Visual Diagnosis: Four Infants Who Have Red, "Bloody" Stools

Abstract

1. Jill Lowers, MD* 2. Arthur Jaffe, MD* 3. Joseph A. Zenel, MD† 4. Michael D. Cabana, MD, MPH§ 5. Clement Donahue, MD‡ 6. Alan Uba, MD‡ 1. *(Cases 1, 2, 3) Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Ore 2. †(Cases 1, 2, 3) Associate Editor, Pediatrics in Review 3. §(Case 4) Departments of Pediatrics, Epidemiology and Biostatistics, Division of General Pediatrics, Institute for Health Policy Studies, UCSF Children's Hospital, University of California, San Francisco, Calif 4. ‡(Case 4) Department of Pediatrics, Division of General Pediatrics, Institute for Health Policy Studies, UCSF Children's Hospital, University of California, San Francisco, Calif A 2-year-old, previously healthy boy presents to the clinic with a history of 24 hours of fussiness, decreased appetite, and several short-lived episodes of acute abdominal pain. During the past 8 hours he has had several red, “bloody” stools. There is no vomiting. Physical examination reveals an alert child whose vital signs are normal. His abdomen is soft and nondistended. A palpable “mass” extends through the right upper and lower quadrants. Rectal examination does not reveal any fissures or tears. Auscultation reveals diminished bowel sounds. His remaining physical findings are within normal limits. After examination, the patient passes a red-colored stool (Fig. 1). Laboratory examination shows normal complete blood count and serum electrolyte concentrations. Stool guaiac testing is positive. Additional testing reveals the diagnosis. Figure 1. Red stool, guaiac-positive. A 2-year-old healthy girl presents with the complaint of a single large, red, “bloody” stool. She has had no vomiting, diarrhea, abdominal pain, fussiness, fever, or other systemic complaints. She has no history of constipation. Her mother brings the stool for examination (Fig. 2). Figure 2. Red stool, guaiac-negative. Physical examination reveals an alert, playful child whose vital signs are normal. Findings on abdominal examination are unremarkable, and the rectal examination does not reveal any fissures or tears. The remainder of her physical examination is normal. Stool guaiac testing is negative. Additional history reveals the diagnosis. A 5-month-old boy who has a recent history of acute otitis media presents with three episodes of red, “bloody” stools in the past 48 hours. The child is otherwise well and has no vomiting, diarrhea, fever, or abdominal pain. His appetite is good, and he drinks 8 oz of formula every 3 to 4 hours. He has no prior history of constipation or formula intolerance. Currently, he is taking oral cefdinir for the otitis media. His mother brings …