History of Present Illness:

A mother brings her 8 month old daughter to the ER for bloody stool.  Mom states the child was doing well until about a week ago when she developed a runny nose followed by irritability and some crying.  She was seen by her pediatrician yesterday and diagnosed with an ear infection.  There has been no vomiting, fever, cough or SOB but stools have been a little loose.  The child is otherwise healthy and up to date on vaccinations.  Other than the antibiotic, mom has been giving ibuprofen for pain.

Vital Signs & Physical Exam:

Vital signs are normal and the child is happy, smiling and skin color is normal.  Physical exam is otherwise normal.  An image mom saved of a full diaper is shown below.

What is the most likely diagnosis?

  • A) Gastritis from ibuprofen
  • B) Hematochezia from a cracked nipple
  • C) Stool color change from drug interaction
  • D) GI bleed from Meckel’s diverticulum

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ANSWER: What is the most likely diagnosis?

  • A) Gastritis from ibuprofen
  • B) Hematochezia from a cracked nipple
  • C) Stool color change from drug interaction – CORRECT
  • D) GI bleed from Meckel’s diverticulum

 

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

GI BLEED – LOWER: Can have melena if source is right colon

DDx:             U DAMP ITCH: Upper GI bleed, Ulcerative colitis, Diverticuli, AVM, Aortoenteric fistula

Meckel’s, Polyp, Ischemia, ID (C. diff), Intussusception, Tic, Cancer, Crohn’s, Hemorrhoid

Mimics:        Cefdinir + iron (or some baby formulas), B12, senna, rifampin, TCN, beets

CASE CONCLUSION: Child looked well; stool tested guaiac negative; mother reassured and they were sent home