The Role of Colonoscopy in Children with Hematochezia

Ju Hee We; Hyun Suk Park; Jae Hong Park

doi:10.5223/kjpgn.2011.14.2.155

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We, Park, and Park: The Role of Colonoscopy in Children with Hematochezia

Original Article

Gastrointestinal Tract

Korean Journal of Pediatric Gastroenterology and Nutrition

Korean Journal of Pediatric Gastroenterology and Nutrition 2011; 14(2): 155-160.

Published online: 30 June 2011

DOI: https://doi.org/10.5223/kjpgn.2011.14.2.155

The Role of Colonoscopy in Children with Hematochezia

Ju Hee We, M.D., Hyun Suk Park, M.D., Jae Hong Park, M.D.

Department of Pediatrics, College of Medicine, Pusan National University, Busan, Korea.

Corresponding author (jhongpark@pusan.ac.kr)

Received 9 February 2011 Revised 12 March 2011 Accepted 15 March 2011

Abstract

Purpose

This study was performed to evaluate the role of colonoscopy in children with hematochezia.

Methods

We retrospectively reviewed the medical records of 277 children who underwent colonoscopy because of hematochezia between January, 2003 and July, 2010.

Results

The mean age of the patients was 6.0±4.4 (7 days~17.8 years) years. The male to female ratio was 2.2 : 1. The duration between the 1st episode of hematochezia and colonoscopy was 4.9±12.1 months. Characteristics of hematochezia included red stool (65.1%), blood on wipe (12.8%), bloody toilet (11.9%), and blood dripping (10.2%). The most proximal region of colonoscopic approach was terminal ileum (84.5%), cecum (9.5%), hepatic flexure (2.8%), and splenic flexure (3.2%). Eighty five patients (30.6%) had no specific abnormal findings. Major causes of hematochezia were polyp (26.4%), food protein induced proctocolitis (6.9%), infectious colitis (5.4%), lymphofolliculitis (5.7%), non specific colitis (5.7%), and vascular ectasia (5.1%). The hemorrhagic sites included the rectum (24.0%), rectosigmoid junction (18.1%), sigmoid colon (13.5%), ascending colon (14.2%), transverse colon (11.3%), descending colon (7.8%), cecum (8.1%), and terminal ileum (3.1%). The recurrence rate of hematochezia after colonoscopy was 19.1%. Colonoscopy was performed in 262 patients (94.6%) with conscious sedation. Endoscopic hemostasis was performed in 5 patients. Complications of colonoscopy or sedation were not found.

Conclusion

The causes and lesional localization of pediatric hematochezia were diverse. Colonoscopy has an important role in the diagnosis and treatment of hematochezia in children. Total colonoscopy is recommended to detect the cause of hematochezia.

Keywords: Hematochezia, Child, Colonoscopy

Figures and Tables

Fig. 1

Localization of the hemorrhage.

Table 1

Causes of Hematochezia

^*Ulcerative colitis, eosinophilic colitis, self-amputated polyp, Crohn disease, neutropenic enterocolitis, Henoch-Schönlein purpura, Peutz-Jeghers syndrome, ischemic colitis, hemangioma, solitary rectal ulcer, familial adenomatosis polyposis, blue rubber nevus syndrome.

References

1. Cynamon HA, Milov DE, Andres JM. Diagnosis and management of colonic polyps in children. J Pediatr. 1989. 114:593–596.

2. Yachha SK, Khanduri A, Sharma BC, Kumar M. Gastrointestinal bleeding in children. J Gastroenterol Hepatol. 1996. 11:903–907.

3. Mandhan P. Sigmoidoscopy in children with chronic lower gastrointestinal bleeding. J Paediatr Child Health. 2004. 40:365–368.

4. Balkan E, Kiristioglu I, Gurpinar A, Ozel I, Sinmaz K, Dogruyol H. Sigmoidoscopy in minor lower gastrointestinal bleeding. Arch Dis Child. 1998. 78:267–268.

5. Cucchiara S, Guandalini S, Staiano A, Devizia B, Capano G, Romaniella G, et al. Sigmoidoscopy, colonoscopy, and radiology in the evaluation of children with rectal bleeding. J Pediatr Gastroenterol Nutr. 1983. 2:667–671.

