Toddler with passage of tissue per rectum.

PATIENT PRESENTATION

A 23‐month‐old unimmunized female presented after passing tissue and blood clots in her stool. She had intermittent episodes of straining and blood on the surface of stools and on toilet paper over several weeks before presentation. Physical examination revealed a happy, well‐appearing child with normal vital signs, a soft, non‐tender abdomen, a normal anogenital examination, and no rashes or mucosal lesions. The patient's mother provided a picture of the tissue present at the anal opening taken 3 days before (Figure 1) and brought the passed tissue to the emergency department (Figure 2). Despite a delay of 12 hours without refrigeration or preservation, histopathology revealed the diagnosis.

FIGURE 1

Photograph of tissue present at the anal opening 3 days before presentation, taken by patient's mother

FIGURE 2

Photograph of tissue expelled from the patient's anus, a 1.4 × 1.4 × 0.9 cm segment of tan‐red soft tissue. One surface has a bloody center ∼2‐3 mm that may correspond to a pedicle

DIAGNOSIS

Juvenile polyp

Histopathology of the tissue revealed multiple cystic and dilated crypts with the lamina propria expanded by lymphocytes, eosinophils, neutrophils, and plasma cells, consistent with a juvenile polyp.

Juvenile polyps occur at any age; however, they are more common in childhood. Sporadic colonic juvenile polyps occur in up to 2% of pediatric patients under age 10 years.1 A solitary polyp is not associated with an increased risk in colorectal cancer. However, screening for an inherited polyposis syndrome is recommended with a sigmoidoscopy or colonoscopy because there is an increased risk for colorectal cancer if 5 or more polyps are found.2 Solitary juvenile polyps are most common in the rectosigmoid colon. Juvenile polyps that cause rectal bleeding or that prolapse through the rectum require polypectomy. Asymptomatic polyps do not require treatment.3