Lymphonodular hyperplasia of the colon as a pathologic finding in children with lower gastrointestinal bleeding

The serious implication of gastrointestinal blood loss in children is well recognized; however, the significance of lymphonodular hyperplasia of the colon (LNHC) as a pathologic finding in this group of children is unclear. We reviewed the records of 95 children, ages 2-48 months, who were referred to our clinic with a history of hematochezia. Proctosigmoidoscopy was performed on 65 of them. Twenty children (31%) examined proctosigmoidoscopically were found to have LNHC, with no other identified source of bleeding. Clinical histories, endoscopic findings, and colonic biopsy specimens from the LNHC group were examined. Clinical pre-sentation of patients in this group was not distinctive. LNHC was most prominent in the distal colon and rectum and was endoscopically characterized by friability (13/20) and ulceration (3/20). Characteristics of biopsy specimens from children with LNHC were then compared with tissue obtained from an age-matched control population and children with colitis. Biopsy specimens from children with LNHC contained increased numbers of lymphoid follicles and larger follicles than those from the control group. Specimens also contained mucosal inflammation and epithelial thinning and ulceration overlying enlarged follicles. We conclude that LNHC is a frequent procto-sigmoidoscopic finding in children evaluated for lower gastrointestinal bleeding. The endoscopic and histologic appearance of these lesions would suggest that LNHC is not a normal finding and represents a potential source of rectal bleeding in children.