[size=20px]A four-year old presents to the emergency department with tissue prolapsing from the anus. On closer examination the tissue proves to be a three cm diameter polyp on a long narrow stalk. The stalk is ligated and the polyp excised. Pathology shows that it is a juvenile polyp.

 

The next step in management for this patient with a juvenile polyp is

 

A colonoscopy.

 

B contrast enema.

 

C genetic testing for polyposis syndromes.

 

D magnetic resonance enterography.

 

E observation.[/size]

A colonoscopy

A colonoscopy

correct

 

Juvenile polyps are benign hamartomas of the gastrointestinal tract. They are the most common colon polyps in children with some estimates of a prevalence of up to two percent in children under 10 years. They are most commonly located in the distal colon with 80% in the rectum or sigmoid colon. They are usually single but may be multiple and although recurrence was once thought to be rare, now it is recognized that a patient who presents with a single juvenile polyp may have up to a 20% chance of recurrence.

 

Juvenile polyps typically occur in children who are two to 10 years of age with a peak occurrence from three to four years of age. The most common clinical presentation is of painless rectal bleeding. Other, less common presentations include abdominal pain, intussusception, prolapse out the rectum or autoamputation. Isolated, sporadic juvenile polyps are not associated with an increased risk for colorectal cancer.

 

Because of the risk of having multiple polyps and the chance to diagnose and treat with polypectomy at the same time, the next step in management would be complete colonoscopy. Colon imaging is not as sensitive in detecting polyps and there would be no opportunity for simultaneous treatment. Further evaluation for polyposis syndromes is reserved for patients with

• adenomatous polyps
  
• multiple (more than five) juvenile polyps
  
• a family history of polyps
  
• other clinical manifestations of hamartomatous polyposis syndromes such as Peutz-Jeghers syndrome or PTEN hamartoma syndrome.