Rectal Bleeding In Children Research Articles

Solitary rectal ulcer syndrome – An uncommon cause of rectal bleeding in children

Background: Solitary rectal ulcer syndrome (SRUS) is a benign chronic disorder rarely found in children commonly presents with rectal bleeding, mucorrhea, straining during defecation, tenesmus, feeling of incomplete defecation, rectal prolapse and constipation. The pathogenesis is not clearly understood but several factors such as trauma, rectal prolapse, ischemia, behavioral disorders such as excessive straining during defecation and rectal manipulation, sexual abuse and disharmony of the pelvic floor muscles during defection may be involved. SRUS is diagnosed on the basis of clinical symptoms and endoscopic and histological findings. Various treatment protocol for SRUS have been described such as conservative management such as family reassurance, regulation of toilet habits, avoidance of straining, encouragement of a high-fiber diet, topical treatments with salicylate, sulfasalazine, steroids and sucralfate, and surgery. Methods: A comprehensive search is done using PubMed, Scopus, Google scholar and MEDLINE. Results: The result of this review will be published in a journal. Conclusion: This study discusses about the pathogenesis, clinical features, diagnosis and various treatment strategy of solitary rectal ulcer syndrome in children. Bangladesh Medical Res Counc Bull 2023; 49(1): 70-74

Solitary Rectal Ulcer Syndrome: An Unusual Cause of Per Rectal Bleeding in Children

Solitary rectal ulcer syndrome (SRUS) is a relatively uncommon but troublesome chronic benign disorder more in young adults and less in children. It is usually presented as rectal bleeding, constipation, copious mucous discharge, prolonged excessive straining, tenesmus, lower abdominal pain, localized pain in the perineal area, feeling of incomplete defecation and rarely rectal prolapse.The underlying etiology is not well known. It is diagnosed based on symptoms and endoscopic and histological findings. J Enam Med Col 2021; 11(1): 47-51

Colonoscopic Evaluation of Per Rectal Bleeding in Children : Our Experience

Background: Most patients with Per Rectal Bleeding (PRB) warrant endoscopic examination of the lower GI tract. This study was done to determine the demographic profile and find out the etiology of bleeding per rectum under colonoscipic evaluation.
 Meterials and methods : In this study, we did a retrospective review of the clinical data of children between 0 and 18 years of age who presented with per rectalbleeding and underwent diagnostic and therapeutic colonoscopy in the Department of Pediatric Gastroenterology & Nutrition, Chattagram Maa-O-Shishu Hospital, Chattagram from July 2014 to July 2021.Patient demographics, clinical features and endoscopic and histopathological findings were recorded.
 Results: Overall, we included 111 patients with mean age 9.6±5.1 years. There were 69 (62.2%) male, 42(37.80%) female and with a male to female ratio of 1.64:1.0 The highest incidence was the age group of 11 to 18 years, 46 (41.40%). The most common colonoscopy finding were juvenile colorectal polyp 46 (41.44% ) which include rectal polyps 21 ( 18.9%), Sigmoid polyp 17 (15.3), recto sigmoid polyp 4 (3.6%), colonic polyp 4(3.6%), followed by internal hemorrhoids (20 cases, 18%) rectal ulcers (5 cases, 4.5%) colitis (4 cases, 3.60%) and findings suggestive of koach’s infection (2 cases, 1.8 %). All polyps were removed by colonoscopic polypectomy (47 cases 42.30%), 64 cases (57.65%) were given conservative treatment.
 Conclusion :We found that Juvenile colorectal polyps constitute the most common cause of per rectal bleeding in pediatric age group followed by hemorrhoids and colitis . Colonoscopy remains a useful and safe procedure in children for evaluation of lower GI bleeding and it’s good for both diagnostic and therapeutic procedure.
 Chatt Maa Shi Hosp Med Coll J; Vol.21 (1); January 2022; Page 66-69

