Rectal Bleeding

Abstract

After reading "Rectal Bleeding in Childhood" by Hillemeier (PIR 5:35, 1983), I would like to raise a question concerning the child with lower rectal bleeding and a demonstrable anal fissure. In the article, the statement is made, "Once the determination has been made that the child has rectal bleeding from the lower GI tract, an endoscopic procedure is required." I would question the necessity of endoscopy with its additional complexity and definite increased costs as a requirement in the treatment of children with anal fissures. Obviously, some clinical judgment is necessary as the presence of an anal fissure does not rule out disease above, but in many clinical situations, a diagnosis can be made and appropriate therapy can be initiated without endoscopy. An additional problem, which has occurred frequently in my experience, is that many of the children with anal fissures have considerable constipated stool present at the time of their visit and the endoscopy requires an additional visit. In the absence of abdominal pain or any evidence of significant bleeding and in a clinical setting that is confirmatory of an anal fissure, I would suggest that a demonstrable fissure may be treated without endoscopy.