Blood in the stool and Rectal prolapse

Introduction

In this section I have picked out some of the common or more important symptoms of disease met with in a casualty depart­ment, giving the chief causes, the important difficulties in di­agnosis, and, where relevant, the management.

Even though the final diagnosis may not be made in the casualty department or in the surgery, I think it adds to the interest of the work if the doctor examining the child has a reasonable knowledge of the possible causes. Potentially serious mistakes may be avoided if he knows the conditions which need further investigation by a pediatrician or pediatric surgeon. 

Blood in the stool

When a baby passes blood in the stool (or vomits blood) in the first two or three days, one must know whether it is the baby's blood or the mother's blood. If necessary the stool or vomitus is filtered, and to the pink solution four or five drops of N/5 NaOH are added: if it is the baby's blood the solution remains pink because the fetal haemoglobin is more resistent 10 alkali, but if it is the mother's blood, the colour changes to yellow. If it is the baby's blood the baby's general condition and haemo­globin is watched. A transfusion may be necessary.

If a rectal thermometer has been used, the bleeding may be due to that.

After the newborn period the commonest causes arc con­stipation, dysentery or salmonella infection, intussusception or ulcerative colitis. Blood from a Meckel's diverticulum is partly red and partly black. Blood may also come from a duplication of the intestine, a polyp, a foreign body or blood disease. Aspirin can cause bleeding.

Blood in the stool has to be distinguished from staining by diazepam syrup, viprynium or red gelatin.                                                                                                                

Rectal prolapse

Rectal prolapse is a relatively common complication of fibro­cystic disease of the pancreas and of meningomyelocele. In otherwise normal children it is usually a self-limiting con­dition, regressing as the child grows. The parents should be shown how to replace the bowel, by elevating the buttocks, inserting a finger previously covered with tissue paper into the lumen of the protruding mass, and pushing it back into the rectum