Lower GI Haemorrhage in Children
Lower gastrointestinal bleeding (LGIB) in children ranges from benign, self‑limited perianal problems to life‑threatening intra‑abdominal haemorrhage. Causes are strongly age‑dependent and often overlap; emergency assessment must prioritise recognition of circulatory compromise and early identification of surgical, toxic or systemic causes that require urgent specialist input.
Triage and initial priorities
- Follow paediatric ABCDE and treat hypovolaemic/haemorrhagic shock immediately (signs include tachycardia, poor perfusion and altered mental state).
- Activate the local paediatric major haemorrhage / massive transfusion protocol (MHP) for life‑threatening bleeding and summon paediatric surgery, gastroenterology and haematology early.
- Red flags requiring urgent escalation:
- Haemodynamic instability or ongoing significant bleeding.
- Signs of peritonitis or intestinal ischaemia.
- Suspected intussusception, volvulus or necrotising enterocolitis (NEC).
- Evidence of haemolytic uraemic syndrome (HUS): anaemia, thrombocytopenia, renal impairment.
- Foreign body hazards: button battery or multiple magnets.
- Significant coagulopathy or anticoagulant use.
Age‑related causes - practical overview
- Neonates: swallowed maternal blood, necrotising enterocolitis (NEC), Hirschsprung disease with enterocolitis, malrotation with midgut volvulus, congenital coagulopathy. Overlap with vascular malformations, gastrointestinal duplication and anal fissure.
- Infants (1 month-2 years): Meckel’s diverticulum, intussusception, very early onset IBD (VEO‑IBD), infectious colitis and foreign body; overlap with malrotation, vascular malformations and anal fissure.