6. de Ridder L, van Lingen AV, Taminiau JA, Benninga MA. Rectal bleeding in children: endoscopic evaluation revisited. Eur J Gastroenterol Hepatol. 2007. 19:317–320.

7. Park KH, Park JH. Changes in pediatric gastrointestinal endoscopy: review of a recent hospital experience. Korean J Pediatr Gastroenterol Nutr. 2007. 10:20–27.

8. Seo JK. Pediatric endoscopy. 1990. In : Proceedings of the 3rd Gastrointestinal Endoscopy Seminar; The Korean Society of Gastrointestinal Endoscopy;29–35.

9. Seo JK. Infant and pediatric endoscopy. 2003. In : Proceeding of the 28th Gastrointestinal Endoscopy Seminar; The Korean Society of Gastrointestinal Endoscopy;36–46.

10. Tabbers MM, Bruin KF, Taminiau JA, Norbruis OF, Benninga MA. An unexpected finding in a child with rectal blood loss using video capsule endoscopy. Eur J Pediatr. 2006. 165:270–272.

11. Guilhon de Araujo Sant'Anna AM, Dubois J, Miron MC, Seidman EG. Wireless capsule endoscopy for obscure small-bowel disorders: final results of the first pediatric controlled trial. Clin Gastroenterol Hepatol. 2005. 3:264–270.

12. Brown RL, Azizkhan RG. Gastrointestinal bleeding in infants and children: Meckel's diverticulum and intestinal duplication. Semin Pediatr Surg. 1999. 8:202–209.

13. Hassall E, Barclay GN, Ament ME. Colonoscopy in childhood. Pediatrics. 1984. 73:594–599.

14. Tytgat GNJ, Mulder CJJ. Endoscopy in gastro-intestinal disease. 1986. 1st ed. Aalsmeer: Mur-Kostverloren;266–267.

15. Gelb AM, Minkowitz S, Tresser M. Rectal and colonic polyps occurring in young people. N Y State J Med. 1962. 62:513–518.

16. Jalihal A, Misra SP, Arvind AS, Kamath PS. Colonoscopic polypectomy in children. J Pediatr Surg. 1992. 27:1220–1222.

17. Cheon KW, Kim JY, Kim SW. Solitary juvenile polyps and colonoscopic polypectomy in children. J Korean Pediatr Soc. 2003. 46:236–241.

18. Poddar U, Thapa BR, Vaiphei K, Singh K. Colonic polyps: experience of 236 Indian children. Am J Gastroenterol. 1998. 93:619–622.

19. Mestre JR. The changing pattern of juvenile polyps. Am J Gastroenterol. 1986. 81:312–314.

20. Im SJ, Kim SH, Bae SN, Park JH. Clinical features of dietary protein induced proctocolitis. Korean J Pediatr Gastroenterol Nutr. 2005. 8:157–163.

21. Kwak JW, Park JH. Clinical features of eosinophilic colitis developed in early infancy. Korean J Pediatr Gastroenterol Nutr. 2005. 8:122–129.

22. Lee NY, Park JH. Clinical features and course of Crohn disease in children. Korean J Gastrointest Endosc. 2007. 34:193–199.

23. Kim KM. The pharmacotherapy of inflammatory bowel disease in child and adolescence. J Korean Med Assoc. 2010. 53:524–530.

24. Hemingway AP. Angiodysplasia as a cause of iron deficiency anaemia. Blood Rev. 1989. 3:147–151.

25. Park JH. Role of colonoscopy in the diagnosis and treatment of pediatric lower gastrointestinal disorders. Korean J Pediatr. 2010. 53:824–829.

26. Kim JY, Park JH, Choi KH, Choi BH. Clinical spectra of auto-amputated polyps: comparison of juvenile polyp and Meckel's diverticulum. Korean J Pediatr Gastroenterol Nutr. 2009. 12:10–15.

27. Moir CR, Scudamore CH, Benny WB. Typhlitis: selective surgical management. Am J Surg. 1986. 151:563–566.

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