Fugatt Robert,  Pasham Vishwajeeth,  Kasi Nagraj,  Mcbee Morgan

Final Pr. ID: Poster #: CR-014

While there are various intestinal polyposis syndromes, the single juvenile retention polyp (JRP) is one of the most common polypoid lesions detected in the pediatric gastrointestinal tract. Although these solitary JRPs are benign entities, they can commonly present with hematochezia. Rarely, they can serve as a nidus for infection. While intestinal polyps are fairly frequently encountered by endoscopy, they are not commonly encountered radiologically.

The subject of this case report is an 8 year old female who experienced intermittent abdominal pain and hematochezia for approximately one year before ultimately presenting with sepsis and colitis. By radiograph, CT, endoscopic sampling, histopathologic and laboratory evaluation, she was found to have sigmoid colitis secondary to a solitary JRP.

Initial abdominal radiograph showed haustral thickening, raising suspicion for colitis. Subsequent contrast enhanced abdominopelvic CT revealed a 2.8 cm peripherally enhancing, centrally hypodense polypoid lesion with internal calcification in the sigmoid colon. There was adjacent colonic wall thickening and mesenteric stranding suggesting an associated infectious or inflammatory process.

Stool studies were positive for enteropathogenic E. Coli and occult blood. The colonic lesion was endoscopically excised and shown to be a JRP. This was the presumed nidus for hematochezia and eventual bacterial translocation leading to colitis. The patient was treated with supportive and antimicrobial therapy, and ultimately improved to her baseline status.

While solitary juvenile retention polyps are non-neoplastic entities, they can often present with hematochezia and rarely serve as a nidus for colitis which may lead to sepsis. If a solitary polypoid lesion is identified in a region of intestinal inflammation, it should be considered as a potential culprit. Read More

Authors:  Fugatt Robert , Pasham Vishwajeeth , Kasi Nagraj , Mcbee Morgan

Keywords:  Juvenile Polyp, Colitis