A Rare Cause of Rectal Bleeding in Children Mimicking Rectal Cancer

A Rare Cause of Rectal Bleeding in Children Mimicking Rectal Cancer

Solitary Rectal Ulcer Syndrome in Children

To describe clinical features, demographic data, and complications of the patients with SRUS, which is a rare cause of rectal bleeding in children. Eleven patients diagnosed with Solitary Rectal Ulcer Syndrome (SRUS) were evaluated. The patients assessed by colonoscopy and the biopsies were investigated. The data evaluated in SPSS Program. The exact Method of the Chi-square test was used to compare groups according to qualitative variables. P <0.05 value was considered statistically significant. The most common symptom of the patients was rectal bleeding followed by abdominal pain and constipation. Lesions were mostly ulcerative in the endoscopic examination. There was a statistically significant relationship between the admission symptom and the response to treatment. Patients with abdominal pain and rectal bleeding had poor responses to treatment. In conclusion, SRUS is not uncommon than is thought in pediatric patients with the symptoms of rectal bleeding and constipation. SRUS should be considered in patients with or without rectal prolapse, with any complaints of any lesions in the rectum, hematochezia, and tenesmus.

Rectal bleeding in children – case report

Intestinal polyps are tumoral masses protruding in the gas­tro­in­tes­tinal lumen, with various histopathological pat­terns, either as neoplastic or non-neoplastic type, and epi­th­e­lial or non-epithelial type. The classical form of cli­ni­cal presentation is rectal bleeding, with or without mu­cus, in a normal appearing stool, and only in a minority of cases there is lower abdominal pain. The standard pro­ce­dure for diagnosis and management of pediatrics co­lo­rec­tal po­lyps is full colonoscopy. Recent studies have re­vealed high levels of fecal calprotectin in patients with in­tes­ti­nal po­lyps and modern sonography empowered the detection rate of colonic polyps before performing co­lo­no­sco­py. We re­port the case of a 5-year-old boy who was refereed to our gastroenterology unit with a history of one month of in­ter­mit­tent rectal bleeding and mild ab­do­mi­nal pain, with an unremarkable medical history, and with nor­mal phy­si­cal and biochemical exam. The abdominal ultra­sound showed abundant blood flow signal in a round pe­dun­­cu­la­ted shaped intraluminal mass situated in the lower left ab­do­men area, measuring 20/15 mm. The co­lo­no­sco­py re­vealed a pedunculated left colon polyp that was re­moved using electroresection. The aim of this report is to draw at­ten­tion to the importance of hematochezia in chil­dren and to the need for adherence to actual guidelines re­gar­ding the endoscopic evaluation of the gastrointestinal tract in chil­dren.

Infantile juvenile polyposis syndrome: A rare cause of protein-losing enteropathy

Juvenile Polyposis Syndrome (JPS) is a rare autosomal dominant hereditary syndrome affecting 1:100000-160000 individuals. JPS most presents with rectal bleeding, anemia, abdominal pain, obstruction and rarely with rectal prolapsus of the polyp. In this case, we diagnosed Infantile Juvenile Polyposis Syndrome due to protein losing enteropathy, rectal bleeding and extraintestinal manifestations of the syndrome. A 2-year-old male infant was referred to the hospital due to complaints of painless rectal bleeding and rectal prolapsus of the polyp which occurred at 15 months of age. Pathological examination revealed that it was a juvenile polyp. After a short while, the patient was hospitalized due to rectal bleeding, paleness, swelling in both legs and periorbital edema. Physical examination of the patient revealed +3 pretibial, scrotal, periorbital edema, clubbing and pale appearance. The patient had macrocephaly, hypotonicity and neuromotor retardation. Laboratory test results revealed low immunoglobulin levels, hypoalbuminemia, anemia, and electrolyte imbalance. We diagnosed the case with JPS due to protein losing enteropathy with extraintestinal manifestations of the syndrome. Gastroscopic and colonoscopic examinations revealed multiple polyps through the antrum and colon. JPS diagnosis is based on the detection of polyps which are histopathologically defined as juvenile polyps. One of the most common causes of painless, rectal bleeding in children are colorectal polyps. We wanted to emphasize that the sporadic juvenile polyp diagnosis should be made by pathological examination of polypectomy material and clinical exclusion of JPS. In our patient, there were extraintestinal system manifestations such as macrocephaly, congenital heart disease and clubbing, accompanied with protein-losing enteropathy. Awareness of these clinical findings is necessary for the differential diagnosis of protein-losing enteropathy and polyposis syndrome. We would also like to draw attention to the importance of a multidisciplinary approach, early recognition of the syndrome and appropriate referral of the patient.

