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Colonoscopic Polypectomy Prompted by Ultrasound Findings in a Pediatric Patient

Wyneski, Matthew J MD*; Kay, Marsha MD*; Karakas, Pinar MD; Wyllie, Robert MD*

Journal of Pediatric Gastroenterology and Nutrition: September 2009 - Volume 49 - Issue 3 - p 267
doi: 10.1097/MPG.0b013e3181b6441c
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*Department of Pediatric Gastroenterology and Nutrition, USA

Section of Pediatric Radiology, The Children's Hospital, Cleveland Clinic, Cleveland, OH, USA

Address correspondence and reprint requests to Marsha Kay, MD, Director of Pediatric Endoscopy, Department of Pediatric Gastroenterology and Nutrition, Cleveland Clinic, 9500 Euclid Ave.—Desk A-111, Cleveland, OH 44195

An 8-year-old boy underwent an abdominal ultrasound for evaluation of posterior urethral valves. A mobile lesion in the distal descending-sigmoid colon suggestive of a polyp was seen, measuring 1.3 × 1.0 cm (Fig. 1). The lesion was echogenic with multiple hypoechoic cyst-like areas, marked vascularity, and evidence of a stalk and was suspicious for a juvenile polyp (1).

FIG. 1

FIG. 1

The patient underwent a complete colonoscopy, and a 1.5 × 1.0 cm pedunculated polyp was found in the sigmoid colon and removed with snare electrocautery (Fig. 2). No other polyps were found. Histologic examination revealed a juvenile polyp (Fig. 3).

FIG. 2

FIG. 2

FIG. 3

FIG. 3

Juvenile polyps can be single or multiple and are typically benign. If more than or equal to 5 polyps are present they may represent a polyposis syndrome, although some authors consider a lower number sufficient for diagnosis of a polyposis syndrome. Histologically, juvenile polyps are hamartomatous overgrowths of the lamina propria with cystic dilatation lined by nondysplastic epithelium (2,3).

On ultrasonographic examination, juvenile polyps appear as spherical hypoechoic nodules within the bowel lumen. Polyps can have both hypovascular and hypervascular areas, with small cystic cavities seen (1,4). Although ultrasound does not eliminate the need for complete colonoscopy and polypectomy, in this asymptomatic patient, ultrasound provided an extremely accurate description of the polyp correlating with both endoscopy and histology.

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