Colonoscopic Evaluation of Bleeding Per Rectum in Children

Abstract

Objective: To evaluate the role of colonoscopy in the diagnosis and management of bleeding
perrectum in children.
Material and Methods: It was descriptive type of studyconducted at Department of Pediatrics,
Services Hospital, Lahore including 50 patients of either sex with age range of 5-15 years in whom
colonoscopy was performedfor bleeding PR. The patients with acute dysentery, melena and
rectal prolapse were excluded from study.
Gut preparation was started forty-eight hours before procedure. The children were given clear
liquids without any milk and fiber containing diet. Liquid paraffin was given orally as laxative and
two doses of kleen enema were given, 12 hours and 1 hour before procedure. Colonoscopy was
performed under deep sedation (Midazolam 0.25-0.5mg/kg) using fiberoptic pediatric
colonoscope in Medical Unit-1 of Services Hospital, Lahore. Polypectomy was done in patient
with pedunculated polyps and colonic biopsy was taken where indicated. The samples were sent
for histopathology in the Department of Pathology of the same hospital. After procedure all
patients were kept under observation for 4-6 hours in pediatric ward.
Results: Colorectal polyps were the most common cause of bleeding per rectum (56%) followed
by ulcerative colitis (12%), solitary rectal ulcer (8%), non-specific colitis (8%) and hemorrhoids in
2%. There was suspicion of malignancy in 2 children on colonoscopy. Biopsy was taken and it
was confirmed as adenocarcinoma on histopathology in one child. Among patients with polyps
(n=28), 22 (78.6%) have single polyp and 6 (21.4%) have more than one. Main site of polyps was
rectum (20 patients) while it was sigmoid/rectosigmoid junction in 5 and descending colon in 2
children. Polypectomy was performed in 21 children while it was not possible in 7 due to sessile
polyps in 6 and polyp size larger than snare in 1 child.
Conclusion: Colonoscopy is safe and very useful tool in the diagnosis and management of
bleeding per rectum in pediatric patients and juvenile polyps are the commonest cause of
bleeding per rectum in this age group.