Yield of colonoscopy in children with rectal bleeding

OBJECTIVE: Rectal bleeding is a common complaint in children and is the most common indication for colonoscopy. The aim of this study is to report the yield of this procedure in children.

METHODS: Analysis of the medical records of all children below 18 years of age, who underwent colonoscopy from 1993 to 2002, in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia for the evaluation of rectal bleeding.

RESULTS: Eighty-nine children presented with bleeding per rectum, accounting for 49% of the indications for colonoscopy. The majority (92%) was Saudi nationals, the age range was from 5 months to 18 years, and the male to female ratio was 1.1: 0.9. There were 22 children between 0-12 years and 35 between 13-18 years. The overall yield of colonoscopy was 57/89 (64%); however, the yield was slightly better 22/32 (69%) for children 0-12 years. In a subset of children (22 patients, 21 of them were in the age group 0-12 years) where rectal bleeding was associated with diarrhea, the yield was 22/23 (97%). The causes of bleeding per rectum are presented in the table indicating that colitis was the most common cause 30/57 (36%), followed by polyps in 15 (27%); whereas rectal ulcers, chronic anal fissures and hemorrhoids accounted for 5% each. However, age-related analysis shows that colitis occurred more commonly in older children and polyps were found almost with equal frequency in both age groups.

CONCLUSION: The diagnostic yield of colonoscopy is very high especially in children presenting with bloody diarrhea.