Blood in Stool: Pediatric Concerns and Diagnosis

Bowel movement issues

A 2-year-old child had a significant amount of dark red blood in the stool two weeks ago (on the surface).
The night before the bloody stool, the child experienced constipation and strained during a bowel movement.
Over the next two weeks, there were instances where harder stools passed every one to two days, occasionally with a drop of red or dark red blood on the surface of the stool.
However, a hospital examination showed no anal fissures, and there were no symptoms of abdominal pain or vomiting.
We are considering whether to perform a nuclear medicine examination and would like to know if Meckel's diverticulum could cause such a situation with one or two drops of blood in the stool.
The initial episode had a larger volume of blood, but subsequent occurrences seem more consistent with blood from an anal fissure.

Nìmíng, 30~39 year old female. Ask Date: 2021/03/10

Dr. Xiao Kaiwen reply Pediatrics

Meckel's diverticulum bleeding is usually more significant and can occur with or without abdominal pain.
Most of the bleeding originates from the small intestine, so it is often mixed throughout the stool (though this is not always the case).
Anal fissures typically involve harder, bulkier stools, with bleeding that is usually minimal.
There is often a sensation of pain at the anal opening, and the bleeding is generally on the surface of the stool.
If the fissure is small, the bleeding may be minimal, and it may not be detected during examination.
Therefore, your child's situation seems more consistent with an anal fissure.
If there are still concerns, it is advisable to consult a pediatric gastroenterologist at a major hospital.

Reply Date: 2021/03/10

More Info

When it comes to pediatric concerns regarding blood in stool, especially in a two-year-old child, it is essential to approach the situation with caution and thoroughness. The presence of blood in a child's stool can be alarming for parents, and understanding the potential causes and necessary diagnostic steps is crucial.

In your case, the child experienced a significant episode of dark red blood in the stool, which was followed by smaller amounts of blood appearing intermittently on the surface of harder stools. The fact that there was a history of constipation and straining during bowel movements raises the possibility of anal fissures, which are common in children and can cause bright red blood on the surface of the stool. However, you mentioned that no anal fissures were found during the examination, which is an important detail.

The absence of abdominal pain or vomiting is reassuring, as these symptoms could indicate a more serious underlying condition. However, the intermittent nature of the blood in the stool warrants further investigation to rule out other potential causes.
One possible condition to consider is Meckel's diverticulum, a congenital abnormality that can lead to gastrointestinal bleeding. Meckel's diverticulum can sometimes present with painless rectal bleeding, and while it is more common in children, it typically does not present with just a few drops of blood. Instead, it may lead to more significant bleeding or other gastrointestinal symptoms.
Given the child's age and the symptoms described, it is advisable to conduct further diagnostic tests to ensure that no underlying issues are present. A nuclear medicine scan, specifically a Meckel's scan, can be useful in identifying the presence of ectopic gastric tissue associated with Meckel's diverticulum. This test is non-invasive and can provide valuable information without the need for more invasive procedures.

In addition to a Meckel's scan, other diagnostic steps may include:
1. Stool Tests: Checking for occult blood can help determine if there is ongoing bleeding that is not visible to the naked eye.

2. Abdominal Ultrasound: This imaging technique can help visualize any abnormalities in the gastrointestinal tract and assess for conditions like intussusception or other structural issues.

3. Endoscopy: If the bleeding persists or if there are other concerning symptoms, a pediatric gastroenterologist may recommend an upper or lower endoscopy to directly visualize the gastrointestinal tract.

4. Dietary Assessment: Sometimes, dietary factors can contribute to gastrointestinal bleeding, especially if the child has recently introduced new foods or has food allergies.

5. Follow-Up: Continuous monitoring of the child's symptoms is essential. If the bleeding persists, worsens, or if new symptoms develop, immediate medical attention should be sought.

In conclusion, while the initial findings may suggest a benign cause, such as constipation-related bleeding, it is crucial to remain vigilant and pursue appropriate diagnostic evaluations. Meckel's diverticulum is a possibility, but the presentation of symptoms and the amount of blood observed should guide the decision-making process. Consulting with a pediatric gastroenterologist can provide further insights and help determine the best course of action for your child's health.

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