Rectal Bleeding in the Pediatric Emergency Department

Abstract

Study objectives: To describe the presumptive diagnoses in an unselected, ambulatory, pediatric population complaining of rectal bleeding; to determine how often those diagnoses changed with follow-up; and to determine how often the bleeding represented an acutely life-threatening condition. Design: Retrospective case series. Setting: Urban, tertiary care pediatric emergency department. Participants: One hundred four patients with 109 visits with a chief complaint of blood in the stool. Interventions: None. Main results: Follow-up was available on 95 of 109 visits (87.1%), with a mean duration of 7.5 months. A specific presumptive etiology was established for 73 of 109 patients (67%) at the initial ED visit and for 74 of 95 patients (77%) at follow-up. The etiologies varied markedly by age. Four patients (4.2%; 95% confidence interval, 0.2% to 8.2%) presented with a life-threatening condition (requiring an RBC transfusion or operative intervention): intussusception (three patients) and Meckel's diverticulum (one patient). Concordance between the ED diagnosis and the follow-up diagnosis was 81%. Conclusion: A complaint of rectal bleeding is typically not life threatening in children. Emergency physicians normally are able to establish a presumptive diagnosis, which usually remains the same with follow-up. [Teach SJ, Fleisher GR: Rectal bleeding in the pediatric emergency department. Ann Emerg Med June 1994;23:1252-1258.]