JUVENILE
POLYPOSIS: A CASE REPORT
Dr. SHARAD BIDARI, Dr. SUYASH
KULKARNI,Dr. (Mrs.) P. S. PENDHARKAR, Prof. & Head,Dr. (Mrs.)
B. D. SONAWANE, Asso. Prof.
Dr. S. Z. SORTE, Asso. Prof.,Dr. R. R. KHANDELWAL, Hon. Asso.
Prof.,Dr. SURESH PHATAK, Hon. Asso. Prof.
Dr. DHANASHREE DANDE, Asst. Lect. DEPT. OF RADIOLOGY, INDIRA
GANDHI MEDICAL COLLEGE, NAGPUR.
Akshay, a 1 year old male infant was
referred to us for distal loopogram. He had undergone transverse
colostomy at birth for high anal atresia. Subsequently at nine
months patient underwent anterior ano rectoplasty . Surgeon now
referred the patient for evaluation of distal loop prior to
closure of transverse colostomy.
DISTAL LOOPOGRAM
Showed innumerable well-defined, round,
nodular filling defects involving the whole of distal loop.
Barium was also instilled into the proximal loop and few similar
filling defects were noticed.
Subsequently barium meal follow through
was done. Stomach, Duodenum and jejunum were normal. Multiple
round well defined filling defects were found in the terminal
ileum.
Retrospective History from the mother
revealed passage of red-coloured mucus after rectoplasty. There
was no family h/o similar complaints.
A diagnosis of non-familial generalised
juvenile polyposis was made. Rectal biopsy was taken.
Histopathologically was reported as retention polyps.
FIGURE1:DISTAL AND PROXIMAL LOOPOGRAM
SHOWING A CARPET OF ROUNDED FILLING DEFECTS.
FIGURE2:BARIUM FOLLOW THROUGH SHOWING
MULTIPLE NODULAR FILLING DEFECTS IN TERMINAL ILEUM.
DISCUSSION
Juvenile polyps are so named because they
generally develop during childhood. These polyps also called
retention or inflammatory polyps. The juvenile polyps have a
smooth round contours, are soft in consistency and in cut surface
reveal many cystic spaces filled with mucin.
These polyps are hamartomatous with
cystic epithelial tubules in an excess of lamina propria- the
"Swiss cheese" effect.
The lesions are non-neoplastic but there
is a significant risk of colo-rectal malignancy in this
condition.
Various types of presentations of
juvenile polyposis :
A] Most juvenile polyps occur in
children as isolated colonic lesions that are either solitary
or few in number.
B] Less commonly colonic Juvenile
polyps may develop as multiple lesions referred to as
Juvenile polyposis coli.
Multiple Juvenile polyps may
1. Exist without extracolonic lesions
in cases of Juvenile polyposis coli.
2. Involve stomach and / or small
bowel apart from carpeting the colon in infants in cases of
generalised juvenile polyposis.
3. Co-exist with adenomatous polyps
in some patients with familial multiple polyposis or
Gardener's Syndrome.
4. Develop in the colon in patients
with Cronkhite-Canada syndrome.
Juvenile polyposis with involvement of
stomach and small bowel usually have positive family history. An
autosomal dominant pattern appears to be present. The most common
clinical symptom is mild rectal bleeding that leads to anemia.
ASSOCIATIONS
- Have greater tendency for rectal
prolapse.
- Association with colon cancer
families has been noted.
A rare, non-familial juvenile polyposis
syndrome has been described in infants (as in our case). Clinical
symptoms generally appear during the first few months after
birth. There is loss of blood and proteins leading to anemia and
hypoproteinemia. Numerous juvenile polyps are present in colon,
may also occur on stomach or small bowel or both.
