Question

A mother has brought in her 2-year-old son with a 2-day history of bleeding of the rectum. Bleeding was very little to begin with, but today the child has soaked 3 diapers. There is no history of fever, vomiting, or loose bowel movements. Child is active and playful and has no obvious discomfort. Stool is brick red in color. Abdomen is soft with no distension or organomegaly. Perianal examination is normal, and there is no fissure.

What is the investigation of choice to confirm the diagnosis?

1 Ultrasound abdomen
2 CT abdomen
3 Lower GI barium studies
4 Colonoscopy
5 Radionuclide scan

Answer 1

The most appropriate first step to investigate a 2-year-old with rectal bleeding is a stool sample analysis to identify possible infectious agents that could cause bloody stools.

Step-by-step explanation:

In the case of a 2-year-old child with a history of rectal bleeding without other symptoms such as fever, vomiting, or diarrhea, and with a normal perianal examination, the first step in investigation would primarily be a stool sample analysis. This is because certain infectious agents can cause bloody stools, and identifying these agents is crucial for appropriate treatment. It is less likely to consider colorectal cancer in this age group, as such cancers are exceptionally rare in children and are usually screened for in individuals over 50 years of age with a history of polyps or other risk factors. Therefore, investigations such as a colonoscopy, while critical for screening adults, are not the immediate investigation of choice in this clinical scenario for a young child.