Juvenile polyps

Introduction to juvenile polyps Juvenile polyp (also known as simple polyps), or retention polyps, occurs mostly in the 2 to 10 years old, with a high incidence rate, accounting for about 80% of pediatric polyps. It is a benign glandular glandular granuloma. More self-healing, no cases of malignant changes, boys are more common. basic knowledge The proportion of illness: 0.001% Susceptible people: Most occur in 2 to 10 years old, more common in boys. Mode of infection: non-infectious Complications: anemia, blood in the stool, rectal prolapse, intussusception, diarrhea

Juvenile polyp cause

(1) Causes of the disease

85% of juvenile polyps are single, 14% are 2, 3 concurrent, more than 90% occur in rectum or sigmoid colon, mostly in the rectum from 3 to 4cm to 7-8cm from the anus, and a few can occur in the right colon. The cause may be based on allergies, due to hard damage, chronic inflammation, beginning of intestinal mucosa with chronic inflammation and limited granulation hyperplasia, gradually increasing the formation of polyps of about 1cm in diameter, mostly spherical, smooth surface Or nodular red, with the peristalsis of the intestines, the roots of the polyps gradually form mucosal pedicles, and finally the pedicles become thinner with the enlargement of the tumor until the blood supply is insufficient or the pedicle is twisted, the polyps are eroded, necrotic, and the self-healing (often more than 1 year).

(two) pathogenesis

The shape of the juvenile polyps is mostly pedicled, only a small polyp without pedicle, pedicle slender, no muscle composition, polyps are mostly 1 ~ 3cm, a few less than 1cm, polyps head is more spherical, surface Smooth or nodular, may also have lobulation, mostly red, often accompanied by erosion or shallow ulcers, tissue fragility, easy bleeding, histological polyps are mucosal lesions, including dilated mucus-curved cystic glands And in the inflammatory cells in the lamina propria, the gland contains well-differentiated mucous cells, the interstitial is significantly broadened, and there is abundant connective tissue, which contains a large number of blood vessels and inflammatory cells, and sometimes contains a small amount of smooth muscle cells. Occasionally, the foreign body giant cell reaction caused by the dilated rupture of the gland is found. Most pathologists believe that juvenile polyps are hamartomas. Because some glands expand into sacs, there is a lot of mucus retention, so It is said that it is not a neoplastic polyp, so it does not cause cancer, but recent reports indicate that adenoma changes can occur in some areas of juvenile polyps. Adenoma components and epithelial hyperplasia may cause cancer, polyps are damaged by feces, stimulation, frequent inflammation and small amount of bleeding, pathological sections showing mucosal epithelial cells and fibrous tissue hyperplasia, and chronic inflammation infiltration.

Juvenile polyp prevention

There are currently no precise precautions. Early detection and early diagnosis are the key to the prevention and treatment of this disease.

Juvenile polyp complications Complications anemia, blood in the stool, rectal prolapse, intussusception, diarrhea

About 1/3 of children with anemia can be complicated by anemia, occasionally a large amount of blood in the stool, rectal prolapse, pedicle polyps occasionally complicated with intussusception, there are also can cause diarrhea.

Juvenile polyp symptoms Common symptoms Colon polyp blood in the stool

Painless chronic blood in the stool is the main symptom of pediatric rectal and colon polyps. Blood in the stool occurs at the end of defecation. Generally, there is a trace of blood on the surface of the feces, which is bright red, not mixed with feces, and the amount is small. After the drip from the anus, a few drops of blood, due to the loss of polyps caused by a large number of bleeding is rare, when there is a secondary infection on the surface of the polyp, in addition to blood in the stool, there is a small amount of mucus, sometimes in the blood of the feces, visible indentation, for polyps oppression Due to feces, there is usually no pain in the defecation of the sick child. There is no urgency after the symptoms, low or long polyps, can be pushed out of the anus when defecation, a red meat ball can be seen at the anus, if the polyp is not returned in time Incarceration can occur and shedding and bleeding, the disease is not much bleeding, children rarely have obvious anemia.

Juvenile polyp examination

General routine examination is normal, a small number of blood routine examination may have hemoglobin reduction, stool routine examination may have occult blood positive, rectal examination, a negative finger test can not rule out the diagnosis of polyps, can be reviewed after defecation or enema, compare high polyps It can be examined by sigmoidoscopy or fiberoptic colonoscopy, or by double contrast between X-ray barium enema and sputum infusion.

1. X-ray examination of X-ray is also very valuable for the diagnosis of high polyps. X-ray barium enema and sputum drainage and gas injection double contrast angiography method can be used to observe the filling defect shadow in the intestinal lumen during the injection process. After the sputum injection, the filling defect has a shadow of a circular ankle ring, but attention should be paid to the identification of air bubbles and feces in the intestine. The identification method: the bubble can move with the change of the body position, and the movement range is large. The block is flat and the outer edge is irregularly filled and defective. It is often broken when pressed by hand. If the dung is hard, it is difficult to identify with the polyp, but the fecal block can change its shape and position during the review, or even disappear. .

2. Endoscopy The endoscopy of the digestive tract can directly observe the location, size, shape, surface traits, number, color tone of the gastrointestinal polyps, and can perform biopsy to determine the nature of the polyps and histological classification. The most accurate and ideal method for diagnosing digestive tract polyps can also remove polyps.

Diagnosis and identification of juvenile polyps

diagnosis

Mainly relying on a history of painless stools with a small amount of blood, more than the rectal posterior wall with a diameter of 0.5 ~ 2cm pedicled or pedicled tumor, plus auxiliary examination can confirm.

Differential diagnosis

1. Familial colonic multiple polyposis may have a family history of hereditary disease, filled with polyps in the colon and rectum, varying in size, due to long-term chronic blood loss, have varying degrees of anemia, rectal examination can touch the rectum all With polyps, the diagnosis can be made clear.

2. Anal fissure has a history of constipation. There is pain in the anus when defecation, blood on the surface of the feces, bright red color, not mixed with feces, sometimes blood drops from the anus, the amount is not much, use the fingers to press the sides of the anus to make the anus Eversion, there is an anal fissure in the front and rear of the anal midline.

3. Ulcerative colitis usually occurs in older children. The number of bowel movements increases, and it is thin. In addition to blood, there is a lot of mucus and pus, and there is a sense of urgency. The rectal examination occasionally touches most polypoid masses, sigmoid colon. A microscopic examination revealed a scattered ulcer surface on the rectal sigmoid wall.

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