G224(P) Rectal bleeding presenting to the paediatric emergency department

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Aims Bleeding per rectum is an alarming symptom for caregivers. The differentials are wide ranging from benign to life threatening. We conducted a literature review and were unable to identify any studies on undifferentiated paediatric patients presenting to the Paediatric Emergency Department (PED) with lower gastrointestinal bleeding in a UK population. We therefore aimed to explore the aetiology, diagnostic tools used and management options for infants, children and young people presenting to the PED with lower gastrointestinal bleeding. Methods Retrospective case note review of all patients presenting to a tertiary PED within a two year period (April 2017 to March 2019) with bleeding per rectum was performed. Cases were identified by reviewing all presenting complaints including the words ‘blood’ or ‘bleeding’ for those including key words e.g. rectal, nappy, stool etc. Data was then collected using a standardised data collection form for the following variables; age, sex, diagnosis in PED, urgent intervention required, diagnosis on follow-up, diagnostic concordance between PED and follow-up diagnosis, investigation (stool, blood, imaging), admission, outpatient referral and reattendance during the study period. Results A total of 90 cases were identified, 10 were excluded as they did not meet inclusion criteria (n = 80). This made up 0.14% of all presentations to the PED within the two year period. Median age was 5 years (3 months – 15 years) with 51% female and 49% male. Collectively constipation and gastroenteritis accounted for 76% of diagnoses. 24% of patients were admitted the same day and 38% referred for outpatient follow up. There was agreement between PED diagnosis and outpatient diagnosis in 87% of cases. 5% of cases required urgent intervention. Conclusion Bleeding per rectum is an infrequent presentation to the PED. The most common diagnoses are benign and may be managed without need of invasive investigation, admission or outpatient follow up. A high index of suspicion remains necessary to identify infrequent but serious pathology.

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