Swallowed Maternal Blood



Seen in the immediate newborn period
May be seen in any breastfed infant
Confirmed if blood turns yellow with Apt test
Anorectal fissure



Most common cause of rectal bleeding < 1y/o
Diagnosed by careful exam of anal area
May be associated with constipation or diarrhea
Necrotizing Enterocolitis (NEC)



Most commonly occurs in premature infants, however 13% of cases are full term
May present with nonspecific systemic signs
Hallmark radiographic finding is pneumatosis intestinalis
Malrotation with midgut volvulus


Abdominal distension, bilious emesis, melena in ill appearing young child or infant
Diagnosed with upper GI contrast study: failure of duodenum to cross midline
Hirschsprung Disease



Delayed passage of meconium with abdominal distention
May progress to toxic megacolon
Contrast enema is used as initial test
Milk induced enterocolitis



Sigmoidoscopy shows friable, red mucosa acutely. May chronically progress to
lymphonodular hyperplasia
Rarely seen after age 2 y/o
Symptoms most commonly seen after changing from breast milk to formula or cow’s
milk
Intussusception




Most common cause of intestinal obstruction in infants 6-36months
Episodic pain
May present with lethargy or altered mental status
Bloody, mucoid stool is late finding
Gastrointestinal Duplication


Intestinal tissue which does not communicate with bowel lumen
Contains gastric mucosa which can ulcerate, perforate, and form fistulas
Shigella




Most commonly 1-4y/o in daycare
Fever, abdominal pain, watery diarrhea that becomes bloody, high band count
Treatment: Bactrim in U.S., 3rd generation cephalosporin in other countries
Complications: toxic megacolon, sepsis, hemolytic uremic syndrome, seizures,
encephalopathy
Salmonella




Highest incidence in 1st year of life, causes bacteremia in 5%
Often food-borne
Treatment only indicated if <3months old and those at risk for invasive disease
Choices of Tx: ampicillin, amoxicillin, bactrim, 3rd gen cephalosporin
E. coli



May occur in clusters of cases
Most serious complication is hemolytic uremic syndrome from 0157:H7 strain
Early administration of antibiotics may increase the risk of developing HUS
Juvenile Polyps




Peak at age 3-4y/o
Confined to rectosigmoid region in 80-90% of cases
60% palpable by rectal exam
May autoinfarct leading to bright red streaks of blood on outside of stool
Inflammatory Bowel Disease



Chronic symptoms
Short stature, wt loss
Anorexia, arthralgia, erythema nodosum
Viral Gastroenteritis


Most commonly caused by Rotavirus
Important cause of dehydration and hospitalization <2y/o

o Otherwise self-limiting course
Bloody stools may be seen, but not commonly
Hemolytic-Uremic Syndrome


Occurs with infection of E. coli 0157:H7 or Shigella
Isolated bloody diarrhea for 3-16 days
o Followed by microangiopathic hemolytic anemia, thrombocytopenia, and renal
insufficiency
Henoch-Schönlein purpura


Most common vasculitis in children
Complications may include intussusception

Tetrad:

Palpable purpura in patients with neither thrombocytopenia nor
coagulopathy

Arthritis/arthralgia


Abdominal Pain
Renal Disease