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- Title
Non-variceal gastrointestinal bleed in children: surgical experience with emphasis on management challenges.
- Authors
Lal, Richa; Yachha, Surender K.; Mandelia, Ankur; Dhoat, Navdeep; Prakash, Divya; Sen Sarma, Moinak; Yadav, Rajanikant R.; Srivastava, Anshu; Poddar, Ujjal; Behari, Anu
- Abstract
<bold>Purpose: </bold>This exclusively surgical series on pediatric non-variceal gastrointestinal bleed (NVGIB) defines three levels of bleed site and describes etiology, bleed severity, diagnostic algorithm, and surgical management for each bleed site. Management challenges are detailed.<bold>Methods: </bold>Patients aged ≤ 18 years treated surgically for NVGIB were analysed.<bold>Results: </bold>Bleed site (n = 87) was classified as: upper gastrointestinal bleed (UGIB; n = 11); small bowel bleed (SBB: n = 52); and lower GIB (n = 24). Four etiology-based groups were identified: lesions with ectopic gastric mucosa (EGM; n = 33), tumours (n = 23), ulcers (n = 21), and vascular pathology (n = 8). Bleed severity spectrum was: acute severe bleed (n = 12); subacute overt bleed (n = 59); and occult GIB (n = 16). Preoperative diagnosis was obtained in all UGIB and LGIB lesions. Eighty-two percent of surgical SB lesions were diagnosed preoperatively on Tc99m pertechnetate scan, computed tomography enterography-angiography, and capsule endoscopy; remaining 18% were diagnosed at laparotomy with intra-operative enteroscopy (IOE). Surgical management was tailored to bleed site, severity, and etiology. Indications of IOE and approach to management challenges are detailed.<bold>Conclusions: </bold>The commonest site-specific bleed etiologies were duodenal ulcers for UGIB, EGM lesions for SBB, and tumours for LGIB. SBB presented diagnostic challenge. Diagnostic algorithm was tailored to bleed site, age-specific etiology, bleed severity, and associated abdominal/systemic symptoms. Management challenges were acute severe bleed, occult GIB, SBB, obscure GIB, and rare etiologies. IOE has a useful role in SBB management.
- Subjects
HEMOPHILIACS; GASTRIC mucosa; MECKEL diverticulum; CAPSULE endoscopy; DUODENAL ulcers; GASTROINTESTINAL hemorrhage; ENTEROSCOPY
- Publication
Pediatric Surgery International, 2019, Vol 35, Issue 11, p1197
- ISSN
0179-0358
- Publication type
journal article
- DOI
10.1007/s00383-019-04522-0