospital in northeastern Romania

The aims of this five-year retrospective study was to investigate the common etiologies, clinical, biological and pathological patterns of lower gastrointestinal bleeding in children from a hospital center in northeastern Romania. We included in the study 118 children with lower gastrointestinal hemorrhage or two consecutive positive fecal occult blood tests. Patients were divided into three age groups (0-2 years, 3-10 years, 11-18 years) and the findings were reported separately for each group. Gastrointestinal bleeding was more common among 3-10-year-old children. Hematochezia was the most common form of presentation (54.2%), followed by rectorrhagia (40.7%). Each patient underwent a colonoscopy with bioptic mapping. The most common colonoscopy finding was solitary colorectal polyps in 39 cases (33.1%), followed by suggestive aspects for ulcerative colitis in 26 patients (22.0%); only 15 (12.7%) were histologically confirmed. Endoscopic polypectomy was performed in all cases. We report two perforations and one hemorrhage that required surgery.

Lower Gastrointestinal Bleeding in Children: Experiences From Referral Center in Southern Iran

Background: Lower gastrointestinal bleeding (LGIB) in infants and children is a common problem in medical centers; however, its epidemiologic properties have not been studied well. Objectives: Due to the fact that LGIB has various causes in different geographical places, considering the importance of etiology in decision making for diagnostic techniques and treatment and since the lack of comprehensive database related to this issue, the main purpose of the current study was to determine the main causes of LGIB in children in a single center from Southern Iran. Patients and Methods: The study was conducted on all the patients less than 18 years old with LGIB who referred to Pediatric Gastroenterology Ward affiliated with Shiraz University of Medical Sciences between 2005 and 2009. The data, including the patients’ sex, age, and endoscopic as well as pathological findings, were collected and analyzed. Results: Overall, our series included a total of 309 patients with LGIB (185 males and 124 females) below 18 years old. The most common causes of LGIB included colorectal polyps (n = 90; 29.1%), lymphoid nodular hyperplasia (n = 62; 20%), solitary rectal ulcer (n = 31; 10%), and inflammatory bowel disease (n = 20; 6.5%). Nevertheless, no obvious causes were identified in 30.7% of the patients. The prevalence of lymphoid nodular hyperplasia in less than 2 years old patients and colorectal polyps in the 2-6 years old patients were significantly higher than the other causes (P = 0.001). The most cases with inflammatory bowel diseases and solitary rectal ulcer were more than 2 years old. On the other hand, no statistically significant differences were observed between males and females as well as different age groups regarding the means of the underlying causes of LGIB (P > 0.05). Conclusions: The results of present study could be used by the Iranian physicians in order to gain an overall picture of LGIB in Iran and guide the management of the patients with LGIB.

Lower Gastrointestinal Bleeding in Children: Experiences From Referral Center in Southern Iran

Background: Lower gastrointestinal bleeding (LGIB) in infants and children is a common problem in medical centers; however, its epidemiologic properties have not been studied well. Objectives: Due to the fact that LGIB has various causes in different geographical places, considering the importance of etiology in decision making for diagnostic techniques and treatment and since the lack of comprehensive database related to this issue, the main purpose of the current study was to determine the main causes of LGIB in children in a single center from Southern Iran. Patients and Methods: The study was conducted on all the patients less than 18 years old with LGIB who referred to Pediatric Gastroenterology Ward affiliated with Shiraz University of Medical Sciences between 2005 and 2009. The data, including the patients’ sex, age, and endoscopic as well as pathological findings, were collected and analyzed. Results: Overall, our series included a total of 309 patients with LGIB (185 males and 124 females) below 18 years old. The most common causes of LGIB included colorectal polyps (n = 90; 29.1%), lymphoid nodular hyperplasia (n = 62; 20%), solitary rectal ulcer (n = 31; 10%), and inflammatory bowel disease (n = 20; 6.5%). Nevertheless, no obvious causes were identified in 30.7% of the patients. The prevalence of lymphoid nodular hyperplasia in less than 2 years old patients and colorectal polyps in the 2-6 years old patients were significantly higher than the other causes (P = 0.001). The most cases with inflammatory bowel diseases and solitary rectal ulcer were more than 2 years old. On the other hand, no statistically significant differences were observed between males and females as well as different age groups regarding the means of the underlying causes of LGIB (P > 0.05). Conclusions: The results of present study could be used by the Iranian physicians in order to gain an overall picture of LGIB in Iran and guide the management of the patients with LGIB.

681 Clinicopathological Aspects of Lower Gastrointestinal Bleeding in Children: A Single Center Experience From Southern Iran

PurposeTo determine the common etiologies and characteristics of lower gastrointestinal bleeding in children in southern Iran.MethodsThis study was performed from March 2006 to March 2011 in Nemazee Hospital. All pediatric...

