Heiss K F, Schaffner D, Ricketts R R, Winn K
Department of General Surgery and Pathology, Egleston Children's Hospital, Atlanta, GA.
J Pediatr Surg. 1993 Sep;28(9):1188-93. doi: 10.1016/0022-3468(93)90162-e.
The presence of juvenile polyps with resulting bleeding and abdominal pain has traditionally been considered a benign, self-limiting process which would resolve with age. The dictum that these polyps were usually solitary, were found predominantly in the rectosigmoid area, and were without malignant potential has been reconsidered in recent years with the increased use of colonoscopy. Several case reports in both adults and children have documented the presence of adenomatous changes in this syndrome. We report 3 cases of children, ages 3, 11, and 11 who were found to have adenomatous polyps in the midst of fields of juvenile polyps on evaluation for rectal bleeding. All three were treated definitively with endorectal pull-through. Two of these patients had atypia on histological evaluation, one of which was severe. We recommend a more aggressive approach to patients found to have multiple juvenile polyps on barium enema, including colonoscopic biopsies at several sites to determine the presence of adenomatous changes, with colectomy and endorectal pull-through should these be found.
伴有出血和腹痛的幼年性息肉的存在，传统上被认为是一个良性的、自限性过程，会随着年龄增长而消退。近年来，随着结肠镜检查使用的增加，关于这些息肉通常为单发、主要位于直肠乙状结肠区域且无恶变潜能的论断已被重新审视。成人和儿童的数例病例报告都记录了该综合征中存在腺瘤样改变。我们报告3例儿童病例，年龄分别为3岁、11岁和11岁，在因直肠出血接受评估时，发现其幼年性息肉区域存在腺瘤性息肉。所有3例均通过经直肠拖出术得到确切治疗。其中2例患者在组织学评估时有异型性，其中1例严重。我们建议，对于在钡灌肠检查中发现有多个幼年性息肉的患者采取更积极的处理方法，包括在多个部位进行结肠镜活检以确定是否存在腺瘤样改变，若发现有腺瘤样改变则行结肠切除术和经直肠拖出术。
