Etiology and Pathology

Polyps of the Gastrointestinal Tract

Treatment

Diagnosis

The exact origin of gastrointestinal hemorrhage remains undiagnosed in about 30-50% of neonates and infants with rectal bleeding. For most of these infants, the blood loss is minor, self-limited and seldom recurs. Diagnosis begins with a thorough history and physical examination. Diagnostic evaluation of significant or recurrent hemorrhage may include upper and/or lower gastrointestinal endoscopy and radiographic procedures including contrast enema, enteroclysis, tagged red cell studies, arteriography, etc. Colonoscopy is the preferred diagnostic modality for rectal bleeding. The choice of diagnostic tests and the urgency of the diagnostic work-up should be based upon the most likely etiologic lesion as well as the severity of bleeding. Contrast enema is the diagnostic procedure of choice in infants suspected of having intussusception. Minor bleeding may resolve spontaneously and require no further evaluation. Major bleeding (i.e., shock, transfusion) requires aggressive evaluation.

Melena per rectum suggests upper gastrointestinal hemorrhage. The initial diagnostic maneuver for suspected upper intestinal hemorrhage is to place a nasogastric tube. Aspiration of gross blood or "coffee ground" appearing fluid confirms the presence of upper gastrointestinal bleeding. Absence of bile in an otherwise nonbloody gastric aspirate does not exclude the possibility of upper gastrointestinal hemorrhage arising distal to the pylorus of the stomach.

The treatment of rectal bleeding in infants depends upon accurate identification of the bleeding source. In many infants, if not most, diagnosis is not possible and reassurance to the parents is all that can be offered. Given the large array of entities that can cause rectal bleeding in infants, a detailed discussion of treatment for each lesion is beyond the scope of this chapter. Information regarding the treatment of many of these entities is provided elsewhere in this book.

Intestinal polyps are much less common in children than in adults, but their association with syndromic clusters is very common. Malignant transformation, except in the syndromic cases, is less than in adults. Management approach is more expectant. Approximately 1% of children may have asymptomatic intestinal juvenile polyps which are benign. Other types of polyps are much rarer.

The etiology of polyps in children is multifactorial and depends on the type of polyp. Etiologies and pathologic features will be discussed individually in the classification section.

Дата добавления: 2014-10-15