Differential Diagnosis for Painless Haematochezia in Pediatrics
Single Most Likely Diagnosis
- Anal Fissure: This is the most common cause of painless hematochezia in children, often resulting from constipation and hard stools that tear the anal mucosa. The blood is typically bright red and seen on the surface of the stool or on the toilet paper after wiping.
Other Likely Diagnoses
- Juvenile Polyps: These are benign growths in the colon that can cause intermittent, painless bleeding. They are common in children and usually present with bright red blood per rectum.
- Meckel's Diverticulum: A congenital anomaly of the small intestine that can cause bleeding due to the presence of ectopic gastric mucosa. It typically presents with painless, bright red or maroon blood in the stool.
- Infectious Colitis: Certain infections, such as Salmonella or Shigella, can cause colitis leading to painless hematochezia. The blood is often mixed with stool and accompanied by other symptoms like diarrhea and abdominal cramps.
Do Not Miss Diagnoses
- Intussusception: A condition where a part of the intestine telescopes into another, leading to bowel obstruction and potentially life-threatening complications if not promptly treated. Although it often presents with abdominal pain, vomiting, and currant jelly stool, some cases may be painless.
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause chronic inflammation of the gastrointestinal tract, leading to painless hematochezia among other symptoms. Early diagnosis and treatment are crucial to prevent long-term complications.
Rare Diagnoses
- Hemangiomas: Vascular malformations in the gastrointestinal tract can cause bleeding, although this is rare in children.
- Arteriovenous Malformations (AVMs): Abnormal connections between arteries and veins can lead to bleeding, but are uncommon in pediatric patients.
- Tumors: Although rare, tumors such as lymphoma or colorectal carcinoma can cause painless hematochezia in children.