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Pink blood mixed and mucus with stool of baby

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hello my baby is a 6 months old male,weights 7kg,breastfed mainly i stopped formula 3 months ago 2 months ago i noticed pink blood mixed with his stool and mucus in his diaper so we had a stool analasys and "culture&senstivty" and no bacteria or parasites were found but there were occult blood, mucus, high pus cells, and high rbcs he was diagnosed as a cow milk protein allergic so i stopped all the dairy products for almost a month but 9 days ago i noticed a rectum viscle and i gave him and oral and cream antibiotic and still no improvment. please find the attached picture kindly advice


Category: Pediatric Surgeon

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Category: ICU/ Critical Care Specialist
Dr. Saptharishi L G is online now

Expert:  Dr. Saptharishi L G replied 4 Days.

Hello, Thank you for your query at DoctorSpring.

As per your description, which is very informative, it appears that your baby has had some inflammation along the lining of his gut. The causes could be infective or non-infective. Among non-infective causes, allergy to animal milk protein is frequent, though not the only cause. The decision to stop formula feeds was indeed an appropriate decision. Breastfeeding is definitely the best gift that any mother can give her child. But infective causes could have existed and gone undetected in routine stool evaluation tests. The fact that your child has remained symptom-free for the last 2 months after stopping formula feeds, points to the absence of any other chronic disease and could retrospectively, point to a diagnosis of Cow milk allergy.

Your current concern regarding a small projection near his anal opening is justified. The photograph appears to indicate the presence of a skin tag. It is important to rule out any fissure or fistula-in-ano by good inspection, examination and investigations if required. It is not-infective and hence unlikely to respond to antibiotics. Kindly stop all topical and oral antibiotics. Consult a paediatrician in person so that the baby can be examined. Constipation, if any, would need to be managed.

With history of occult GI bleed and probably fistula-in-ano, a possibility of Inflammatory bowel disease (Crohn's disease) also may have to considered. At this point, though there is no emergent concern, it needs to be evaluated so that the underlying cause can be identified at the earliest.

Hope this helps, please feel free to discuss further.

Regards


Patient replied :

your opinion is highly appreciated but i didn't get to a result you said" points to the absence of any other chronic disease and could retrospectively, point to a diagnosis of Cow milk allergy " then you said "With history of occult GI bleed and probably fistula-in-ano, a possibility of Inflammatory bowel disease (Crohn's disease) also may have to considered " so i am confused about that part and also is it a fistula for sure or could it be a vesicle or a hemorrhoids and does it need surgery or what's the followed protocol? and what do you recommend? and a pediatric already examined him and advised to see a surgeon and why should i stop the antibiotics?


Expert:  Dr. Saptharishi L G replied 3 Days.

Dear parent,

I tried to convey that though cow milk allergy appears to be the most likely cause, it may be prudent to rule out an underlying inflammatory bowel disease (IBD) if the lesion of interest turns out to be a fistula. If the lesion is not a fistula, then IBD is very less likely.

Hemorrhoids in a young infant is generally seen with liver disease and portal hypertension. It is otherwise uncommon. Only close inspection and palpation can differentiate the two. Antibiotics will not help in either hemorrhoids or fistula.

Hope this helps. Please let me know if you further queries.

Regards


Dr. Saptharishi L G
Category: ICU/ Critical Care Specialist
Experience: 
Senior Residency: DM,  Pediatric Critical Care, PGIMER

Residency: MD, Pediatrics, Postgraduate Medical Education & Research (PGIMER), Chandigarh, 2013

Internship: JIPMER, 2009

Medical School: MBBS, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, 2008
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