Colocolic intussusception in children: A case series and literature review

Background Colocolic intussusceptions is a rare subtype of intussusception mostly caused by juvenile polyps. The treatment of colocolic intussusception caused by other pathologic lead points remains poorly understood. Methods A systematic literature review between January 2000 and June 2021 was performed to characterize the comprehensive treatment of colocolic intussusception in children. This report also included 10 patients admitted to our center between 2010 and 2020 not previously reported in the literature. Results We identified 27 patients in 20 studies in addition to 10 patients from our center for a total of 37 patients (median age, 4.0 years; 54.1% male). The lead point was identified in 33 patients (33/37, 89.2%). The most common lead point was juvenile polyps (16/33, 48.5%). A therapeutic enema was performed in 12 patients with colocolic intussusception caused by juvenile polyps and was successful in 8 patients (8/12, 66.7%). Colonoscopic polypectomy was subsequently performed in 7 patients and was successful in 6 patients (6/7, 85.7%). The other patient had undergone laparoscopic exploration, and no abnormality was found. Subsequently, the patient underwent open surgery. The patients with colocolic intussusception caused by other pathologic lead points almost underwent surgical treatment (14/17, 82.4%), including 12 open surgeries and 2 laparoscopic surgeries. Conclusion A therapeutic enema followed by colonoscopic polypectomy is feasible to treat colocolic intussusception caused by juvenile polyps unless the patient has bowel perforation; however, open surgery is sometimes needed. For patients with colocolic intussusception caused by other pathologic lead points, open surgery may be preferable to laparoscopic surgery.

Solitary Juvenile Polyp at a Rural Ugandan Hospital Presenting with Recurrent Rectal Bleeding

Juvenile polyps (JP) are rare but important causes of acute gastrointestinal symptoms in children. They are a recognized cause of painless rectal bleeding in preschool age children and also the most common intraluminal disorder of the colon in children They are often solitary, pedunculated and small in size but may occasionally grow to large sizes or occur in great numbers, as in juvenile polyposis syndrome. Histologically juvenile polyps are similar to inflammatory polyps with irregular dilated glands, lamina propria expansion and granulation tissue expansion. Sporadic juvenile polyps of the colon occur in up to 2 percent of children under the age of 10 years, are usually solitary, and are not associated with an increased cancer risk. The etiology, diagnosis, clinical presentation, and management of these intestinal polyps depend on the type of polyp or polyposis syndrome. A change in bowel habits, abdominal pain, rectal bleeding, rectal prolapse, and even intussusception may be the initial presentation in children. In addition to a careful history, including a detailed family history, a physical examination, contrast studies, and endoscopic examination are vital diagnostic tools. Juvenile polyps may also present with prolapse of the polyp from the anus, abdominal pain due to intussusception or may even be asymptomatic. All such polyps should be removed by colonoscopy or transanal resection

The Value of Colorectal Filling Contrast Ultrasonography in Diagnosing Paediatric Juvenile Polyps

Objectives: To describe a facilitated procedure of colorectal filling contrast ultrasonography (CFCUS) and investigate its potential role in the assessment of paediatric juvenile polyps. Methods: The general information, clinical symptoms, ultrasound image characteristics, and colonoscopy findings of 101 children with clinical signs of colorectal polyps admitted to our hospital between May 2018 and May 2021 were retrospectively reviewed. All children underwent conventional transabdominal ultrasonography (CTUS), and CFCUS before colonoscopy, and the latter served as the gold standard. Chi-squared tests and Mann-Whitney U tests were used for the statistical analysis. Results: Forty-five children with fifty-two colorectal polyps were diagnosed by colonoscopy. Ten polyps had false-negative results on CTUS, six of which were detected by CFCUS. The sensitivity, specificity, positive predictive value, and negative predictive value of CFCUS vs CTUS was 92.3% vs 80.7%, 100% vs 100%, 100% vs 100%, 93.3% vs 84.8%, respectively. The maximum diameter of polyps (mean ± standard deviation) missed by CTUS was significantly smaller than that detected by CTUS (7.50±2.12 mm [range 4–12 mm] vs. 19.62±7.89 mm [range 6–41 mm], P<0.0001). A significant difference was observed between CTUS and CFCUS. The difference between CTUS and CFCUS regarding the detection rate of polyps with a diameter < 1 cm (P=0.031). A statistical difference was observed in the detection rate of polyps (P=0.031), and pedicles (P<0.001) between CTUS and CFCUS. The Kappa values for the assessment of Yamada’s classification between CTUS and colonoscopy and CFCUS and colonoscopy were 0.51 and 0.84, respectively. Six colonic polyps were accompanied by a punctate hyperechoic area on the surface, which may be suggestive of a correlation with erosion and bleeding findings.Conclusion: CFCUS can increase the detection rate of polyps and pedicles, especially polyps with diameters <1 cm, and accurately evaluate Yamada’s classification, providing useful preoperative information for colonoscopy.

