Life threatening rectal bleeding due to a giant solitary juvenile polyp in a child. A case report and review of the literature.

Juvenile polyps (JP) are a recognized cause of painless rectal bleeding in preschool age children. They are often solitary, pedunculated and small in size but may occasionally grow to large sizes or occur in great numbers, as in juvenile polyposis syndrome. A nine-year-old previously healthy Hispanic boy with prior history of recurrent abdominal pain and vomiting for 4 months presented with sudden onset of massive painless hematochezia and hemorrhagic shock. Following blood transfusion the bleeding spontaneously stopped. Though further evaluation was delayed due to family reticence, eventually colonoscopy was performed and revealed a giant pedunculated solitary polyp in the traverse colon. After resection, the polyp measured 3.2 x 2.2 x 1.7 cm. Histological evaluation revealed juvenile retention polyp. Giant juvenile polyps (greater than 30 mm) are exceedingly rare in children. Life threatening rectal bleeding due to giant solitary juvenile polyp has rarely been previously reported in children. Spontaneous cessation of bleeding should not delay the endoscopic evaluation. In a child with massive hematochesia, JP should still be considered in the differential diagnosis, as highlighted by this case.