Differential Diagnosis for Episode of Blood in Stool in a 6-Year-Old
Single Most Likely Diagnosis
- Anal Fissure: This is a common cause of rectal bleeding in children, often due to constipation or hard stools, leading to a tear in the anal mucosa. The pain associated with defecation can further exacerbate constipation, creating a cycle.
Other Likely Diagnoses
- Constipation with Hemorrhoids: Similar to anal fissures, constipation can lead to straining during bowel movements, which may cause hemorrhoids. These can bleed, especially if they become thrombosed.
- Gastrointestinal Infection: Infections such as Salmonella, Shigella, or Escherichia coli (E. coli) can cause dysentery, which is characterized by bloody diarrhea.
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can present with bloody stools, although they are less common in young children and typically have other symptoms like chronic diarrhea, abdominal pain, and weight loss.
Do Not Miss Diagnoses
- Intussusception: A condition where a part of the intestine telescopes into another, which can cause bowel obstruction and ischemia. It's a medical emergency and can present with bloody stools, often described as "currant jelly" due to the presence of mucus and blood.
- Meckel's Diverticulum: A congenital anomaly of the small intestine that can cause painless rectal bleeding due to the presence of gastric mucosa that secretes acid, leading to ulceration and bleeding.
- Abuse: Physical abuse can sometimes present with rectal bleeding, and it's crucial to consider this in the differential diagnosis to ensure the child's safety.
Rare Diagnoses
- Juvenile Polyps: These are benign growths in the colon that can cause rectal bleeding, especially if they are large or numerous. They are more common in younger children.
- Vascular Malformations: Rare conditions like arteriovenous malformations (AVMs) or hemangiomas can cause rectal bleeding due to abnormal blood vessel structures in the gastrointestinal tract.
- Henoch-Schönlein Purpura (HSP): A systemic vasculitis that can affect various parts of the body, including the gastrointestinal tract, leading to abdominal pain and sometimes bloody stools.