Differential Diagnosis for Hematochezia

Hematochezia refers to the passage of fresh blood per the rectum, which can be a symptom of various conditions affecting the gastrointestinal tract. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Diverticulosis: This is a common condition, especially in older adults, where small, bulging pouches (diverticula) develop in the digestive tract. It is a leading cause of hematochezia due to the erosion of blood vessels within the diverticula.

• Other Likely Diagnoses

  • Hemorrhoids: Swollen veins in the lowest part of the rectum or anus can cause bleeding, especially during bowel movements.
  • Anal Fissures: Tears in the lining of the anus can lead to painful bleeding during and after bowel movements.
  • Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause chronic inflammation and ulcers in the gastrointestinal tract, leading to bleeding.
  • Gastrointestinal Infections: Certain infections can cause inflammation and bleeding in the GI tract.

• Do Not Miss Diagnoses

  • Lower Gastrointestinal Malignancy: Although less common, cancers of the colon, rectum, or anus can present with hematochezia. Early detection is crucial for treatment and survival.
  • Angiodysplasia: Vascular malformations in the GI tract can cause significant bleeding, especially in the elderly.
  • Ischemic Colitis: Reduced blood flow to the colon can cause tissue damage and bleeding, which can be life-threatening if not promptly addressed.
  • Meckel's Diverticulum: A congenital anomaly of the small intestine that can cause bleeding due to the presence of ectopic gastric mucosa.

• Rare Diagnoses

  • Intussusception: A condition where a part of the intestine slides into an adjacent part, potentially causing bowel obstruction and bleeding.
  • Blue Rubber Bleb Nevus Syndrome: A rare condition characterized by vascular malformations that can cause GI bleeding.
  • Dieulafoy's Lesion: A rare cause of GI bleeding due to a mucosal ulceration overlying a persistent, large-caliber, tortuous arteriole.
  • Arteriovenous Malformations (AVMs): Abnormal connections between arteries and veins can cause bleeding in the GI tract.

Each of these diagnoses has a different set of risk factors, symptoms, and diagnostic approaches. A thorough medical history, physical examination, and diagnostic tests such as endoscopy, colonoscopy, and imaging studies are essential for determining the underlying cause of hematochezia.