Solitary Rectal Ulcer Syndrome in a 12-Year Bangladeshi Boy: an Unusual Cause of Rectal Bleeding

Solitary rectal ulcer syndrome (SRUS) is an uncommon cause of per rectal bleeding in children. Due to it's wide variety of presentation and rarity, it is frequently misdiagnosed as other clinical condition like inflammatory bowel disease, rectal polyp, amoebiasis or malignancy. Here we presenting a case initially misdiagnosed as ulcerative colitis, latter after thorough evaluation diagnosed as a case of SRUS.
 KYAMC Journal Vol. 11, No.-2, July 2020, Page 104-107

Digital rectal stimulation associated with psychiatric disorders as a rare reason of solitary rectal ulcer in children and adolescents: a case series study

Solitary rectal ulcer syndrome is one of the rare causes of rectal bleeding in children and adolescents. Traumatic and ischemic mucosal injury is the main cause of its etiopathogenesis. A rare but important cause of traumatic mucosal injury is digital rectal stimulation. It is known that digital rectal stimulation is used in order to increase intestinal motility and to reduce the feeling of inadequate defecation. In this study, it was emphasized that digital rectal stimulation can be seen as a consequence of psychiatric disorders, and with proper psychiatric interventions, digital stimulation behavior and solitary rectal ulcer syndrome can be improved. Moreover, the importance of a cooperation between gastroenterologist and psychiatrist in such cases has been stressed.

A survey on rectal bleeding in children, a report from Iran

Background/aim: Studies on the epidemiology of rectal bleeding in children are limited in Iran. Our aim was to assess etiologies of rectal bleeding in children in Iran. Materials and methods: We enrolled 730 children with rectal bleeding. All the patients underwent colonoscopy, and 457 were further evaluated with histopathology. Results: According to colonoscopy and histopathology, respectively, inflammatory bowel disease (IBD) (29.4%, 15.8%), nodular hyperplasia (NH) (24.9%, 10%), and juvenile polyposis (JP) (12.6%, 9.9%) were the most common causes of rectal bleeding. Other conditions were solitary rectal ulcer (5.3%), chronic colitis (4.6%), allergic colitis (3.3%), focal colitis (1.3%), and infectious colitis (1.1%). In colonoscopy, there were no significant differences in the distribution of pathologies regarding sex, while the youngest and oldest mean ages were found for patients with NH (4.6 ± 3.9 years, P < 0.0001) and those with normal appearance (8.1 ± 4.4 years, P < 0.0001) respectively. Based on histopathologic reports, the youngest patients were diagnosed with infectious colitis (4.6 ± 2.8 years), while patients with chronic colitis were the oldest (9.2 ± 4.6 years, P = 0.003). Conclusion: JP, NH, and IBD constituted the most common etiologies of rectal bleeding in our patients. It is recommended to perform a complete diagnostic approach to accurately assess rectal bleeding in children.

