Acute abdomen Inpatient surgical referral
Intermittent blood in stool  Gastroenterology referral for consideration of a Meckel’s scan, or colonoscopy to assess for rectal ulcer, polyps or colitis
Bloody diarrhoea Consider infectious colitis vs IBD, paediatric referral as inpatient or outpatient, depending on clinical assessment

Learning bite

The two instances of LGIB that present most commonly to the emergency department are constipation resulting in anal fissures or haemorrhoids, and infectious gastroenteritis.

If an anal fissure or haemorrhoids are found it is likely there is an underlying diagnosis of constipation. Take a history of stool frequency and type of stool passed and consider starting a laxative. In the case of a child with infectious gastroenteritis, the need for admission will be determined by hydration status, and whether NG or IV fluids are indicated.