Question

The commonest cause of bleeding per rectum in children is

• A. Rectal polyp
• B. Intussusception
• C. Meckel's diverticulum
• D. Haemorrhoids

Hint:

Think of the small, benign growth that bleeds painlessly in young children between two and ten years.

Answer 1

The Correct Option is A

This question asks for the single commonest cause of rectal bleeding in children, comparing four possible causes.

1. Rectal polyp: A small, benign, solitary juvenile polyp, most often seen between two and ten years of age, has a fragile surface that bleeds easily as stool passes over it, giving painless bright red blood on the stool or toilet paper. Because this happens so often across this wide age range, it is the leading cause overall.
2. Intussusception: One part of the bowel telescopes into the next, mainly in infants under two years, and causes colicky pain, vomiting, and red currant jelly stools. It is a surgical emergency but is not the most frequent cause of rectal bleeding across all childhood ages.
3. Meckel's diverticulum: A remnant pouch from fetal life that can contain acid making tissue, leading to sudden, painless, sometimes heavy rectal bleeding, mainly in infants and toddlers. It is an important cause but is outnumbered overall by juvenile polyps.
4. Haemorrhoids: Rare in children, usually linked with straining from constipation, and give only small streaks of blood, not a major cause of significant bleeding.

When all ages of childhood are considered together, juvenile rectal polyps bleed often enough and are common enough to be the leading cause, even though Meckel's diverticulum and intussusception matter more in the youngest infants.

Let's summarize:

• Meckel's diverticulum and intussusception are important causes mainly in infants.
• Juvenile rectal polyps are the overall commonest cause of painless rectal bleeding across childhood.

So the commonest cause of bleeding per rectum in children is a rectal polyp.