A child is passing blood with act of defecation. The probable diagnosis is
**Core Concept**
The child's symptom of passing blood with defecation, known as rectal bleeding, suggests a gastrointestinal issue. This symptom can be caused by various factors, including inflammation, infection, or structural abnormalities in the rectum or anus.
**Why the Correct Answer is Right**
The most likely cause of rectal bleeding in a child is anal fissure. An anal fissure is a small tear in the lining of the anus, which can cause pain and bleeding during defecation. This occurs due to the increased pressure and tension during bowel movements, leading to the formation of a fissure. The pain and bleeding can be exacerbated by constipation, which is common in children.
**Why Each Wrong Option is Incorrect**
**Option A:** Hemorrhoids are less likely in children, as they are more common in adults and are often associated with chronic constipation, straining during bowel movements, or increased intra-abdominal pressure.
**Option B:** Rectal prolapse is a condition where the rectum loses its normal attachments inside the body, but it is less common in children and typically presents with a palpable mass or incomplete evacuation of stool.
**Option C:** Intussusception is a condition where a part of the intestine telescopes into another part, leading to bowel obstruction and potentially ischemia. While it can cause abdominal pain and bleeding, it is more common in infants and young children, and the presentation is often more acute.
**Clinical Pearl / High-Yield Fact**
A classic exam trap is to remember that anal fissures are more common in children, especially if they have a history of constipation or straining during bowel movements. The "3 Ps" of anal fissures are pain, prolapse, and posterior midline location.
**Correct Answer: C. Intussusception**