Lower GI Bleeding

Lower GI Bleeding is a topic covered in the 5-Minute Pediatric Consult.

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Basics

Description

Lower gastrointestinal bleeding (LGIB) is defined as bleeding that occurs distal to the ligament of Treitz. The classic clinical symptom is hematochezia. However, always keep in mind that severe upper gastrointestinal bleeding can present with hematochezia. Melena and maroon-colored stools can be seen with small bowel bleeding.

Epidemiology

Incidence

  • The incidence of GI bleeding in children is not well established in the general population.
  • In a population study of LGIB based on 40,000 admissions to a tertiary care pediatric emergency department, LGIB was seen in 0.3% of all admissions.
  • Few patients have severe life-threatening LGIB.

Etiology

Causes of LGIB vary by age:

  • Neonatal period (birth to 1 month)
    • Allergic colitis
    • Anorectal fissure
    • Necrotizing enterocolitis
    • Enteric infections
    • Upper GI source
    • Duplication cyst
    • Hirschsprung disease enterocolitis
    • Meckel diverticulum
    • Malrotation with volvulus
    • Hemorrhagic disease of the newborn
  • Infancy (1 month to 2 years)
    • Allergic colitis
    • Anorectal fissure
    • Enteric infections
    • Intussusception
    • Meckel diverticulum
    • Malrotation with volvulus
    • Lymphonodular hyperplasia
    • Upper GI source
    • Duplication cyst
    • Enterocolitis with Hirschsprung disease
    • Vascular malformation
  • Preschool age (2 to 5 years)
    • Anorectal fissure
    • Enteric infections
    • Polyps
    • Parasites
    • Meckel diverticulum
    • Intussusception
    • Lymphonodular hyperplasia
    • Inflammatory bowel disease
    • Hirschsprung disease enterocolitis
    • Hemolytic uremic syndrome
    • Henoch-Schönlein purpura (HSP)
    • Vascular malformation
    • Volvulus
    • Rectal prolapse/rectal ulcer
    • Child abuse
    • Perianal streptococcal cellulitis
  • School age (5 to 13 years)
    • Anorectal fissure
    • Enteric infections
    • Inflammatory bowel disease
    • Intussusception
    • Meckel diverticulum
    • Polyps
    • HSP
    • Hemolytic uremic syndrome
    • Intestinal ischemia
    • Neutropenic colitis (typhlitis)
    • Parasites
    • Child abuse
    • Vascular malformations
    • Perianal streptococcal cellulitis
  • Adolescent (>13 years)
    • Anorectal fissure
    • Hemorrhoids
    • Parasites
    • Enteric infections
    • Inflammatory bowel disease
    • Hemolytic uremic syndrome
    • Intussusception
    • Midgut volvulus
    • Intestinal ischemia
    • Neutropenic colitis (typhlitis)
    • Polyps
    • Vascular malformations
    • Lymphonodular hyperplasia

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