Differential Diagnosis for a 2-year-old Boy with Dark Red, Formed Stool
- Single most likely diagnosis:
- Intussusception: This condition, where a part of the intestine telescopes into another, is a common cause of rectal bleeding in toddlers, especially given the age of the patient and the presence of a formed, dark red stool. The child's tiredness could be indicative of anemia due to chronic blood loss.
- Other Likely diagnoses:
- Cow's milk protein allergy or intolerance: This could lead to gastrointestinal bleeding, especially in young children. The family's involvement in raising cattle might suggest a higher exposure to cow's milk products.
- Gastrointestinal infection: Although the child's temperature is normal, some gastrointestinal infections can cause bleeding without significant fever, especially in the early stages.
- Anal fissure (despite none being found): Sometimes, anal fissures can be internal and not visible on external examination. They are a common cause of painful, bloody stools in children.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Meckel's diverticulum: A congenital anomaly of the small intestine that can cause significant gastrointestinal bleeding due to the presence of ectopic gastric mucosa. It's crucial to consider this diagnosis due to the potential for severe blood loss.
- Hemolytic uremic syndrome (HUS): Typically follows a diarrheal illness caused by E. coli O157:H7, which could be related to the family's exposure to cattle and goats. Although the child does not have diarrhea, HUS can present with abdominal symptoms and later with renal failure and hemolytic anemia.
- Abuse: Although not directly related to the physical findings of gastrointestinal bleeding, it's essential to consider non-accidental trauma in any case of unexplained injury or illness in a child.
- Rare diagnoses:
- Juvenile polyps: These are rare in children as young as 2 but can cause rectal bleeding.
- Inflammatory bowel disease (IBD): Conditions like Crohn's disease and ulcerative colitis are rare in toddlers but should be considered if other diagnoses are ruled out and the child continues to have gastrointestinal symptoms.
- Vascular malformations or arteriovenous malformations (AVMs): These are rare causes of gastrointestinal bleeding and would typically present with more significant, possibly life-threatening hemorrhage.