Blood in the stool from the anus, whether the stool is bloody or all bloody, bright red, dark red or tarry in color, is called blood in the stool. Blood in the stool mostly indicates bleeding in the lower gastrointestinal tract, especially in the colon and rectum. Blood in the stool with vomiting is a sign of upper GI bleeding. The color of the stool depends on the location of the bleeding, the amount of bleeding and the time it stays in the intestine, and upper GI bleeding is mostly black stool, or dark red or even bright red if there is a lot of bleeding and it is expelled quickly. Lower gastrointestinal bleeding is mostly bright red or dark red, if it stays in the intestine for a long time, it can also turn into black stool. Tarry black stools indicate bleeding of more than 60 ml. Blood in the stool may be without vomiting, while black stools are often present in those with vomiting. Blood in the stool can also be part of the manifestation of systemic diseases, and sometimes “blood in the stool” can be caused by swallowing blood from outside the digestive tract. Common causes of blood in the stool: 1. Lower gastrointestinal tract diseases (1) Anal fissure and hemorrhoids. (2) rectal diseases anal and rectal injuries, rectal polyps, rectal tumors, etc. (3) Bacterial dysentery, amoebic dysentery, restrictive enteritis, intestinal entrapment, intestinal tuberculosis, intestinal typhoid, distal ileal diverticulitis, melanotic plaques – gastrointestinal polyposis, intestinal duplication malformation, small intestinal hemangioma, small intestinal tumor, mesenteric artery embolism, etc. of the colon and small intestine. 2. Upper gastrointestinal diseases esophagus, stomach and duodenum, biliary tract diseases, etc. 3. Systemic and toxic diseases (1) Hemorrhage, coagulation dysfunction blood diseases, neonatal bleeding disorders, severe infections and DIC, etc. (2) acute infectious and parasitic diseases epidemic hemorrhagic fever, typhoid, paratyphoid and typhus, leptospirosis, leptospirosis, schistosomiasis, sepsis, etc. (3) Poisoning or drug toxic effects sepsis, bacterial food poisoning, toxic plant poisoning, drug toxic effects, chemical poisoning, etc. (4) Hereditary hemorrhagic capillary dilation The above diseases cause intestinal inflammation and ulceration, intestinal blood circulation disorders, gastrointestinal mucosal injury or increased capillary permeability resulting in blood in the stool. Clinical manifestations When encountering pediatric blood in stool, a detailed medical history and comprehensive physical examination should be taken, paying attention to the following points: 1. Examination before blood in stool Before determining that it is blood in stool, it should be carefully examined whether it is black stool caused by bleeding from the mouth, nasopharynx, bronchi and lungs after being swallowed, as well as excluding blood-like or black stool caused by certain drugs and foods. 2, according to the age of the child Most newborns have blood in the stool due to swallowing blood from the mother’s birth canal or nipple rupture or suffering from natural neonatal hemorrhage, hemorrhagic necrotizing small bowel infection, gastrointestinal malformation, etc. In infants and toddlers, blood in the stool is most often due to intussusception, meconium diverticulum, intestinal polyps, prolapse, and anal fissure. Preschool and school-age children with blood in stool should consider esophageal varices, ulcer disease, intestinal polyps, anal fissures, allergic purpura, etc. 3, the amount and color of blood in the stool A small amount of blood in the stool and bright red, blood attached to the surface of the stool, mostly rectal, sigmoid or descending colon disease bleeding, if the child does not cry when relieving the stool to consider rectal polyps, if the child cries a lot to consider anal fissure, also seen in intestinal overlap and so on. A large amount of blood in the stool, dark red or black, mostly bleeding from the upper gastrointestinal tract or acute hemorrhagic necrotizing enterocolitis, intestinal typhoid, etc. Jam-like stool is a mixture of blood and mucus like mucus jelly-like stool, such as children aged 6 to 18 months, accompanied by paroxysmal crying, to consider intussusception. Bean soup-like stool: stool is bloody water-like, fishy, in consideration of hemorrhagic necrotizing small intestinal infection, children often have abdominal pain, abdominal distension is obvious. 