Angiodysplasia in a Child as a Cause of Lower GI Bleeding: Case Report and Literature Review

Angiodysplasia or vascular ectasia of the colon is a rare but important cause of recurrent lower gastro-intestinal bleeding in children and should be kept in mind as a diagnostic possibility. This case reports of intermittent rectal bleeding with early presentation caused by angiodysplasia. Therefore, early diagnosis of this rare lesion is important to avoid a possible fatal outcome, and thus the pediatrician should be aware of this lesion as a rare cause of intestinal bleeding in children.

Diagnosis and treatment of lower gastrointestinal bleeding in children

Diagnosis and treatment of lower gastrointestinal bleeding in children

The Floating Meckel

A 10-year-old girl was hospitalized because of abdominal pain and significant gastrointestinal bleeding for 3 days with hematocrit of 28% and hemoglobin of 6.1 mmol/L. Gastroscopy and abdominal ultrasound did not reveal any gastrointestinal abnormalities and parameters of coagulation were normal. Because a Meckel diverticulum is one of the most common causes of lower gastrointestinal bleeding in children, a Tc-99m pertechnetate scan (Meckel's scan) was performed to identify ectopic gastric mucosa. Normally, a Meckel diverticulum is found in the right lower quadrant.

Lower gastrointestinal bleeding in children.

Lower gastrointestinal bleeding is a common problem in the practice of general pediatrics. The differential diagnosis can be extensive and varies according to the age of the child. A specific diagnosis can usually be made with a thorough history, physical examination, simple laboratory investigations, and appropriate diagnostic studies. Treatment should be directed at the underlying cause. In most children, bleeding ceases spontaneously, and only supportive therapy is necessary. If there is evidence of hypovolemia, the patient must be hemodynamically stabilized, active bleeding stopped, and recurrent bleeding prevented.

65 COLONIC ANGIODYSPLASIA PRESENTING IN PEDIATRIC PATIENTS.

Although angiodysplasia of the colon is diagnosed frequently in the elderly, it is a very rare cause of massive lower gastrointestinal bleeding in children. We report two pediatric patients ages 13 and 15, in whom life threatening gastrointestinal hemorrhage was due to colonic angiodysplasia. Both patients were in good health until they presented with painless rectal bleeding. Physical exam was unremarkable except for orthostasis. Both patients had severe anemia at presentation with hemoglobin levels ranging from 4.4 to 8.9 g/dl. Colonoscopy and angiography established the diagnosis. Both patients had ileocecal involvement; one patient also had rectal and perianal lesions. Both underwent ileocecal resection with significant improvement postoperatively. One patient has required endoscopic sclerotherapy for lesions in the rectum. Although vascular malformations account for a minority of episodes of lower gastrointestinal bleeding in pediatric patients, the occurrence of these lesions should be considered in the differential diagnosis of severe gastrointestinal hemorrhage in children.

Lower Gastrointestinal Bleeding

The differential diagnosis of lower gastrointestinal bleeding in children can be reduced markedly simply by taking into account the age of the child. The clinical condition of the patient can further help narrow the diagnostic possibilities. Newborns and infants who are clinically unstable are more likely to have diseases such as necrotizing enterocolitis, volvulus, Hirschprung disease, intussusception, or Meckel diverticulum. A baby who appears healthy should be examined for swallowed blood, allergic colitis, anal fissures, or lymphonodular hyperplasia. An older child of healthy appearance with bleeding is likely to have a juvenile polyp or infectious colitis, but a child who appears sick may have hemolytic uremic syndrome, Henoch-Schoenlein purpura, or inflammatory bowel disease. This information, along with that gleaned from the physical examination, can lead the pediatrician to determine the need for specific tests, such as abdominal radiographs, stool cultures, and an endoscopic evaluation. We have come a long way in our ability to diagnose the causes of lower gastrointestinal bleeding. With the availability of newer radiographic and nuclear medicine modalities and the ability to visualize the colon endoscopically, the need for exploratory laparotomy for diagnosis is rarer. While surgery may still be the therapy of choice, new diagnostic modalities give the surgeon much more preoperative information.

Lower Gastrointestinal Bleeding

The differential diagnosis of lower gastrointestinal bleeding in children can be reduced markedly simply by taking into account the age of the child. The clinical condition of the patient can further help narrow the diagnostic possibilities. Newborns and infants who are clinically unstable are more likely to have diseases such as necrotizing enterocolitis, volvulus, Hirschprung disease, intussusception, or Meckel diverticulum. A baby who appears healthy should be examined for swallowed blood, allergic colitis, anal fissures, or lymphonodular hyperplasia. An older child of healthy appearance with bleeding is likely to have a juvenile polyp or infectious colitis, but a child who appears sick may have hemolytic uremic syndrome, Henoch-Schoenlein purpura, or inflammatory bowel disease. This information, along with that gleaned from the physical examination, can lead the pediatrician to determine the need for specific tests, such as abdominal radiographs, stool cultures, and an endoscopic evaluation. We have come a long way in our ability to diagnose the causes of lower gastrointestinal bleeding. With the availability of newer radiographic and nuclear medicine modalities and the ability to visualize the colon endoscopically, the need for exploratory laparotomy for diagnosis is rarer. While surgery may still be the therapy of choice, new diagnostic modalities give the surgeon much more preoperative information.