Bleeding may be a sign of GI inflammation, duplication, foreign-body infection, or systemic illness, or it may be nothing more than an anal fissure or milk allergy. GI bleeding in the newborn, either vomited or per rectum, may be the result of swallowed maternal blood. The laboratory can differentiate between maternal and fetal blood by the Kleihauer-Betke test or hemoglobin electrophoresis. Rarely, hemorrhagic states cause GI bleeding in the newborn. Small amounts of blood in the stool of an infant, if fresh, may be a manifestation of anal fissures, which are easily identified. In children 2 to 10 years of age, painless bleeding of small to moderate amounts of fresh blood usually mixed through the stool might be an indication of benign GI polyps, or bloody diarrhea may indicate a bacterial infection or inflammatory bowel disease.4
The presence of small to moderate amounts of blood in the stool of an infant (particularly associated with vomiting) must lead the physician to consider malrotation of the midgut. This is a life-threatening condition that requires immediate investigation and surgical consultation because volvulus of the midgut can lead to midgut gangrene if the problem is not identified and corrected early in its course.
Major painless upper GI bleeding in infants or children is most commonly the result of bleeding varices secondary to portal hypertension. Major painless lower GI bleeding in infants or children is frequently ascribable to a Meckel's diverticulum.
Frequently, the cause of minimal to moderate amounts of blood in the stool of an infant or a child may never be identified. Repeated episodes of bleeding require GI studies, endoscopic evaluation, and Meckel isotope scanning ( Table 1.23-6).
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