The Clinical Analysis Of Colonoscopy In 113 Infants With Hematochezia

Hematochezia is one common symptom of digestive system diseases in infancy.Because of the uniqueness of the infant,hematochezia during infancy has its own characteristics in etiologies,clinical manifestations,concomitant symptoms,laboratory tests,colonoscopy and so on.Hematochezia degrees is varying from mild to severe.The severe hematochezia can cause hypovolemic shock due to excessive blood loss which may threaten life.Therefore,it is very important to identify hematochezia early,assess the severity of hematochezia,identify the cause,and treat early.In recent years,with the application of electronic colonoscopy in infancy,there has been great advances in the diagnosis and the treatment in infancy hematochezia.At present,there are relatively few relevant studies on infant hematochezia.This study mainly analyzes the clinical features of infant hematochezia in terms of age,sex,course of disease,clinical manifestations,history of allergies,feeding history,laboratory tests,colonoscopy,and etiology to provide an early assessment of the severity of hematochezia,reduction of misdiagnosis and missed diagnosis.Objective:To analyze the clinical features,etiology and diagnosis and to summarize the clinical diagnosis and the treatment experience-Methods:A retrospective analysis was on clinical manifestations,allergies,feeding history,laboratory tests,and colonoscopy of 113 infants with hematochezia from January 2014 to December 2017 in Children's Hospital of Zhejiang University School of Medicine.Results:(1)General date:There were 70 males and 43 females in 113 infants.The youngest patient is 1.17 months,and the oldest patient is 17 months.The shortest duration is 3 hours(0.04 months)and the longest duration is 12 months.(2)Clinical manifestations:The most common clinical manifestation is hematochezia(76.1%),and the other manifestations include diarrhea,fever,vomiting,malnutrition,hematemesis and anemia(47.8%,28.3%,10.6%,9.7%,4.4%,and 1.8%,respectively).(3)Laboratory results:The percentage of eosinophils(EOS)was from 0.1%to 30.6%,and the average was 4.0%;the value of hemoglobin(HGB)was from 48 g/L to 135 g/L,and the average was 102.59g/L.The fecal occult blood test was negative in 40 cases(35.4%),weakly positive in 21 cases(18.6%),positive in 42 cases(37.2%),and strongly positive in 10 cases(8.8%).(4)Etiologies:The most common etiology is allergic colitis(34.5%),and the other common etiologies are colitis,Crohn's disease,Merkel's diverticulum,polyps(sigmoid colon polyps and rectal polyps),eosinophilic colitis,anal fissure,antibiotic-associated colitis and obscure gastrointestinal bleeding(9.7%,7.1%,6.2%,6.2%,4.4%,3.5%,3.5%and 16.8%,respectively);There are also some rarely etiologies including eosinophilic gastroenteritis,bacterial colitis,chronic diarrhea,Small intestine polyps with intussusception,Kasabach-Merritt syndrome,immunodeficiency disease,milk protein allergy,small intestinal vascular malformation and external hemorrhoids,each of which is only one patient(0.9%).In addition,after treatment,the 18 infants whose coagulation function were abnormal were still had hematochezia,which indicated that there was no significant correlation between coagulation dysfunction and hematochezia in this retrospective analysis.(5)History of allergies and feeding:In this case group,there were 9 cases of food allergy,6 cases of drug allergy,8 cases of eczema,and 1 case of cough.History of allergies is more common in allergic colitis.There are 73 cases of breastfeeding,16 cases of artificial feeding,and 24 cases of mixed feeding.There was no significant difference in the etiology of feeding methods.(6)There was no significant difference in the distribution of etiologies in different age groups(<3 months,3-6 months,6-9 months,9-12 months,?12 months).Colitis,Crohn's disease,Meckel's diverticulum,obscure gastrointestinal bleeding were significantly different in the course of disease(<0.5 months,0.5-1 month,1-3 months,3-6 months,?6 months)difference.(7)Compared with the normal intestinal mucosa,the blood eosinophil counts of infants were significant difference in allergic colitis and eosinophilic colitis.There was a statistically significant difference in the blood eosinophil counts between colitis and eosinophilic colitis,allergic colitis and eosinophilic colitis.(8)In treatment,there were 40 patients who changed their diet.Patients with critical illness and unstable vital signs were given symptomatic treatment including early fasting,blood volume supplementation,hemostasis,and anti-infection.According to the condition and etiology,patients with stable vital signs should be given a change in diet structure,anti-infection,acid suppression,anti-inflammatory,immunosuppression,polypectomy,surgery,and intervention.Conclusions:(1)The most common etiologies of hematochezia in infants include allergic colitis and colitis,and the other common etiologies are Crohn's disease,Merkel's diverticulum,polyps,eosinophilic colitis,anal fissure.When there is excessive bleeding or intractable hematochezia,small intestine polyps with intussusception,small intestinal vascular malformation,immunodeficiency disease,Kasabach-Merritt syndrome and some other rare diseases may be considered a possible factor.(2)Colonoscopy plays an important role in diagnosing the etiology of hematochezia in infants.(3)It is necessary to make the examination such as MRI?ECT?DSA and even surgical exploration for those infants who has unexplained or intractable hematochezia.