Per Rectal Bleeding in Children: Experiences in the Department of Paediatric Surgery in BSMMU

Per rectal bleeding is a frequently encountered clinical complaint in routine medical/surgical practice in paediatric patients. It has different aetiology in both extremes of age. This study was carried out in an attempt to find out causes, presentation and the proper management that can be offered to the affected infants and children.This retrospective study was carried out from January 2012 to December 2014 in the department of Paediatric Surgery of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. All patients presenting with the complaint of per rectal bleeding were included. But patients who needed emergency surgical intervention were excluded from this study. The data were reviewed for gender, age, causes of rectal bleeding and type, number, site, recurrence rate and the modality of treatment employed in children having colorectal polyp. Technetium-labeled red blood cells scans was used for the diagnosis of Meckel's Diverticulum. Complete blood picture and routine stool examination were done for all cases.Most polyp cases were diagnosed with digital rectal examination (DRE). Colonoscopy was performed for some cases in the Paediatric Gastroenterology Department of BSMMU. Also all the rectal polyps and colonic mucosal biopsies taken during colonoscopy submitted to histopathological examination. Per rectal bleeding was the chief complaint in 326 (1.5%) patients Out of 21,533 patients presenting to the outpatient department of Paediatric Surgery of BSMMU, Dhaka, Bangladesh over a period of three years. In this study, it was reviewed 326 patients, among them 208 (63.89%) were boys and 118 (36.19%) were girls. The male female ratio was 1.8:1. The ages ranged from 14 months to 14 years (mean age: 5.8years) at diagnosis. The most common aetiology was juvenile polyps which were found in 209 (64.11%) of the cases. It was to be found that anal fissure in 33 (10.12%) patients, rectal prolapse in 27 (8.2%) patients, non-specific colitis in 15 (4.60%) patients, Meckel's Diverticulitis in 3 (0.9%) patients, juvenile polyposis coli in 5 (1.5%) patients and familial adenomatous polyposis coli (FAP) in 4 (1.2%) patients. However, the cause of per rectal bleeding remained unknown suspecting chronic constipation in 30 (9.20%) patients. No statistically significant differences were observed between males and females as well as different age groups regarding the means of the underlying causes of per rectal bleeding in children(p &gt; 0.05). The prevalence of anal fissure in less than 2 years old patients and juvenile polyps in the 2-6 years old patients were significantly higher than the other causes (p &lt; 0.001). Other causes of per rectal bleeding prevailed in children were more than 2 years old. Colorectal polyps are common causes of per rectal bleeding in children. Proper physical examination including DRE along with the colonoscopy promotes both rapid and accurate diagnosis and the opportunity for immediate therapeutic measures.

Clinical, endoscopic, and pathologic characteristics of colorectal polyps in Indian children and adolescents.

Colorectal polyps are among the common causes for rectal bleeding in children. We studied the clinical, colonoscopic, and histopathological features of colorectal polyps and polyposis syndrome in Indian children and adolescents. Medical records of children and adolescents with colorectal polyps and polyposis syndrome were retrospectively reviewed from 2001 to 2014 at Department of Gastroenterology, in large tertiary care center of Mumbai. A total of 120 patients were found to have colonic polyps during study period. Mean age of presentation in children was 7.31 ± 4.05 years (range 2 to 19 years), with male-to-female ratio of 2.16:1. Rectal bleeding was presenting symptom in 95.8 % with mean duration of 12.6 ± 15 months. Majority of polyps (77.5 %) were juvenile, and 97.2 % were located in left colon. Solitary polyps were seen in 76.6 %, multiple polyps in 11.6 %, juvenile polyposis syndrome in 6.6 %, familial adenomatous polyposis in 4.2 %, and Peutz-Jeghers syndrome in 0.8 % of the children. The polyposis syndrome group had higher age at presentation (p = 0.00006), greater likelihood of anemia, abdominal pain, and diarrhea (p = 0.0001, 0.0002, and 0.0051, respectively). Likelihood of adenomatous change in polyps was higher in polyposis syndrome group (p = 0.0003). Left colonic polyps were more common in non-polyposis group, whereas pan-colonic polyps were more common in polyposis syndrome group (p < 0.00001). Presence of anemia, abdominal pain, diarrhea, higher age at presentation (more than 10 years), and history of polypectomy are clinical indicators of polyposis syndrome.

