Differential Diagnosis for Blood in Stool in a 9-Year-Old
Single Most Likely Diagnosis
- Anal Fissure: This is a common cause of rectal bleeding in children, often due to constipation and hard stools that tear the anal mucosa. The pain associated with an anal fissure can lead to further constipation, creating a cycle.
Other Likely Diagnoses
- Constipation: Hard stools can cause bleeding due to the pressure and strain during bowel movements.
- Gastroenteritis: Infections that cause diarrhea can also lead to rectal bleeding, especially if the diarrhea is bloody.
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause chronic diarrhea, abdominal pain, and rectal bleeding.
- Food Allergy or Intolerance: Certain food allergies, such as a milk protein allergy, can cause rectal bleeding in children.
Do Not Miss Diagnoses
- Intussusception: A condition where a part of the intestine slides into an adjacent part, which can cause bowel obstruction and ischemia. It's a medical emergency and a common cause of intestinal obstruction and bleeding in children.
- 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.
- Infectious Colitis: Certain bacterial infections (e.g., Salmonella, Shigella) can cause dysentery, characterized by bloody diarrhea.
- Henoch-Schönlein Purpura (HSP): A systemic vasculitis that can cause abdominal pain, gastrointestinal bleeding, and a characteristic rash.
Rare Diagnoses
- Juvenile Polyps: Benign growths in the colon that can cause rectal bleeding, though they are less common in this age group.
- Hemolytic Uremic Syndrome (HUS): A condition that can follow certain bacterial infections, leading to kidney failure and sometimes gastrointestinal symptoms, including bleeding.
- Vascular Malformations: Rare congenital conditions that can cause rectal bleeding due to abnormal blood vessel formation in the gastrointestinal tract.
- Tumors: Though extremely rare in children, tumors such as lymphoma or colorectal carcinoma can cause rectal bleeding and should be considered in the differential diagnosis if other causes are ruled out.