This document discusses rectal and umbilical polyps. For rectal polyps, it notes they occur most often in preschool children, are usually solitary, and can cause bleeding. It describes their appearance and causes, including obstruction of colonic glands. Diagnosis involves history, exam, and colonoscopy. Treatment is removal during colonoscopy. For umbilical polyps, it explains they are remnants of embryonic structures that normally dissolve. They present as masses or discharge from the umbilicus. Histology shows enteric or colonic mucosa. Treatment is surgical excision of the polyp, which is usually adequate without further inspection.

1. Rectal and Umbilical
polyps
Pushpa Lal Bhadel
Department of Pediatric surgery
Kathmandu Model Hospital

2. Rectal polyp
 Occur in approx. 1 % of preschool children
 Peak incidence between 3-5 years of age
 50% of them has solitary polyps
 Rest has 2-10 polyps
 40% of juvenile polyps are found in rectum or sigmoid colon
 Rest of the 60% are found distributed throughout the colon

3. Rectal polyp
 Juvenile polyps : retention/inflammatory or cystic polyps
 Grossly these have glistening, smooth, spherical, reddish head and
range from 2mm to several cms in diameter
 Often have ulcerated surface
 Attached by a long, narrow stalk covered by colonic mucosa

4. Rectal polyp
 Results from a structural arrangement of mucosa secondary to inflammatory
process
 Initially ulceration and subsequent inflammation of mucosa
 Obstruction of regional, small colonic glands of mucosa
 Obstructed glands enlarge with mucous secretion and push up into the lumen
 Fecal stream and peristalsis push the mass down the lumen causing the stalk to
elongate- pedunculated appearance

5. Rectal polyp
Clinical features
Ulceration of surface or autoamputation leads to bright
red blood on defecation
Prolapse of polyp present as dark, cherry red protrusion at
the anus
Most of the polyps are within reach of digital rectal
examination

6. Rectal polyp
Diagnosis:
Pertinent history
Digital rectal examination
Colonoscopy

7. Rectal polyp
Management:
Anoscopy with removal of polyp and pancolonsocopy

8. Rectal polyp
Complication:
Perforation
Hemorrhage

9. Umbilical polyp
 Umbilicus — The umbilicus is composed
of three distinct anatomic areas
oMamelon – Area of central depression
oCicatrix – Dense scar, which marks the
intersection of fetal intra- and extra-
embryonic mesoderm
oCushion – Slightly raised margin
around the mamelon and cicatrix

10. Umbilical polyp
Introduction
Firm masses comprised of intestinal epithelium or
uroepithelium, which are omphalomesenteric or urachal
embryologic remnants.
Umbilical cord : paired umbilical arteries, umbilical vein,
allantois (urachus) and omphalomesenteric duct (OMD) or
vitelline duct (VD).
Connects the yolk sac to the midgut.

11. Umbilical polyp
The OMD/VD obliterates by the 5–9th week of gestation
while the urachus obliterates by the 4–5th months of
gestation.
In the newborn, the umbilical cord typically separates
within 3 weeks, leaving a dry, star-like central abdominal
scar that forms the umbilicus.

12. Fig. Umbilical cord development third to fifth week gestation

13. Umbilical polyp
 Persistent or failure of involution of OMD result in spectrum of
congenital anomalies ranging from umbilical polyp, Meckel's
diverticulum
 Seen in 2%–3% of the population
 Umbilical polyp may be difficult to distinguish from an umbilical
granuloma

14. Umbilical polyp
 Clinical presentation of umbilical lesions depends on the age of the patient.
 In the newborn, delayed umbilical separation and omphalitis are common.
 In childhood and among adults, umbilical mass and umbilical discharge or
wet umbilicus take precedence.
 Characterized by the presence of a firm, reddish and discharging polypoid
lesion

15. Umbilical polyp

16. Umbilical polyp
Histopathology
Shows remnants of enteric mucosa which is usually of
small intestine or colonic type, but occasionally of
gastric type in direct continuity with the adjacent
epidermis.
Other variant, fibrous umbilical polyp; is a distinctive
umbilical polyp devoid of any epithelial component.

17. Umbilical polyp
Management:
 Show unresponsiveness to conservative management with
repeated tropical silver nitrate ablation, ligation or use of alcoholic
wipes.
 Simple surgical excision is adequate.
 A study by Pacilli et al. also show that surgical excision is adequate
and that inspection and probing of the base of the polyp after its
excision is not necessary.
 Exploration of the peritoneal cavity in children with an umbilical
polyp does not seem to be necessary.

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