Mysterious rectal bleeding in a female adolescent

A 15-year-old female referred to our adolescent clinic for further evaluation of rectal bleeding was seen a week earlier in the acute care clinic with a two-day history of bright red rectal bleeding. The physical examination at that time was reportedly normal, including the rectal exam. The blood count with differential, liver function tests, ESR, and barium enema were all within normal limits. The patient, however, continued to complain of rectal bleeding and this led to the referral. She was known in the adolescent clinic as having a history of learning disability and mild mental retardation. She was started on depot medroxy-progesterone acetate one month earlier and had been sexually active since age 13. Additional history with specific questions revealed that the “heavy” bleeding always happened with bowel movements. Physical examination and pelvic ultrasound showed a slightly enlarged uterus and thickened endometrium. Sonohysterogram was done and two posterior polyps were identified. The patient underwent endometrial ablation without complications, and no further bleeding was reported on follow-up for three months. Endometrial polyps are rare m adolescents, but should be in the differential diagnosis of vaginal bleeding.