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Introduction: Familial adenomatous polyposis (FAP) is a rare disease with hundreds to thousands adenomatous polyps in large intestine which inherits in the form of autosomal dominant, but 25% of patients have no positive family history. Rectorrhagia and rectal prolapsus are the most prevalent symptoms. Diagnosis is based on clinical findings and results of colon investigation, and prompt colectomy prevents carcinoma in patient. In this article a case report of familial adenomatous polyposis is presented. Case: The patient is a 17 years old teenager, a known case of familial adenomatous polyposis, who was refered with severe obstruction signs of gastrointestinal tract. The disease was diagnosied when he was 5 years old. In 6 years old he was treated by partital colectomy and in 11 years old by total colectomy and ileorectal anastomosis. The patient was investigated by endoscopy and small bowel transit. Because of many polyps in stomach, duodenum and jejunum polypectomy, gastrectomy and duodenotomy were done. Diffuse carcinoma in situ was reported in pathology. Conclusion: Rectal and colonic polyps are rarely obsereved below 10 years old, but rectorrhagia and rectal prolapsus suspects the diagnosis of FAP in children. In the case of dysplasia and carcinoma abdominal pain, anemia and weight loss will be presented. In children with suspecting FAP, screening of extracolonic manifestation and dysplasia should be considerd and elective surgery should be done.

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Background: Upper gastrointestinal bleeding is a common medical emergency condition which can be very costly with potential risks. Prompt evaluation of the patients’ status and determination of the risks involved are of utmost significance. Rockall score is one of the Methods determining the risk of bleeding. The aim of the present study was to determine sensitivity, specificity and negative and positive predictive values of Rockall scoring system during a 3-month follow-up period in patients with upper gestronintestinal bleeding.

Materials and Methods: 340 hospitalized patients with acute upper gastrointestinal bleeding in Imam Reza hospital were studied from December 2013 to September 2014. The full and clinical Rockall scores, sensitivity, specificity and negative and positive predictive values were specified for all the subjects who were followed for 3 months in relation to complications and mortality.

Results: Of all patients, 204 were males and 136 were females who 15.6% of the subjects had a clinical Rockall score under 3, with 84.4% having a score over 3. In relation to endoscopic Rockall score, 15.6%, 66.8% and 17.6% of the subjects had a score under 3, between 3-8 and over 8, respectively. During the 3-month follow-up period, in the low-risk group, 92.5% did not exhibit hemorrhage again, 3.8% had one recurrent episode of hemorrhage, 1.9% exhibited 2 hemorrhage episodes, with 1.9% having 3 hemorrhage episodes. In the moderate-risk group, 90.9% experienced no recurrence and 9.1% exhibited 1 case of recurrent hemorrhage (p=0.4). There was no mortality in the low-risk group. In the moderate-risk and high-risk groups, the mortality rates were 8.07% and 22.7%, respectively (p<0.001). The sensitivity and specificity of the test were calculated at 11.1% and 81.1%, respectively. The positive and negative predictive values were 5% and 91.4%, respectively.

Conclusion: With due attention to the specificity of 81.8% and negative predictive value of 91.4% for the Rockall score, it might be guaranteed the patient will not suffer from the complications resulting from recurrence of hemorrhage. Given the low sensitivity of the test, the test is not appropriate to rule out disease.