- Most rectal bleeding in children is benign
- It however may signify a life-threatening disease
- Likely aetiology can be dictate by patients age and other assocaited clinical features
| Neonates |
Infants |
Children |
| Anal fissure |
Anal fissure |
Anal fissure |
| Necrotising enterocolitis |
Intussusception |
Juvenile polyp |
| Viral gastroenteritis |
Gastroenteritis |
Meckel's diverticulum |
| Midgut volvulus |
Meckel's diverticulum |
Inflammatory bowel disease |
| Intussusception |
Upper GI haemorrhage |
Intussusception |
|
|
Vascular malformations |
|
|
Solitary rectal ulcer |
|
|
Henoch Schonlein purpura |
Anal fissures
- Can occur at any age in child
- Child in often constipated
- Fissure is often visible
- Often settles with laxative but may need anal stretch
Necrotising enterocolitis
- Typically seen in premature and sick neonates
- Presents with abdominal distension, vomiting and rectal bleeding
- Plain abdominal x-ray shows intramural gas
- Treatment is with fluid resuscitation, antibiotics and parenteral nutrition
- Surgery necessary if perforation, stricture or abscess formation
Large bowel polyps
- Present with painless bleeding in other fit and well child
- Juvenile polyps account for 80% of rectal polyps in childhood
- 70% of patients are less than 5 years old
- Polyps are usually solitary and are often found in the rectum
Infective enteritis
- Infective enteritis can occur at any age
- Causative agents include:
- Viruses - rotavirus, cytomegalovirus
- Bacteria - Campylobacter, Shigella, Salmonella, E. coli
- Protozoa - Amoeba, Giardia
- Fresh stool should be send for microscopy, virology and culture
Meckel's diverticulum
- Remnant of vitello-intestinal duct
- Found in 2% of population
Picture provided by Mr D M G Bowley, Surgical SpR, Derriford Hospital, Plymouth, UK
Picture provided by Gary Atkin, Mount Vernon Hospital, Northwood, Middlesex
- 30% have heterotopic rectal mucosa that can result in ulceration and bleeding
- Usually presents with painless rectal bleeding
- Best diagnosed with radioisotope scan
- Other complications include:
- Intussusception
- Meckel's diverticulitis
- Small bowel obstruction
- Perforation
Bibliography
Bemelman W A, Hugenholtz E,
Heij H A, Wiersma P H, Obertop H. Meckel's diverticulum in Amsterdam:
experience in 136 patients. World J Surg 1995;
19: 734-736.
Fa-Si-Oen P R, Roumen R M,
Croiset van Uchelen F A. Complications and management of
Meckel's diverticulum - a review. Eur J Surg 1999;
165: 674-678. |