Characteristics and potential malignancy of colorectal juvenile polyps in adults: a single-center retrospective study in China

BackgroundColorectal juvenile polyps are rare and usually considered benign in adults. Carcinogenesis or neoplastic changes are rarely mentioned in the literature. We aimed to systematically evaluate the characteristics and potential malignancy of colorectal juvenile polyps in adults.MethodsWe retrospectively reviewed the medical records of 103 adults diagnosed with colorectal juvenile polyps from 9/2007 to 5/2020 in our hospital. The characteristics, endoscopic findings, occurrence of intraepithelial neoplasia, carcinogenesis and diagnostic value of chicken skin mucosa (CSM) were analyzed.ResultsThe average age of patients with juvenile polyps was 43.2 years (range, 19 to 78). A total of 101 patients (101/103, 98.1%) had a single juvenile polyp, while two had multiple polyps (107 polyps in total). Polyp sizes ranged from 0.5 to 5 cm. One (1/107, 0.9%) juvenile polyp was cancerous, and 7 (7/107, 6.5%) developed low-grade intraepithelial neoplasia. Neoplasia or cancerization was not associated with the number of polyps. A 27-year-old female had a polyp with well-differentiated adenocarcinoma in the mucosa that was 2 cm in the sigmoid colon with erosion on the surface. According to immunohistochemistry, the Ki-67 was approximately 80%. P53 was mutated with diffuse and strongly positive expression. CSM was observed beside 17 polyps, which were all located in the rectum and sigmoid colon; one polyp had low-grade intraepithelial neoplasia.ConclusionsColorectal juvenile polyps in adults have neoplastic potential. Neither neoplasia nor carcinogenesis was associated with the number of polyps. CSM was not a tumorigenesis marker in colorectal juvenile polyps in the distant colorectum. Colorectal juvenile polyps in adult may go through a ‘low-grade intraepithelial neoplasia to high-grade intraepithelial neoplasia to carcinoma’ path and should be treated and regularly followed up as adenomas.

N-Acetyl-d-Glucosamine-Binding Lectin in Acropora tenuis Attracts Specific Symbiodiniaceae Cell Culture Strains

Many corals establish symbiosis with Symbiodiniaceae cells from surrounding environments, but very few Symbiodiniaceae cells exist in the water column. Given that the N-acetyl-d-glucosamine-binding lectin ActL attracts Symbiodiniaceae cells, we hypothesized that corals must attract Symbiodiniaceae cells using ActL to acquire them. Anti-ActL antibody inhibited acquisition of Symbiodiniaceae cells, and rearing seawater for juvenile Acropora tenuis contained ActL, suggesting that juvenile A. tenuis discharge ActL to attract these cells. Among eight Symbiodiniaceae cultured strains, ActL attracted NBRC102920 (Symbiodinium tridacnidorum) most strongly followed by CS-161 (Symbiodinium tridacnidorum), CCMP2556 (Durusdinium trenchii), and CCMP1633 (Breviolum sp.); however, it did not attract GTP-A6-Sy (Symbiodinium natans), CCMP421 (Effrenium voratum), FKM0207 (Fugacium sp.), and CS-156 (Fugacium sp.). Juvenile polyps of A. tenuis acquired limited Symbiodiniaceae cell strains, and the number of acquired Symbiodiniaceae cells in a polyp also differed from each other. The number of Symbiodiniaceae cells acquired by juvenile polyps of A. tenuis was correlated with the ActL chemotactic activity. Thus, ActL could be used to attract select Symbiodiniaceae cells and help Symbiodiniaceae cell acquisition in juvenile polyps of A. tenuis, facilitating establishment of symbiosis between A. tenuis and Symbiodiniaceae cells.

Etiologies and outcome of lower gastrointestinal bleeding in patients presenting to a tertiary care Children’s Hospital

Objective: To determine etiology and outcome of children with lower gastrointestinal bleeding (LGIB). Methods: This was a prospective study conducted at the Department of Pediatric Gastroenterology and Hepatology, Children’s Hospital and The Institute of Child’s Heath, Multan, Pakistan, from July 2019 to March 2020. A total of 148 cases presented with bleeding per rectum and underwent colonoscopy, were included. Children of both genders and aged three month to 15 years were included. Detailed history, clinical examination, laboratory studies, colonoscopy and histopathology were done in all cases. Study information like demographics, complaints, general clinical examination, colonoscopy and histopathological findings were recorded. Results: Overall, mean age was noted to be 7.20±1.83 years. Abdominal pain was reported in 41 (27.7%), diarrhea 36 (24.3%), fever 12 (8.1%) and constipation in 4 (2.7%). Pallor was noted among 68 (45.9%), weight loss 39 (26.3%) and tachycardia 31 (20.9%). Colonoscopy revealed juvenile colonic / rectal polyps, infectious colitis and solitary rectal ulcer (SRU) as the most common etiologies found among 58 (39.2%), 20 (13.5%) and 19 (12.8%) cases respectively. Juvenile polyps and non-specific colitis were the commonest histopathological findings seen in 55 (37.2%) and 20 (13.5%) cases respectively. Colonoscopic polypectomy was used to remove all juvenile polyps. Conclusion: LGIB is presentation of various underlying causes. Children with LGIB commonly present with abdominal pain. Juvenile polyps were the most frequent cause of LGIB among children flowed by non-specific colitis. Most of the children having LGIB were diagnosed and treated successfully, few are in remission and very few were found resistant to treatment. doi: https://doi.org/10.12669/pjms.37.2.2676 How to cite this:Talib MA, Aziz MT, Suleman H, Khosa GK, Joya SJ, Hussain I. Etiologies and outcome of lower gastrointestinal bleeding in patients presenting to a tertiary care Children’s Hospital. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.2676 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.