From the Guidelines
The leading cause of gastrointestinal bleeding in children is anal fissure, which is the most common cause of lower GI bleeding in this population. This condition often presents with small amounts of bright red blood on the stool or toilet paper. According to the provided information, anal fissure is the correct answer, and it is essential to consider this condition when evaluating gastrointestinal bleeding in children 1.
Some studies suggest that Meckel's diverticulum is a common cause of painless massive lower GI bleeding in children due to ectopic gastric mucosa causing ulceration 1. However, the most recent and highest-quality study is not available to support this claim.
Other significant causes of gastrointestinal bleeding in children include juvenile polyps, peptic ulcer disease, and inflammatory bowel disease. Treatment for these conditions typically involves addressing the underlying cause of the bleeding, which may include surgical resection, medication, or other interventions.
It is crucial to note that a clear nasogastric aspirate does not reliably rule out upper GI bleeding, especially if bleeding is intermittent or has ceased temporarily 1. Therefore, a comprehensive evaluation, including endoscopy and other diagnostic tests, may be necessary to determine the cause of gastrointestinal bleeding in children.
In terms of management, the approach will depend on the underlying cause of the bleeding, and treatment options may include surgical intervention, endoscopic procedures, or medical management. The goal of treatment is to control the bleeding, manage any underlying conditions, and prevent future episodes of gastrointestinal bleeding.
Key points to consider when evaluating gastrointestinal bleeding in children include:
- Anal fissure is the most common cause of lower GI bleeding in children
- Meckel's diverticulum is a potential cause of painless massive lower GI bleeding
- Other significant causes of gastrointestinal bleeding in children include juvenile polyps, peptic ulcer disease, and inflammatory bowel disease
- A clear nasogastric aspirate does not rule out upper GI bleeding
- Comprehensive evaluation, including endoscopy and other diagnostic tests, may be necessary to determine the cause of gastrointestinal bleeding.
From the Research
Gastrointestinal Bleeding in Children
The leading cause of gastrointestinal bleeding in children is anal fissure, which is a common clinical problem in children and is defined as a longitudinal tear in the anal canal 2.
Causes of Gastrointestinal Bleeding
Some key points to consider:
- Anal fissure is the most common cause of lower GI bleeding in children, often presenting with small amounts of bright red blood on the stool or toilet paper.
- A clear nasogastric aspirate does not reliably rule out upper GI bleeding, especially if bleeding is intermittent or has ceased temporarily.
- Meckel’s diverticulum is a common cause of painless massive lower GI bleeding in children due to ectopic gastric mucosa causing ulceration 3, 4.
- The most common presentation of intussusception is intermittent abdominal pain, not bleeding, although “currant jelly stool” (blood and mucus) may appear but is less common.
Diagnosis and Treatment
Diagnosis of gastrointestinal bleeding in children can be reduced by taking into account the age of the child and the clinical condition of the patient 5. Some key points to consider:
- Newborns and infants who are clinically unstable are more likely to have diseases such as necrotizing enterocolitis, volvulus, Hirschprung disease, intussusception, or Meckel diverticulum.
- A baby who appears healthy should be examined for swallowed blood, allergic colitis, anal fissures, or lymphonodular hyperplasia.
- An older child of healthy appearance with bleeding is likely to have a juvenile polyp or infectious colitis, but a child who appears sick may have hemolytic uremic syndrome, Henoch-Schoenlein purpura, or inflammatory bowel disease.
Specific Conditions
Some specific conditions to consider:
- Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract and can present with bleeding, obstruction, or diverticulitis 4.
- Ileal tubular adenoma is a rare cause of lower gastrointestinal bleeding in infants 6.
- Push-and-pull enteroscopy using the double-balloon technique can be used to diagnose Meckel's diverticulum in adult patients with GI bleeding of obscure origin 3.