The etiology of hematochezia can be divided into systemic diseases, digestive tract diseases, perianal diseases and other diseases.
Systemic diseases: Henoch-Schonlein purpura (HSP);
HSP is a common immune complex in childhood, which acts on small blood vessels in many systems of the whole body, causing extensive allergic inflammation of small blood vessels. It usually happens after virus infection, and the physical examination may lead to skin purpura rash. Patients with HSP involving gastrointestinal tract may have bloody stool with obvious abdominal pain, which is characterized by positive fecal occult blood, a large number of bright red bloody stools or black stools.
Hemolytic uremic syndrome (HUS)
HUS is a disease characterized by microvascular hemolytic anemia, acute renal failure and thrombocytopenia, which is more common in infants, and its incidence has increased in recent years. The most common clinical symptoms are oliguria, anuria or hematuria. HUS patients may have HUS colitis, involving gastrointestinal tract, and usually have bloody diarrhea after 3 10d, accompanied by hemolytic anemia and thrombocytopenia.
Polyps of large intestine in digestive tract diseases
Most of the hematochezia caused by colorectal polyps is intermittent, and the amount of bleeding is small. Often manifested as chronic painless bloody stool, bright red in color, generally not mixed with feces. The bloody stool of polyps located at the proximal end of the colon can be dark red and mixed with feces. Colorectal polyp can occur in children of any age, but it is more common in children aged 3-5.
Allergic conjunctivitis (AC)
Children's AC is the most common inflammatory reaction to milk or soy protein, and children may have diarrhea, occult blood in stool or bloody stool visible to the naked eye.
Inflammatory bowel disease (IBD)
IBD is a chronic intestinal nonspecific inflammatory disease, including ulcerative colitis (UC) and Crohn's disease (CD). About 25% of patients occur in childhood and adolescence. The course of UC is more than 4 6 weeks, and its clinical manifestations are persistent or recurrent mucopurulent bloody stools, often accompanied by abdominal pain, diarrhea, acute diarrhea and systemic symptoms of different degrees. The amount of blood in the stool is related to the severity of the disease. The common symptoms of CD are abdominal pain, diarrhea and weight loss, and a few children may have bloody stools.
intussusception
Intussusception is the insertion of intestinal segments into adjacent intestinal tubes, which is more common in children, mostly under 2 years old. The clinical manifestations are paroxysmal abdominal pain, jam-like bloody stool and sausage-like mass in the abdomen. The hematochezia in intussusception occurred more than 612 hours after the onset, showing mucinous hematochezia. Because the mesentery is embedded between the intestinal walls during intussusception, the blood circulation is disturbed, and the mucosa oozes and mixes with intestinal mucus to form a dark red colloidal liquid.
Congenital volvulus
Congenital volvulus is the failure of intestinal rotation and intestinal fixation during embryonic development, which leads to the distortion of superior mesenteric artery and superior mesenteric vein, and then leads to volvulus or intestinal obstruction. The disease usually occurs around the narrow mesentery and is one of the surgical emergencies in children. Intestinal ischemia is caused by twisted mesenteric blood vessels. Its typical symptoms are paroxysmal abdominal pain and intermittent vomiting, abdominal distension, bloody stool or peritonitis. With the gradual necrosis of the intestine, abdominal erythema, septic shock and even death may occur. Clinically, about 20% cases have black or bright red bloody stools.
Necrotizing colitis
NEC is also one of the diseases that need emergency surgery, and its cause is not very clear. It may be due to relative intestinal ischemia and intestinal infection caused by bacterial translocation through immature intestinal epithelium. The risk factors of NEC include bacterial colonization, formula feeding, intestinal ischemia and premature delivery. Children may have occult or active massive bleeding, and in the case of clinical decompensation, abdominal distension, vomiting or diarrhea may also occur. Ileum, cecum and right colon are the most common lesions.
Hirschsprung's disease
HD is a kind of intestinal developmental malformation, and there is a lack of ganglion cells in the diseased intestinal wall. The incidence rate is1(500010000), and the ratio of male to female is about 4 1. HD is most common in newborns with delayed meconium. Clinically, it can be manifested as bloody diarrhea, often accompanied by poisoning symptoms, lethargy or fever. Its complications include HD-related enteritis, and bloody stool may be life-threatening.
Perianal disease anal fissure
Anal fissure is one of the most common causes of hematochezia in children. Younger children can't accurately express their pain, which may be manifested as crying, hunchback or muscle tension. For the bleeding caused by anal fissure, there is usually no blood in stool, but bright red blood can be observed on the surface of feces or diapers and toilet paper. During anal examination, cracks can be seen in the perianal skin, especially in the lithotomy position at 6 o'clock and 12.
Hemorrhoid disease
Hemorrhoids are rare in children, which can be clinically manifested as anal mass prolapse, hematochezia or anal pruritus. Blood in the stool usually manifests as painless blood in the stool, and the blood is not mixed, mostly intermittent. When defecating, the toilet paper is stained with blood, drops blood or spits blood.
Other diseases include swallowing maternal blood and postoperative anastomotic ulcer.
What is the cause of hematochezia in children?
The common causes of hematochezia in children are anal fissure, hemorrhoids, intestinal polyps, gastrointestinal diverticulum, intussusception, intestinal hemangioma (congenital malformation), acute necrotizing enteritis, dysentery, blood system diseases and so on. Therefore, it is necessary to see a doctor in time to find out the cause.
4. Acute intussusception: It is a common acute abdomen in children, and hematochezia can also occur. It is more common in children under 3 years old, especially in infants aged 4- 10 months. The main symptoms are bloody stool, jam-like stool and paroxysmal crying due to abdominal pain.
5. Acute necrotizing enteritis: It often occurs in summer and autumn and may have a history of unclean diet. Sudden onset, manifested as bloody stool and acute abdominal pain, mostly starting from the navel or upper middle abdomen, showing paroxysmal colic or persistent pain, accompanied by paroxysmal aggravation.
6. Dysentery: The main symptoms are fever, abdominal pain, diarrhea, acute diarrhea, bloody stool with mucus purulent, which may be accompanied by systemic toxemia, and in severe cases, septic shock and toxic encephalopathy may occur.
7. Blood diseases, such as thrombocytopenia and leukemia. , may be accompanied by bleeding gums, nosebleeds and other systems.
This content was reviewed by Zhao Lisi, Deputy Chief Physician of Pediatrics, Oriental Hospital, Beijing University of Chinese Medicine.
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It's hard to draw conclusions. Generally speaking, sometimes because of the urgency and heat, the baby is still young, so it is best to consult pediatrics.
Bright red is the lower digestive tract, and dark red is the upper digestive tract. You can look at the blood to see if the child is scratching the anus when defecating.
There may be something wrong with the intestine. Let's go to the hospital.
In severe cases, it may be intussusception and proctitis. See how the baby is. If he is in a bad mood, it is recommended that the stool be sent for inspection.
It should be infected by a virus.