Rectal Bleeding

The conditions most often associated with rectal blood or blood in the diaper are polyps (24 to 25 percent), swallowed maternal blood (12 percent), anal fissures (1 to 36 percent), intussusception (7 to 26 percent), Meckel diverticulum (6 percent), and unexplained causes (31 to 48 percent). In unstable patients, management requires volume replacement followed by evaluation, identification, and control of the bleeding. Swallowed maternal blood from the delivery or from nursing on a nipple with a fissure appears in the second or third day of life. The Apt test can identify blood that is maternal in origin. Anal fissures are readily diagnosed as hairline breaks in the epithelium of the anus. In both swallowed blood and anal fissures, small amounts of blood are passed. Diaper blood stains are rarely larger than the size of a 50-cent piece. Patients present with no other signs and are stable and well hydrated. Meckel diverticulum, colonic polyps, and rectal varices are rare in newborns. The history is that of painless, fresh bleeding but no loose and no hard stools. Meckel diverticulum is seen in infants less than 1 year old, while polyps and varices are seen in infants older than 1 year. Intussusception presents with intermittent cramping, abdominal pain, and vomiting. Blood in the stools ("currant-jelly stools") is a late sign. Radiographic studies with contrast confirm the diagnosis.

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