The Young Child With Lower Gastrointestinal Bleeding Or Intussusception

Lumba, Angela K. MD
Conrad, Heather MD
Sharieff, Ghazala Q. MD, FACEP, FAAEM, FAAP
Mannick, Elizabeth MD
Wiebe, Robert A. MD, FAAP, FACEP

¹Authors
²Department of Pediatric Emergency Medicine, Rady Children's Hospital, University of California San Diego, CA
⁴Guest Editor
⁵Associate Clinical Professor, Children's Hospital and Health Center/University of California; Director of Pediatric Emergency Medicine, California Emergency Physicians, San Diego, CA
⁶Peer Reviewers
⁷Assistant Clinical Professor, University of Hawaii Medical School, Kapiolani Women and Children's Medical Center, Honolulu, Hawaii
⁸Professor, Division of Pediatric Emergency Medicine, University of Texas, Southwestern Medical Center at Dallas, Dallas, TX

Date of original release: January 1, 2012 Date of most recent review: December 10, 2011 Termination date: January 1, 2015 Medium: Print and Online Method of participation: Print or online answer form and evaluation Prior to beginning this activity, see “Physician CME Information” on the back page.

Pediatric Emergency Medicine Practice 9(1):p 1-14, January 2012.

Abstract

Lower gastrointestinal (LGI) bleeding in the pediatric patient 5 years of age or younger is an uncommon ED presentation that causes anxiety and concern both in the child's family and in the clinician. A report from Boston Children's Hospital in the early 1990s showed that rectal bleeding was a presenting complaint in 0.3% of pediatric patients who visited the emergency department (ED) within a 1-year period. The emergency clinician may find this presentation daunting, since the differential diagnosis of LGI bleeding includes numerous age-specific disorders not found in the adult population, ranging from self-limited anal fissures to surgical emergencies. The time to diagnosis and reduction will influence morbidity and mortality in these patients; hence, the emergency clinician should have a high index of suspicion as well as knowledge of current evidence for diagnosis and treatment. This issue of Pediatric Emergency Medicine Practice reviews the common differential diagnoses of LGI bleeding in children younger than 5 years of age, relying on the best available evidence from the literature. Readers will be able to apply clinically appropriate guidelines regarding diagnosis and treatment in an effective and patient-specific manner. In particular, this article focuses on the challenge of evaluating and managing the pediatric patient with intussusception.