4, blood in the stool and the relationship between defecation blood in the stool after the drip, and the stool does not mix mostly seen in internal hemorrhoids, anal fissure, also seen in rectal polyps, rectal cancer, etc.. If the stool is pus-like or bloody with pus-like mucus, attention should be paid to dysentery, schistosomiasis, intestinal tuberculosis, chronic colitis, etc. 5, other accompanying symptoms Blood in stool with severe abdominal pain or even shock should be noted mesenteric vascular obstruction, hemorrhagic necrotizing enterocolitis, intussusception; blood in stool with abdominal masses should be noted intussusception, tumors, etc.; blood in stool with bleeding from other parts of the body is mostly seen in blood system diseases, acute serious infections, vitamin C deficiency, etc.; blood in stool with fever and systemic toxic symptoms are mostly acute infections. Blood in the stool with unknown causes must be carried out anal examination and rectal finger examination, which can help detect anal fissures, rectal polyps, hemorrhoids, intestinal overlap and cancer. 6, common blood in the stool disease characteristics (1) hemorrhoids in general hemorrhoids caused by anal bleeding, is internal hemorrhoids bleeding, occurs in the process of defecation or after defecation, blood is bright red, not mixed with feces, and will be accompanied by foreign bodies out of the anus. (2) The biggest symptom of anal fissure bleeding is pain, bright red blood, dripping blood, and severe pain after defecation. (3) Anal fistula bleeding is not a lot, the stool is pus and blood, regular defecation, the child also has nausea, dizziness, bleeding a lot, the patient’s body will develop iron deficiency anemia, serious cases also have shock. (4) Bleeding from enteritis is intermittent, similar to anal fistula bleeding, and the amount of bleeding is not very large. (5) Intestinal polyps are painless, and the blood is bright red, not mixed with feces, and often accompanied by mucus flowing out from the inside of the anus, and occasionally with the feeling of prolapse. Examination 1.Laboratory examination The color of the stool, the amount of blood, whether with mucus and pus blood, and whether the blood is mixed with the stool can be observed with the naked eye. Stool microscopy can detect pathological components of intestinal inflammation, parasitic eggs and certain parasites (such as amoeba). Blood is easy to microscopically examine without red blood cells, and an occult blood test should be performed. Peripheral blood hemoglobin and red blood cell counts help to understand the extent of blood loss. Bleeding and coagulation function tests. Stool culture, schistosome larvae hatching, immunological tests such as serum ring egg precipitation test and indirect hemagglutination test with lyophilized red blood cells, Fester’s reaction and exophthalmic reaction. 2, special examination (1) proctoscopy, sigmoidoscopy can directly understand the lesions, such as internal hemorrhoids, polyps, ulcers, tumors, etc., and take the contents for microscopic examination and biopsy. (2) Fiberoptic colonoscopy can observe deep colon lesions. (3) Gastrointestinal barium meal fluoroscopy, photographs and barium enema angiography are helpful for the diagnosis of gastrointestinal ulcers, diverticula, polyps, tumors, etc. (4) Selective abdominal arteriography and nuclear scan are helpful for the diagnosis of unexplained gastrointestinal bleeding. Treatment 1.Etiology Treatment for the cause can mostly cure blood in stool. For example, in neonatal hemorrhage, treatment with vitamin K1 alone is generally effective. Blood in the stool often disappears quickly after the use of effective drugs for intestinal infectious diseases. Systemic infectious diseases caused by blood in the stool, should be treated on the basis of comprehensive therapy. 2, symptomatic treatment (1) general treatment of active bleeding should be absolute bed rest, the use of sedatives. Closely observe and record the child’s consciousness, pulse, blood pressure and urine output. Keep the airway open to prevent asphyxia caused by vomiting blood. (2) Blood transfusion For those who bleed heavily, actively replenish blood volume. If there is no condition for immediate blood transfusion, dextrose, 5% glucose saline or compound sodium chloride solution can be input first. (3) Hemostatic agents should be selected according to the nature of bleeding, such as anilox blood, phenolsulfonamide, 6-amino acid, p-carboxybenzylamine, etc. For upper gastrointestinal bleeding, norepinephrine 4-8mg can be added to 150-250ml of saline orally or intra-gastric tube drip for local mucosal vasoconstriction. Cimetidine and omeprazole have good hemostatic effect on acute mucosal lesions and ulcer bleeding in the stomach and duodenum. 3.Surgical treatment Most rectal polyps can be removed under colonoscopy. Multiple polyps in the colon and small intestine, long-term large amounts of blood in the stool, can be dissected to remove polyps more concentrated intestinal segment, in order to stop bleeding and prevent malignant transformation. Intussusception such as air or barium enema can not be reset or time more than 48 hours should be treated surgically. Local intestinal resection is feasible for distal ileal diverticula and intestinal duplication malformation with bleeding.