Endoscopic Mucosal Resection of a Large Rectal Juvenile Polyp in a 7-Year-Old Child: A Case Report

Summary

This report summarizes the diagnostic journey and surgical management of a large rectal retention polyp in a 7-year-old child. It details the standardized protocol for Endoscopic Mucosal Resection (EMR) to prevent diagnostic delays and demonstrate safe therapeutic intervention for large pediatric colorectal lesions.

Abstract

Pediatric hematochezia is a frequent clinical symptom that often poses a diagnostic challenge for gastroenterologists. This study presented the case of a 7-year-old female patient with a one-year history of intermittent hematochezia. Due to the painless nature of the bleeding, the condition was initially misdiagnosed as internal hemorrhoids by several clinics, leading to a year of ineffective conservative management. Upon admission via the emergency department, a comprehensive diagnostic workup was initiated. An abdominal contrast-enhanced three-dimensional computed tomography (3D CT) scan was prioritized to rapidly rule out life-threatening acute surgical abdomens. Subsequent diagnostic colonoscopy identified a large sub-pedunculated polyp, measuring 20 mm × 25 mm, located on the left rectal wall. The patient was successfully treated with Endoscopic Mucosal Resection (EMR) under intravenous general anesthesia. The procedure utilized a submucosal saline injection to create a protective fluid cushion, followed by high-frequency snare resection and mechanical closure with titanium clips. No immediate or delayed complications occurred. Histopathological analysis confirmed the diagnosis of a retention polyp, characterized by cystic glandular dilation and an inflammatory stroma. This case demonstrates that early endoscopic evaluation is critical for children with unexplained lower gastrointestinal bleeding. Furthermore, it highlights EMR as an illustrative and effective minimally invasive therapeutic option for managing large pediatric colorectal polyps, providing an excellent long-term prognosis.

Introduction

Lower gastrointestinal bleeding (LGIB) in the pediatric population represents a frequently encountered clinical scenario that poses significant diagnostic and therapeutic challenges for gastroenterologists worldwide¹. While many episodes of rectal bleeding in children are benign and self-limiting, persistent or recurrent hematochezia necessitates a rigorous and systematic diagnostic evaluation to identify the underlying etiology and prevent long-term sequelae². Among the diverse causes of pediatric LGIB, colorectal polyps are identified as the most prevalent etiology, accounting for approximately 12% to 15% of all pediat....

Protocol

This protocol was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the 922nd Hospital of the Joint Logistic Support Force (Approval number: 2025-12). The following steps outline the specific clinical workflow utilized for this illustrative single-case report. Procedural parameters were tailored to this patient and should be adapted based on individual patient needs, lesion characteristics, and institutional standards in general practice. The reagents and the equipment used are listed in the Table of Materials.

1. Patient selection and preoperative preparation

Results

The EMR procedure was executed successfully in 9 min, without any perioperative or immediate postoperative complications. The estimated immediate intraoperative blood loss was minimal, ranging from 1–2 mL. Initial endoscopic inspection via the video colonoscope identified a large, sub-pedunculated polyp measuring 20 mm × 25 mm on the left rectal wall, approximately 5 cm from the anal verge. The polyp exhibited a hyperemic, ‘strawberry-like’ appearance with distinct punctate white sediment on its surface (

Discussion

The clinical management of pediatric hematochezia remains a significant challenge in gastroenterology due to the overlap of symptoms between benign anal conditions and more serious intra-luminal pathologies¹. The present case of a 7-year-old girl with a large rectal retention polyp illustrates a classic diagnostic dilemma frequently referred to as the “hemorrhoid trap” in pediatric practice¹⁰. Because pediatric colorectal polyps typically present with painless b.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Bacillus licheniformis Capsules	Northeast Pharmaceutical	N/A
Disposable Endoscopic Injection Needle	Boston Scientific	M00516150
Electrosurgical Unit	Erbe Elektromedizin	VIO 300 D
Epinephrine Injection (1 mg/mL)	Pfizer	0069-3041-01
Hematoxylin and Eosin (HE) Stain Kit	Sigma-Aldrich	HT110116
Hemostatic Clips (Rotatable)	Micro-Tech (Nanjing)	ROCC-F-26-195-C
High-frequency Snare (25 mm, stiff braided)	Cook Medical	M00562100
Indigo Carmine (0.8% for injection)	Akorn	17478-501-02
Neutral Buffered Formalin (10%)	Sigma-Aldrich	HT501128
Normal Saline (0.9% NaCl)	Baxter	2B1324
Pediatric Amino Acid Injection (18AA-I)	Baxter	N/A
Polyethylene Glycol (PEG) 3350	Braintree Laboratories	52268-0100-01
Propofol (1% Injection)	AstraZeneca	N/A
Specimen Retrieval Net (Roth Net)	US Endoscopy (Steris)	711105
Video Colonoscope System	Olympus	CF-HQ190L