Investigation of melena and hematochezia as the chief complaint of gastrointestinal bleeding in pediatric surgical patients

Abstract

The causes of melena or hematochezia in 48 pediatric patients were examined. Malrotation with volvulus was an important cause of hemorrhage during the newborn period, and intussusception was very typical in patients aged from 1 month to 1 year. Polyps of the rectum and colon were the most common causes of melena or hematochezia in patients older than 1 year. No cause of melena or hematochezia could be identified in 11 children. Ten patients have remained in good health with no further episodes of melena or hematochezia. Localized multiple polyps of the rectum with focal carcinoma were detected in only one patient. In general, although no further investigation is required after detection of the cause of bleeding and its successful treatment, it should be kept in mind that gastrointestinal malignancy can occur in children.

Causes of hematochezia and hemorrhagic antibiotic-associated colitis in children and adolescents

“…Although hematochezia is a sign frequently encountered in clinical practice, there are only a few prospective studies about the frequency, age distribution, and differential diagnoses causing bloody stools in pediatric patients. [ 3 – 10 , 21 ] Our study includes 221 pediatric patients (0–19 years), which were recruited in a (nonsurgical) pediatric setting. An even distribution of patients across age groups in our cohort allows comparison of the frequency of diagnoses according to age.…”

“…Cucchiara et al, [ 7 ] Yachha et al, [ 4 ] , and Teach and Fleisher [ 6 ] described infectious colitis as 1 of the most common causes of hematochezia. Spencer, [ 5 ] Uno et al, [ 21 ] and Moravej [ 9 ] did not mention this illness, although some of these studies recruited patients in a nonsurgical setting. Some diagnoses causing hematochezia (eg, suspected FPIP, IBD) are correlated to certain age groups, which is reflected in our results.…”

“…Studies that recruited in a pediatric surgical setting did not mention this diagnosis. [ 3 , 5 , 21 , 22 ] In contrast, IBD was a frequent diagnosis in children and adolescents. Apart from de Ridder et al, none of the other studies about causes of hematochezia mentioned IBD in a comparable number of patients.…”

“…[ 3 , 4 , 6 , 7 , 9 , 10 , 21 ] This might be explained by younger patient cohorts [ 3 , 4 , 7 , 10 , 21 ] and/or high proportions of infants and young children in these studies. [ 3 , 4 , 6 , 7 , 9 , 10 , 21 ] Two studies from a surgical department observed intussusception as 1 of the most common diagnoses. [ 6 , 21 ] Studies from pediatric departments (ie, nonsurgical setting), in accordance to our results, did not mention this condition.…”

Rectal Polyp in a newborn leading to massive lower gastrointestinal bleed

“…The causes of melena or hematochezia were studied by Uno et al [4] in 48 pediatric patients. Malrotation with volvulus was the important cause of hemorrhage during the newborn period, and the intussusception was very typical of patients aged 1 month to 1 year.…”