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Rectal red blood loss in a healthy toddler is not always a juvenile polyp

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Abstract
Aim: Heterotopic gastric mucosa is a well-known congenital anomaly in Meckel's diverticula and duplication cysts. Solitary heterotopic gastric mucosa in the rectum is a rare and frequently overlooked abnormality. Starting from a patient history, the literature is searched and all cases reported over the past 20 years are reviewed and compared to a summary of the older cases. Differences between adult and childhood presentation are outlined and our patient is compared with prior reported cases. Case: A 3-year-old girl presented with recurrent rectal blood loss caused by heterotopic gastric mucosa without duplication cyst. She was endoscopically treated with two-stage endoscopic surgical dissection (ESD). Up to now, rectal heterotopic gastric mucosa has been reported in 34 adults and 24 children, including this patient. There is an overall male dominance (69%). Presenting complaints in children were recurrent fresh blood loss per anum (96%), pain (46%), perineal ulcers (25%), diarrhoea (8%) and one patient had an ano-cutaneous fistula. Endoscopy revealed a mucosal elevation with a slightly different aspect (33%), a polyp (42%) and a solitary ulcer (25%). Endoscopy in adults reveals more frequently polyps compared to children. Treatment in childhood is mainly surgical where adults are more frequently treated with endoscopic techniques. Conclusion: In a child with recurrent rectal bleeding in good general health, it is important to withhold heterotopic gastric mucosa in the differential diagnosis and take sufficient biopsies during endoscopy.
Keywords
heterotopic gastric mucosa, rectal blood loss, children, HETEROTOPIC GASTRIC-MUCOSA, OF-THE-LITERATURE, RARE CAUSE, ULCER, ANUS

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Chicago
ROUSSEFF, THAIS, Lucas Matthyssens, Katrien Van Renterghem, Dirk Van de Putte, Dominic De Wulf, Myriam Van Winckel, Saskia Vande Velde, Ruth De Bruyne, and Stephanie Van Biervliet. 2017. “Rectal Red Blood Loss in a Healthy Toddler Is Not Always a Juvenile Polyp.” Acta Gastro-enterologica Belgica 80 (1): 67–70.
APA
ROUSSEFF, T., Matthyssens, L., Van Renterghem, K., Van de Putte, D., De Wulf, D., Van Winckel, M., Vande Velde, S., et al. (2017). Rectal red blood loss in a healthy toddler is not always a juvenile polyp. ACTA GASTRO-ENTEROLOGICA BELGICA, 80(1), 67–70.
Vancouver
1.
ROUSSEFF T, Matthyssens L, Van Renterghem K, Van de Putte D, De Wulf D, Van Winckel M, et al. Rectal red blood loss in a healthy toddler is not always a juvenile polyp. ACTA GASTRO-ENTEROLOGICA BELGICA. 2017;80(1):67–70.
MLA
ROUSSEFF, THAIS et al. “Rectal Red Blood Loss in a Healthy Toddler Is Not Always a Juvenile Polyp.” ACTA GASTRO-ENTEROLOGICA BELGICA 80.1 (2017): 67–70. Print.
@article{8591854,
  abstract     = {Aim: Heterotopic gastric mucosa is a well-known congenital anomaly in Meckel's diverticula and duplication cysts. Solitary heterotopic gastric mucosa in the rectum is a rare and frequently overlooked abnormality. Starting from a patient history, the literature is searched and all cases reported over the past 20 years are reviewed and compared to a summary of the older cases. Differences between adult and childhood presentation are outlined and our patient is compared with prior reported cases.
Case: A 3-year-old girl presented with recurrent rectal blood loss caused by heterotopic gastric mucosa without duplication cyst. She was endoscopically treated with two-stage endoscopic surgical dissection (ESD). Up to now, rectal heterotopic gastric mucosa has been reported in 34 adults and 24 children, including this patient. There is an overall male dominance (69\%). Presenting complaints in children were recurrent fresh blood loss per anum (96\%), pain (46\%), perineal ulcers (25\%), diarrhoea (8\%) and one patient had an ano-cutaneous fistula. Endoscopy revealed a mucosal elevation with a slightly different aspect (33\%), a polyp (42\%) and a solitary ulcer (25\%). Endoscopy in adults reveals more frequently polyps compared to children. Treatment in childhood is mainly surgical where adults are more frequently treated with endoscopic techniques.
Conclusion: In a child with recurrent rectal bleeding in good general health, it is important to withhold heterotopic gastric mucosa in the differential diagnosis and take sufficient biopsies during endoscopy.},
  author       = {ROUSSEFF, THAIS and Matthyssens, Lucas and Van Renterghem, Katrien and Van de Putte, Dirk and De Wulf, Dominic and Van Winckel, Myriam and Vande Velde, Saskia and De Bruyne, Ruth and Van Biervliet, Stephanie},
  issn         = {0001-5644},
  journal      = {ACTA GASTRO-ENTEROLOGICA BELGICA},
  language     = {eng},
  number       = {1},
  pages        = {67--70},
  title        = {Rectal red blood loss in a healthy toddler is not always a juvenile polyp},
  volume       = {80},
  year         = {2017},
}

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