Stress Duodenal Ulcer Presenting as Hematochezia in a Neonate

Abstract

Background Primary duodenal ulcers are very rare in children under 10 years of age but stress induced ulceration in the stomach occurs more often in the neonatal period due to birth asphyxia, prolonged labour, caesarean deliveries, instrumentations, respiratory distress syndrome and sepsis. These present as acute onset of gastrointestinal bleed commonly as altered gastric aspirate, hematemesis or melena. Aim Management of a neonate with stress ulcer presenting as hematochezia Methods Upper Gastrointestinal Endoscopy (UGIE) done which revealed a large ,clean based ulcer in the antero-superior wall of the first part of the duodenum. Child was treated with lansoprazole. Result The use of lansoprazole resulted in the complete healing of the ulcer after 7 days of the therapy. Conclusion Stress peptic ulcers should be suspected in a neonate presenting with massive gastrointestinal bleeding after difficult delivery and birth asphyxia. UGIE is mandatory to rule out lesions bleeding from stomach or duodenum or both.