4-Year-Old Male Patient with 3-month History of Intermittent Abdominal Pain

Case Summary

• 4-yr-old male presents to the emergency department with a history of 3 mo of intermittent abdominal pain.
• He also has a history of pinworms.
• After a bowel movement, he reported he had severe anal pain with a visible protrusion from the anus.
• Ultrasound of the left lower quadrant was obtained, which showed intussusception.
• On physical exam, there was bowel prolapsing from the anus. Unclear if tissue was connected to the colon.
• He underwent reduction of the prolapsed tissue and a diagnostic laparoscopy with open resection of the polyp. Polyp was identified in the operating room, and it was sent to pathology. Pathology resulted as a juvenile polyp of 2.9 cm x 1.6 cm x 1.6 cm.

Takeaways

Physical exam typical for anal prolapse includes visible tissues protruding. This differs from rectal prolapse which often has visible circumferential rings.

Pathologic lead points include colonic polyps (such as mucosal neurofibroma), pneumatosis intestinalis in Morbus Crohn, bezoars, hereditary angioneurotic edema, Henoch Schoenlein purpura, cystic fibrosis and postoperatively.

There was no resection of the bowel for this case.