A diagnostic challenge in painless rectal bleeding in a 10-month-old infant: a case report

Abstract

Painless rectal bleeding in infants can occur due to various causes, including cow’s milk protein allergy (CMPA), juvenile polyp, Meckel’s diverticulum, angiodysplasia and internal hemorrhoids. Symptoms typically arise in the first or second year of life, with an average age of 2.5 years. Intermittent painless rectal bleeding is often caused by ulceration of the adjacent normal ileal mucosa and may be associated with iron deficiency anemia. We present the case of a 10-month-old female infant with complaints of painless rectal bleeding and iron deficiency anemia. The child had a history of cow’s milk as a primary source of nutrition along with inadequate and improper complementary feeding practices despite advice. She had a similar episode of blood in the stool at the age of 6 months. Clinical examination revealed an anal fissure on the posterior wall. Initial Meckel’s scan at 6 months was negative. The patient was advised to discontinue cow’s milk due to suspected cow’s milk protein allergy, following which the bleeding subsided. However, at the age of 10 months, the child again presented with bleeding per rectum. A repeat Meckel’s scan demonstrated focal tracer uptake in the right iliac fossa, suggestive of ectopic gastric mucosa, consistent with Meckel’s diverticulum. The child subsequently underwent Meckel’s diverticulectomy.