Differential Diagnosis for a 13-year-old male with BRBPR (Bright Red Blood Per Rectum)
- Single most likely diagnosis:
- Anal fissure: This is a common cause of bright red blood per rectum in children and adolescents, often associated with pain during or after defecation. The blood is typically seen on the surface of the stool or on the toilet paper after wiping.
- Other Likely diagnoses:
- Hemorrhoids: Although less common in adolescents, hemorrhoids can cause bright red blood per rectum, especially if they are thrombosed or prolapsed.
- Rectal prolapse: This condition can cause bleeding, especially if there is a significant prolapse that leads to mucosal trauma.
- Inflammatory bowel disease (IBD): Conditions like Crohn's disease or ulcerative colitis can present with rectal bleeding, although they are typically accompanied by other symptoms such as diarrhea, abdominal pain, and weight loss.
- Do Not Miss diagnoses:
- Intussusception: A condition where a part of the intestine telescopes into another, which can cause intestinal obstruction and ischemia. It's a medical emergency that requires prompt diagnosis and treatment.
- Meckel's diverticulum: A congenital anomaly of the small intestine that can cause significant bleeding due to the presence of ectopic gastric mucosa.
- Infectious colitis: Certain infections (e.g., Salmonella, Shigella) can cause severe colitis with bleeding.
- Rare diagnoses:
- Juvenile polyps: Although usually benign and more common in younger children, they can cause rectal bleeding.
- Colonic arteriovenous malformations: Rare vascular anomalies that can cause significant bleeding.
- Trauma: Sexual abuse or accidental trauma can cause rectal bleeding and should be considered in the differential diagnosis, especially if there are other suspicious findings or history.