Rectal bleeding in children – causes and investigations

Abstract Rectal bleeding in children is an alarming symptom which can lead to significant parental anxiety. Mostly the causes are benign and self-limiting however sometimes a lower GI bleed may be due to a significant pathology or can lead to life-threatening haemorrhage. Hence it requires careful assessment and appropriate investigations, taking into account the age of the child and the nature of the bleed. This review covers common causes and investigations of rectal bleeding in children.

More on Fecal Occult Blood Test Misuse

The current issue of the Journal includes a study by Narula et al (1) (pages 421–426) that nicely demonstrates the numerous reasons why fecal occult blood test (FOBT) use outside of screening purposes should be considered inappropriate and how it may, in fact, negatively impact patient care. The authors performed a chart review of all FOBTs ordered in Hamilton Health Sciences’ (Hamilton, Ontario) acute care campuses over a three-month period in 2011, combined with a survey of health care providers on their practices regarding the use of FOBT. Use of point-of-care FOBT was not included. The clinical presentations were anemia, overt or suspected gastrointestinal (GI) bleeding, diarrhea, iron deficiency and dyspepsia. Thirty-four percent of patients underwent ≥2 FOBTs, and the majority of tested patients were either on medications or on a diet that could interfere with the test. Only 50% of the FOBT positives were ever referred for a GI consultation and, most importantly, 27% of patients presenting with overt GI bleeding in whom an FOBT was ordered experienced a delay in the GI referral because of the FOBT process. The survey included 67 health care professionals (mainly primary care physicians and nurses); the most common reasons for ordering an FOBT were: symptoms potentially consistent with GI bleeding (84%); anemia (53%); iron deficiency with or without anemia (31%); overt GI blood loss (26%); and nonbloody diarrhea (10%). Interestingly, screening for colorectal cancer was a cited reason in only 25% of the cases.

Juvenile polyp in children in Kano Nigeria: Clinical presentation and management challenges

Background: Juvenile polyps are a common cause of low volume painless rectal bleeding in children. Most of these polyps are located within the sigmoid colon and the rectum. Objective: The aim of this study was to describe the clinical characteristics of children presenting with colorectal polyp in Kano, Nigeria and to document the challenges faced in their management. Materials and Methods: We undertook a retrospective review of the clinical records of all children aged 13 years or less who presented to our hospital with a colorectal polyp between January 2008 and December 2008, and also prospectively enrolled all those presenting between January 2009 and December 2010. Demographic, clinical and laboratory data were collected. Data were analysed using SPSS 15.0 (SPSS Inc, Chicago, IL). Results: There were 16 patients in all, with their ages ranging between 2.5 years and 9 years (mean 6.03 years). There were 8 boys and 8 girls (M: F = 1:1). Haematochezia was the most common presenting symptom, followed by a prolapsing rectal mass and rectal prolapse. In 13 of the patients, there was a solitary polyp, while 3 patients had 2 polyps each. All the polyps were located in the rectum within 7 cm of the anal verge. Only one patient had a sessile polyp, while all the others were pedunculated. Histopathology reported juvenile polyp without evidence of adenomatous change in all of them. Conclusion: A careful digital rectal examination is recommended for all children presenting with a bloody stool to rule out juvenile polyp.

Endoscopic Appearance of Meckel's Diverticulum

Meckel's diverticulum is a remnant of the omphalomesenteric duct located in the ileum. Although typically asymptomatic, it may cause rectal bleeding in children. Owing to improved endoscopic techniques for the small bowel, it is increasingly also recognized as a potential bleeding site in adults. Endoscopic appearance is characterized by two lumina, a thickened bridge, ulcer, and occasionally direct visualization of ectopic gastric mucosa. This article is part of an expert video encyclopedia.

