Abstract
BackgroundMassive gastrointestinal bleeding in children is uncommon. Dieulafoy lesion is an uncommon disease which may lead to massive and repeated upper gastrointestinal hemorrhage. We report two cases of gastric Dieulafoy lesion successfully treated with either band ligation or endoscopic hemoclipping.Case presentationFirst case report: A previously healthy 18-month-old female infant with E. coli sepsis, pneumonia and respiratory failure with bilateral pneumothorax requiring chest drainage. Over a few days, the patient presented hematemesis and melena with progressively worsening anemia. The esophagogastroduodenoscopy revealed an arterial vessel with eroded apex located between the body and the fundus of the stomach. Two elastic bands were applied which resulted in resolution of hematemesis and melena and improvement of the anemia.Second case report: A 8-year-old male was admitted to our department with sudden massive hematemesis and melena. Clinical examination revealed anemia (hemoglobin, 6.8 g/dl). Esophagogastroduodenoscopy revealed a mucosal erosion with visible vessel located along the small curvature, close to the antrum. Three hemostatic clips were placed on the Dieulafoy lesion and hemostasis was obtained.Conclusionswe showed that, similar to gastric DL in adult patients,, gastric DL in pediatric patients can be successfully treated with endoscopic therapy, and both hemoclipping and band ligation are suitable techniques.
Highlights
Massive gastrointestinal bleeding in children is uncommon
Dieulafoy lesion (DL) is an extremely rare cause of massive and repeated upper gastrointestinal (GI) bleeding in children, which may lead to consequences ranging from anemia to hypovolemic shock [1]
DL is typically located in the fundus and in the small curvature of the stomach and only rarely in the distal part, with 80 to 95% of lesions occurring within 6 cm from the gastroesophageal junction
Summary
Dieulafoy lesion (DL) is an extremely rare cause of massive and repeated upper gastrointestinal (GI) bleeding in children, which may lead to consequences ranging from anemia to hypovolemic shock [1]. Bleeding starts from the small mucosal vessels and is followed by erosion of the vein. The artery tends to rupture soon afterward, resulting in massive bleeding [2]. DL is typically located in the fundus and in the small curvature of the stomach and only rarely in the distal part, with 80 to 95% of lesions occurring within 6 cm from the gastroesophageal junction. Massive upper GI bleeding occurs with gastric and duodenal lesions. Small intestinal lesions lead to upper GI bleeding and hematochezia, while colonic lesions can cause fresh blood per rectum [6]. Two cases of gastric DL successfully treated with two different endoscopic approaches are reported
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