From the Guidelines
The correct answer is D. Bleeding is the most common presentation of intussusception. However, it's essential to note that intussusception typically presents with a classic triad of symptoms: abdominal pain, vomiting, and "currant jelly" stools, which is a mixture of blood and mucus, rather than frank bleeding as the primary symptom 1. Regarding the other options:
- Anal fissure can cause gastrointestinal bleeding in children, but it is not the leading cause of massive bleeding.
- A clear nasogastric aspirate does not definitively rule out upper GI bleeding as bleeding may be intermittent.
- Meckel's diverticulum can cause significant bleeding when it contains gastric mucosa that secretes acid, and it is not seldom a cause of massive bleeding. It's crucial to understand the common causes of GI bleeding in children for appropriate diagnosis and management in pediatric patients. Some key points to consider in the diagnosis of gastrointestinal bleeding in children include:
- The possibility of intussusception, which can occur in later childhood and adolescence, and the need for urgent management of acute abdominal pain 1.
- The increased lifetime risk for a wide variety of malignancies in patients with Peutz-Jeghers syndrome, including cancers of the gastrointestinal tract, pancreas, breast, testis, and ovary 1.
From the Research
Gastrointestinal Bleeding in Children
The correct answer is:
- D. Bleeding is the most common presentation of intussusception
Evidence for the Correct Answer
- According to the study 2, rectal bleeding is the most common clinical feature of intussusception, presenting in 81% of cases.
- The study 3 also mentions that the classical triad of symptoms, including abdominal pain, vomiting, and bleeding, is evident at the time of presentation in only about 20% of cases, but bleeding is a common presenting feature.
Evidence Against the Other Options
- Option A: Anal fissure is not mentioned as the leading cause of gastrointestinal bleeding in children in any of the provided studies.
- Option B: A clear nasogastric aspirate does not rule out upper GI bleeding, but this is not directly addressed in the provided studies.
- Option C: Meckel's diverticulum can be a cause of massive bleeding, as mentioned in the study 4, which states that life-threatening complications of Meckel's diverticulum include bleeding. Therefore, it is not correct to say that Meckel's diverticulum is seldom a cause of massive bleeding.