Non-variceal gastrointestinal bleed in children: surgical experience with emphasis on management challenges.
Pediatr Surg Int
; 35(11): 1197-1210, 2019 Nov.
Article
em En
| MEDLINE
| ID: mdl-31300851
ABSTRACT
PURPOSE:
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.METHODS:
Patients aged ≤ 18 years treated surgically for NVGIB were analysed.RESULTS:
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.CONCLUSIONS:
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Hemorragia Gastrointestinal
Limite:
Adolescent
/
Child
/
Child, preschool
/
Female
/
Humans
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Infant
/
Male
Idioma:
En
Revista:
Pediatr Surg Int
Assunto da revista:
PEDIATRIA
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Índia