Rectal Bleeding in Childhood

Abstract

The passing of blood through the rectum is not an uncommon event in the pediatric age group. The most likely etiology varies to a large degree depending upon the age of the patient. Fortunately, the risk of malignancy in children with lower gastrointestinal (GI) tract bleeding is considerably less than that of adults, and the degree of the invasive diagnostic work-up can often be far less extensive than that used in an adult with a similar clinical presentation. Bleeding anywhere throughout the GI tract will cause blood to be present in the stools. Melena refers to the passage through the rectum of black tarry stools and usually denotes bleeding from the upper gastrointestinal tract or small bowel. The tarry stools may be intermingled with maroon or red blood. Hematochezia is a passage of bright red blood through the rectum and usually indicates a source of bleeding low in the GI tract, often in the colon. However, inasmuch as blood exerts a strong Cathartic action, massive upper GI tract hemorrhage may occasionally present as bright red blood passed through the rectum. In most instances a negative gastric aspirate for blood will assure that the bleeding is distal to the ligament of Treitz Many substances ingested by children may simulate fresh or chemically changed blood.