Cap polyposis: A rare cause of rectal bleeding in children

To evaluate the clinicopathological features and treatment outcomes of cap polyposis in the pediatric population. All pediatric patients with histologically proven diagnosis of cap polyposis were identified from our endoscopy and histology database over a 12 year period from 2000-2012 at our tertiary pediatric center, KK Women's and Children's Hospital in Singapore. The case records of these patients were retrospectively reviewed. The demographics, clinical course, laboratory results, endoscopic and histopathological features, treatments, and outcomes were analyzed. The study protocol was approved by the hospital institutional review board. The histological slides were reviewed by a pediatric histopathologist to confirm the diagnosis of cap polyposis. Eleven patients were diagnosed with cap polyposis. The median patient age was 13 years (range 5-17 years); the sample included 7 males and 4 females. All of the patients presented with bloody stools. Seven patients (63%) had constipation, while 4 patients (36%) had diarrhea. All of the patients underwent colonoscopy and polypectomies (excluding 1 patient who refused polypectomy). The macroscopic findings were of polypoid lesions covered by fibrinopurulent exudates with normal intervening mucosa. The rectum was the most common involvement site (n = 9, 82%), followed by the rectosigmoid colon (n = 3, 18%). Five (45%) patients had fewer than 5 polyps, and 6 patients (65%) had multiple polyps. Histological examination of these polyps showed surface ulcerations with a cap of fibrin inflammatory exudate. Four (80%) patients with fewer than 5 polyps had complete resolution of symptoms following the polypectomy. One patient who did not consent to the polypectomy had resolution of symptoms after being treated with sulphasalazine. All 6 patients with multiple polyps experienced recurrence of bloody stools on follow-up (mean = 28 mo). Cap polyposis is a rare and under-recognised cause of rectal bleeding in children. Our study has characterized the disease phenotype and treatment outcomes in a pediatric cohort.

A clinical experience on pediatric colorectal polyps

SUMMARY Background: Colorectal polyps are among the common causes for rectal bleeding in children. They rarely have malignant potential. This study aims to present a clinical experience on colorectal polyps with an emphasis on utility of colonoscopy in these children. Methods: File records of patients treated between the years 2001-2011 were retrospectively evaluated in terms of age, sex, diagnostic methods, localization of polyps and pathological results. Results: There were 63 patients with a mean age of 6 years (1-15 years). Among these, 38 (60 %) were males and 25 (40 %) females. The presenting complaint was rectal bleeding in 60, prolapsed polyps in 2 and prolapsed rectum in one. The use of colonoscopy was initiated within the last 9-month of the study period. The polyps were removed by transanal route in 54. Colonoscopy was done with successful removal in all except one for the remaining 9 and yielded polyps in rectum in 4, in sigmoid colon in 3, in transverse colon in one and multiple polyps in one. Histopathology results were available in 62 and consistent with juvenile polyps in 51, hamartamatous in 2, hyperplastic in 2, pseudopolyps in 4, lymphoid in 2 and inflammatory fibroid in one. Conclusions: Although many rectal polyps are palpated and can be removed by anorectal route in children, the incidence of nonpalpable rectal polyps and colonic polyps should not be underestimated. The polyps are benign in most children. Colonoscopic examination increases the diagnostic accuracy and adds to the treatment keeping the possible presence of premalignant conditions in these children. Routine colonoscopic examination should be offered for all children with suspected or proven polyps.

Colonoscopic examination of rectal bleeding in children: A report of two cases

Rectal bleeding in children is a frightening and cause of great concern, and of parental anxiety. In this report, we present the value of colonoscopy to unravel the diagnostic conundrum often associated with rectal bleeding in children.

A Rare Cause of Chronic Rectal Bleeding in Children: Solitary Rectal Ulcer (Case Report)

Solitary rectal ulcer causing lower gastrointestinal bleeding is extremely rare in children. Rare presentation, non-specific symptoms, insufficient experience, and characteristics mimicking other rectal diseases may cause misdiagnosis or delay of diagnosis in some pediatric patients. Here, we report a 10-year-old boy with solitary rectal ulcer diagnosed two years after onset of the symptoms who responded well to the conservative therapy, including high-fiber diet, laxatives, defecation training, and sucralfate enema.