Leeds General Infirmary, Leeds, UK.
Arch Dis Child. 2017 Nov;102(11):1049-1051. doi: 10.1136/archdischild-2016-311245. Epub 2017 May 26.
It is often stated that if a patient presents with 'painless rectal bleeding' then a rectal polyp is the probable diagnosis. The aim of this study is to review our experience of children undergoing endoscopy to assess if the above statement is correct.
The senior author keeps a prospective database of every child undergoing flexible sigmoidoscopy or colonoscopy. As part of this database, the symptoms and signs that the patient presents with, specifically abdominal pain, diarrhoea, mucous per rectum and rectal bleeding, are recorded. These results have been analysed specifically to assess whether the opening statement is correct.
Between 2000 and 2014, a total of 401 children have undergone flexible sigmoidoscopy (21) or colonoscopy (380) to investigate rectal bleeding. Of these 401 patients, 42 (10.5%) had at least one polyp. Four polyps (9%) occurred in 159 patients with no rectal bleeding during the study period. The remaining 42 polyps (91%) were identified in patients with rectal bleeding. Of these 42 polyps, painless rectal bleeding was the only symptom in 24 (57%). However, 123 patients were endoscoped with painless rectal bleeding alone, giving a polyp rate of 19.5% for this symptom. The polyp pickup rate was increased to 28% if rectal bleeding and mucous per rectum were present; however, only 25 patients had this clinical history.
We confirm that the most common symptom of rectal polyps is painless rectal bleeding. However, only one in five patients with this clinical history has a rectal polyp at endoscopy. The polyp pickup rate at endoscopy is greater (28%) when a history of both rectal bleeding and mucous per rectumispresent. This information can be used to counsel parents preoperatively.
常有人说，如果患者出现“无痛性直肠出血”，那么直肠息肉是可能的诊断。本研究旨在回顾我们对接受内镜检查的儿童的经验，以评估上述说法是否正确。
资深作者保存了每一位接受软性乙状结肠镜检查或结肠镜检查的儿童的前瞻性数据库。作为该数据库的一部分，记录了患者出现的症状和体征，特别是腹痛、腹泻、直肠粘液和直肠出血。这些结果已被专门分析，以评估上述陈述是否正确。
在 2000 年至 2014 年间，共有 401 名儿童接受了软性乙状结肠镜（21 例）或结肠镜（380 例）检查以调查直肠出血。在这 401 名患者中，有 42 名（10.5%）至少有一个息肉。在研究期间无直肠出血的 159 名患者中有 4 个息肉（9%）。其余 42 个息肉（91%）是在有直肠出血的患者中发现的。在这 42 个息肉中，24 个（57%）仅有无痛性直肠出血这一症状。然而，有 123 名患者仅因无痛性直肠出血而接受内镜检查，因此该症状的息肉检出率为 19.5%。如果存在直肠出血和直肠粘液，息肉检出率会增加到 28%；然而，仅有 25 名患者有这种临床病史。
我们证实，直肠息肉最常见的症状是无痛性直肠出血。然而，在有这种临床病史的五分之一患者中，内镜检查发现有直肠息肉。当同时存在直肠出血和直肠粘液时，内镜检查的息肉检出率更高（28%）。这些信息可以用于术前向家长提供咨询。
