UPPER GASTROINTESTINAL BLEEDING IN CHILDREN
Category: Pediatric Surgery
Abstract : In the initial evaluation a history should be obtained for bleeding disorders, skin lesions, and aspirin or steroid ingestion. The physical exam for presence of enlarged liver, spleen, masses, ascites, or evidence of trauma or portal hypertension. Labs such as bleeding studies and endoscopy, contrast studies if bleeding stops. Common causes of upper gastrointestinal bleeding in children are: 1. Es
In the initial evaluation a history should be obtained for bleeding disorders, skin lesions, and aspirin or steroid ingestion. The physical exam for presence of enlarged liver, spleen, masses, ascites, or evidence of trauma or portal hypertension. Labs such as bleeding studies and endoscopy, contrast studies if bleeding stops. Common causes of upper gastrointestinal bleeding in children are: 1.
Esophagus (a) Varices- usually presents as severe upper gastrointestinal bleeding in a 2-3 year old who has previously been healthy except for problems in the neonatal period. This is a result of extrahepatic portal obstruction (portal vein thrombosis most commonly), with resulting varices. The bleeding may occur after a period of upper respiratory symptoms and coughing. Management is initially conservative with sedation and bedrest; surgery ir rarely needed. (b) Esophagitis- this is a result of persistent gastroesophageal reflux leading to inflammation and generally slow, chronic loss of blood from the weeping mucosa. Treatment consist of antacids, frequent small feeds, occasionally medications and if not rapidly improved, then surgical intervention with a fundoplication of the stomach. © Mallory-Weiss- this is a tear of the distal esophagus and/or gastroesophageal junction secondary to severe regurgitation. This was thought to be uncommon in children because it was not looked for by endoscopy. It probably occurs more often than previously thought. Treatment initially is conservative and, if persistent, oversewing of the tear through an incision in the stomach will be successful. (d) Duplication cysts- Rare cause, they are seen on the mesenteric side of the intestine anywhere from the esophagus to the anus. They bleed when there is ectopic gastric mucosa present. Total excision is curative. 2. Stomach (a) Gastric Erosions- managed medically in most cases. (b) Ulcer- treated medically unless there is persistent hemorrhage, obstruction or perforation. © Hematoma- usually secondary to trauma or bleeding disorders. 3. Duodenum (a) Duodenitis- associated to acid peptic disease. (b) Hematobilia- secondary to blunt or penetrating abdominal injury. Occasionally requires surgical intervention with local repair or ligation of hepatic vessels.
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