Endoscopic Mucosal Resection of a Large Rectal Juvenile Polyp in a 7-Year-Old Child: A Case Report

Pediatric hematochezia is a frequent clinical symptom that often poses a diagnostic challenge for gastroenterologists. This study presented the case of a 7-year-old female patient with a one-year history of intermittent hematochezia. Due to the painless nature of the bleeding, the condition was initially misdiagnosed as internal hemorrhoids by several clinics, leading to a year of ineffective conservative management. Upon admission via the emergency department, a comprehensive diagnostic workup was initiated. An abdominal contrast-enhanced three-dimensional computed tomography (3D CT) scan was prioritized to rapidly rule out life-threatening acute surgical abdomens. Subsequent diagnostic colonoscopy identified a large sub-pedunculated polyp, measuring 20 mm × 25 mm, located on the left rectal wall. The patient was successfully treated with Endoscopic Mucosal Resection (EMR) under intravenous general anesthesia. The procedure utilized a submucosal saline injection to create a protective fluid cushion, followed by high-frequency snare resection and mechanical closure with titanium clips. No immediate or delayed complications occurred. Histopathological analysis confirmed the diagnosis of a retention polyp, characterized by cystic glandular dilation and an inflammatory stroma. This case demonstrates that early endoscopic evaluation is critical for children with unexplained lower gastrointestinal bleeding. Furthermore, it highlights EMR as an illustrative and effective minimally invasive therapeutic option for managing large pediatric colorectal polyps, providing an excellent long-term prognosis.