Introduction: To reveal a source of obscure recurrent gastrointestinal bleeding (GIB) in infants leading to iron deficiency anemia is challenging. A very rare source of bleeding can be sporadic juvenile intestinal polyps. We present a clinical case which demonstrates endoscopic diagnostics and resection of a jejunum polyp in a child weighing 6,3 kg. 

Clinical observation: A 12-month-old boy was admitted to CRIEPST with long-lasting dark stool and iron deficiency anemia. For the first time melena appeared at the age of 1 month and anemia – at 6 months. The child was repeatedly examined: ultrasound, computed tomography, esophagogastroduodenoscopy (EGD), colonoscopy, but bleeding source was not found. The child was prescribed symptomatic therapy for iron deficiency anemia including red blood cell transfusion. On admission to our clinic skin pallor, asthenia, melena and anemia (Hb – 82 g/L) were registered. In our clinic intestinal intussusception and a solid formation up to 2 cm in size were suspected at abdominal ultrasound examination. The child underwent EGD, video capsule endoscopy, colonoscopy, laparoscopy. But the bleeding source was not found. On the 3d EGD the polyp 17x15 mm with erosions was found 40 cm distally to the pylorus. Endoscopic mucosal resection with the polyp was performed. The histology confirmed a juvenile polyp. The postoperative period was uneventful. No complaints, no signs of anemia were found in 1 month after, the stool was normal.

 

Conclusion: A sporadic juvenile jejunal polyp can be a bleeding source in infants though a very rare one. Modern endoscopic technologies allow not only to diagnose, but also to perform minimally invasive surgery. This case is the youngest and the smallest child with a sporadic juvenile jejunal polyp treated endoscopically. No similar publications were found in the available literature. 

Key words: Gastrointestinal bleeding, sporadic juvenile polyp, endoscopic resection, iron deficiency anemia, children, clinical observation