Issn Print: 0277-2116

Publication Date: 2004/06/01


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P0885 LYMPHONODULAR HYPERPLASIA: A COMMON CAUSE OF RECTAL BLEEDING IN YOUNG CHILDREN

B. Weiss; I. Barshak; A. Fradkin; I. Weintraub; Y. Bujanover

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Author Information: Pediatric Gastroenterology and Nutrition, Safra Children’s Hospital, Tel-Hashomer, and Sackler School of Medicine,

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Excerpt

Introduction: Lymphonodular hyperplasia (LNH) of the gastrointestinal (GI) tract is a frequently observed in the terminal ileum and colon in children undergoing endoscopic evaluation. Abdominal pain and hematochezia have been described as clinical patterns of LNH, however, the role of LNH as a cause of GI bleeding is controversial. Our aim was to determine the frequency of LNH in children who present with rectal bleeding.
Methods: A retrospective analysis of all children undergoing endoscopic evaluation (colonoscopy or sigmoidoscopy) for rectal bleeding between Jan 1999 and Sep 2003 was carried out. Medical records were reviewed for clinical data, and all the biopsies taken during endoscopy were reviewed by a single pathologist unaware of the previous diagnosis. Patients lost to follow-up were contacted and asked about continuous or new gastrointestinal symptoms and diagnosis.
Results: 137 patients (M=72), aged 1–18 year, were evaluated for rectal bleeding. LNH was the only endoscopic and histologic finding in 13 patients (9.5%). Another source of bleeding was identified in 69 patients, and no source was found in 55 patients. 12/13 patients with LNH were under 10 years of age (median 4.5). Endoscopy revealed 1–2 mm pale nodules scattered along the mucosa, some with a punctuate spot, most prominent in the rectum and sigmoid colon. Biopsies of the lesions revealed lymphoid follicles, (1–8, median 4 follicles), and in 2 patients ulcerations of the mucosa. Five patients had a mild increase in the number of lymphocytes in the lamina propria. The patients were followed for 2 month to 4.5 years (median 1 year). 4 patients had hematochezia after 2–8 months, one patient was diagnosed with undetermined colitis, and 8 were free of symptoms
Conclusion: LNH is a common cause of rectal bleeding in young children and most patients have no long term sequelae.
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