What's Your Diagnosis? Pediatric Gastrointestinal Bleeding

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got the previous case on Pediatric Sinusitis: Complications and Management in the Emergency Department right.

Case Presentation: Pediatric Gastrointestinal Bleeding: Identification and Management in the Emergency Department

A 2-year-old previously healthy boy presents with 2 episodes of rectal bleeding since yesterday evening…

The boy’s parents report no vomiting or signs of pain. They brought a diaper with a large amount of bloody stool in it. They say the boy continues to tolerate his diet well.
On examination, the boy has no fever, his heart rate is 130 beats/min, and his blood pressure is 95/50 mm Hg. His abdomen is soft and nontender, with no palpable masses, and his external perianal examination is normal.
Considering the patient’s clinical presentation, which diagnostic and management steps would be most appropriate to prioritize?

Case Conclusion
Basic laboratory studies were performed, revealing a hemoglobin level of 9.5 g/dL, with normal white blood cell and platelet counts. Given his age and symptoms, concern arose for Meckel diverticulum, so you ordered a technetium-99m nuclear scan, which confirmed the presence of Meckel diverticulum. Pediatric surgery was consulted, and a laparotomy was performed, followed by resection of the diverticulum. The patient recovered well and was subsequently discharged home.