Differential Diagnosis for Massive Lower Gastrointestinal Bleeding in Children
- Single most likely diagnosis
- (b) Intussusception: This is the most common cause of intestinal obstruction and a leading cause of lower gastrointestinal bleeding in children, typically presenting with sudden onset of abdominal pain, vomiting, and bloody stools.
- Other Likely diagnoses
- (c) Meckel’s diverticulum: A congenital anomaly of the small intestine that can cause bleeding due to the presence of ectopic gastric mucosa. It is a common cause of gastrointestinal bleeding in children.
- (a) Anal fissure: Although more commonly associated with painful defecation, anal fissures can cause significant bleeding in children, especially if the fissure is deep or if there is an associated infection.
- Do Not Miss
- Inflammatory bowel disease (IBD): Conditions like Crohn's disease and ulcerative colitis can present with massive lower GI bleeding and require prompt diagnosis and treatment to prevent complications.
- Vascular malformations: Similar to angiodysplasia, other vascular malformations can cause significant bleeding and are important not to miss due to their potential for severe outcomes if left untreated.
- Rare diagnoses
- (e) Angiodysplasia: A vascular malformation of the gut that can cause bleeding. It is rare in children and more commonly seen in the elderly.
- Hemolytic uremic syndrome (HUS): Although primarily known for its association with renal failure and hemolytic anemia, HUS can also cause gastrointestinal symptoms, including bleeding, due to the ischemic effects on the bowel.
- Gastrointestinal tumors: Rare in children, but tumors such as lymphoma or other malignancies can cause lower GI bleeding and must be considered in the differential diagnosis to ensure timely and appropriate management.