A Study of Bleeding Per Rectum in Paediatric Age Group

Abstract

Background: Gastrointestinal bleeding is a frequently encountered clinical complaint in routine medical/surgical practice. It has different aetiology in both extremes of age. There are many reports regarding the aetiology, presentation, epidemiology and management of this complaint in adults. Yet, there is little literature exploring its different aspects in infants and children. This study was carried out in an attempt to find out causes, epidemiology, presentation and the proper management that can be offered to affected infants and children.Objectives: This study tries to assess the multiple aetiologies and different modalities further management of bleeding per rectum occurring in infants and children in our locality.Methods :All children below 12 years of age presenting with the complaint of passing blood per rectum were included. The data was reviewed for gender, age, the clinical presentation and the modality of management employed. Complete blood picture and general stool examination were done for all the cases. Flexible sigmoidoscopy was performed for some cases. Also all the rectal polyps and colonic mucosal biopsies taken during sigmoidoscopy were submitted to histopathological examination.Results :In our study we reviewed 80 patients, of whom 57 (71.25%) were boys and 23 (28-75%) were girls. The male: female ratio ratio was 2.5: 1. The mean age at diagnosis was 6.31 years. The most common aetiology was rectal polyps which was found in 45 (56.25) of the cases. Rectal polypswere diagnosed by performing per rectum exam and/or sigmoidscopy. Twenty one (26.25%) of the patients were treated conservatively with the provisional clinical diagnosis of infectious colitis. We revealed non-specific colitis in 2 patients, ulcerative colitis in 2, anal fissure in 2, complicated Meckels diverticulum in 1 and intussusception the remaining 2 cases.Conclusion : A complete and proper physical exam including per rectum digital exam together with sigmoidoscopy when required helps promotion of both fast and precise diagnosis and offers the opportunity for quick management procedures to be undertaken. The most common cause for bleeding per rectum were rectal polyps.