Differential Diagnosis for Polyp in a Neonate with Hematochezia
- Single most likely diagnosis
- Juvenile polyp: This is the most common cause of rectal bleeding in neonates and infants, often presenting with a single polyp in the rectosigmoid region. The polyp is usually benign and can cause intermittent bleeding due to its fragile nature.
- Other Likely diagnoses
- Anal fissure: Although more commonly associated with painful defecation, anal fissures can cause bleeding in neonates, especially if the fissure is deep or if there is an associated infection.
- Allergic proctocolitis: This condition, often related to milk protein allergy, can cause rectal bleeding in infants. The presence of blood in stool is usually accompanied by other symptoms like diarrhea or mucus.
- Infectious colitis: Bacterial or viral infections can lead to colitis, which may present with hematochezia in neonates. The diagnosis is often suggested by the presence of other symptoms such as fever, diarrhea, or abdominal pain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Intussusception: Although rare in neonates, intussusception is a life-threatening condition that requires immediate attention. It can present with a classic triad of abdominal pain, vomiting, and "currant jelly" stool, but in neonates, the presentation might be atypical.
- Volvulus: This condition involves the twisting of a portion of the intestine, which can lead to ischemia and necrosis if not promptly treated. Neonates might present with nonspecific symptoms including abdominal distension, vomiting, and blood in stool.
- Hirschsprung's disease: A congenital condition characterized by the absence of ganglion cells in the distal bowel, leading to obstruction. While it typically presents with constipation, in severe cases or early in the disease process, it might cause enterocolitis with bloody stools.
- Rare diagnoses
- Congenital vascular malformations: Rare conditions such as hemangiomas or arteriovenous malformations within the gastrointestinal tract can cause bleeding.
- Inflammatory bowel disease (IBD): Extremely rare in neonates, but conditions like Crohn's disease or ulcerative colitis can present with hematochezia among other symptoms.
- Neoplastic conditions: Although exceedingly rare, tumors such as neuroblastoma or other rare neonatal tumors could potentially cause gastrointestinal bleeding.