Question

A child presents with abdominal pain only during passage of stools. There are no other symptoms like vomiting or blood in stools, and there are no signs of intestinal obstruction. The most probable diagnosis is?

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

Hint:

Pain only while passing stool, otherwise well, in a child points to a low rectal lesion.

Answer 1

The Correct Option is A

Step 1: Pick out the key features. The pain occurs only at the time of passing stool, with no vomiting, no blood and no features of obstruction. This points to a low rectal lesion that is irritated during defecation.
Step 2: Consider rectal polyp. A juvenile rectal polyp is the commonest cause of such localised symptoms in a child and characteristically causes discomfort or pain during defecation; it is the best fit here.
Step 3: Eliminate intussusception. Intussusception causes colicky pain, vomiting and red-currant-jelly (bloody) stools with a mass, none of which are present.
Step 4: Eliminate Meckel's diverticulum. It classically causes painless lower GI bleeding, not pain limited to defecation.
Step 5: Eliminate necrotising enterocolitis. NEC is a neonatal emergency with feed intolerance, abdominal distension, bloody stools and an unwell infant, not an otherwise well child with isolated pain on defecation.
Step 6: The correct answer is rectal polyp (option 1).