Abstract

Lower gastrointestinal (LGI) bleeding in the pediatric patient 5 years of age or younger is an uncommon ED presentation that causes anxiety and concern both in the child’s family and in the clinician. A report from Boston Children’s Hospital in the early 1990s showed that rectal bleeding was a presenting complaint in 0.3% of pediatric patients who visited the emergency department (ED) within a 1-year period. The emergency clinician may find this presentation daunting, since the differential diagnosis of LGI bleeding includes numerous age-specific disorders not found in the adult population, ranging from self-limited anal fissures to surgical emergencies. The time to diagnosis and reduction will influence morbidity and mortality in these patients; hence, the emergency clinician should have a high index of suspicion as well as knowledge of current evidence for diagnosis and treatment. This issue of Pediatric Emergency Medicine Practice reviews the common differential diagnoses of LGI bleeding in children younger than 5 years of age, relying on the best available evidence from the literature. Readers will be able to apply clinically appropriate guidelines regarding diagnosis and treatment in an effective and patient-specific manner. In particular, this article focuses on the challenge of evaluating and managing the pediatric patient with intussusception.

Keywords: pediatric GI bleeding, intussusception, Meckel diverticulum, bowel malrotation, milk-protein sensitivity, milk-protein allergy, pediatric GI hemorrhage, blood per rectum, inflammatory bowel disease, necrotizing enterocolitis, GI arteriovenous malformation, pediatric rectal/anal trauma