Abstract
Gastrointestinal hemorrhage in infants and children is a catastrophic event but is not associated with significant mortality except in those with a severe primary illness. Upper gastrointestinal bleeding in infants and young children is most often associated with stress ulcers or erosions, but in older children it may also be caused by duodenal ulcer, esophagitis, and esophageal varices. Lower gastrointestinal bleeding may be caused by a variety of lesions among which are infectious colitides, Meckel's diverticulum, bleeding disorders, gastrointestinal allergy, and inflammatory bowel disease. Techniques of diagnosis and management are discussed.
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- Alavi A., Ring E. J. Localization of gastrointestinal bleeding: superiority of 99mTc sulfur colloid compared with angiography. AJR Am J Roentgenol. 1981 Oct;137(4):741–748. doi: 10.2214/ajr.137.4.741. [DOI] [PubMed] [Google Scholar]
- Atkinson J. B., Woolley M. M. Treatment of esophageal varices by sclerotherapy in children. Am J Surg. 1983 Jul;146(1):103–106. doi: 10.1016/0002-9610(83)90268-4. [DOI] [PubMed] [Google Scholar]
- BERKOWITZ D., WAGNER B. M., URICCHIO J. F. Acute peptic ulceration following cardiac surgery. Ann Intern Med. 1957 Jun;46(6):1015–1023. doi: 10.7326/0003-4819-46-6-1015. [DOI] [PubMed] [Google Scholar]
- Bahna S. L., Heiner D. C. Cow's milk allergy: pathogenesis, manifestations, diagnosis and management. Adv Pediatr. 1978;25:1–37. [PubMed] [Google Scholar]
- Bradley E. L., 3rd, Goldman M. L. Gastric infarction after therapeutic embolization. Surgery. 1976 Apr;79(4):421–424. [PubMed] [Google Scholar]
- Chandrakamol B. Gastric heterotopia in the ileum causing hemorrhage. J Pediatr Surg. 1978 Oct;13(6):484–487. doi: 10.1016/s0022-3468(78)80310-8. [DOI] [PubMed] [Google Scholar]
- Cheung L. Y., Chang N. The role of gastric mucosal blood flow and H+ back-diffusion in the pathogenesis of acute gastric erosions. J Surg Res. 1977 Apr;22(4):357–361. doi: 10.1016/0022-4804(77)90157-3. [DOI] [PubMed] [Google Scholar]
- Collins R. E. Some problems of gastrointestinal bleeding in chiddren. Arch Dis Child. 1971 Feb;46(245):110–112. doi: 10.1136/adc.46.245.110. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cooperman M., Martin E. W., Jr, Evans W. E., Carey L. C. Use of Doppler ultrasound in intraoperative localization of intestinal arteriovenous malformation. Ann Surg. 1979 Jul;190(1):24–26. doi: 10.1097/00000658-197907000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cox K., Ament M. E. Upper gastrointestinal bleeding in children and adolescents. Pediatrics. 1979 Mar;63(3):408–413. [PubMed] [Google Scholar]
- Duane W. C., Wiegand D. M. Mechanism by which bile salt disrupts the gastric mucosal barrier in the dog. J Clin Invest. 1980 Nov;66(5):1044–1049. doi: 10.1172/JCI109932. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Eisenberg H., Steer M. L. The nonoperative treatment of massive pyloroduodenal hemorrhage by retracted autologous clot embolization. Surgery. 1976 Apr;79(4):414–420. [PubMed] [Google Scholar]
- Fowler D. L., Fortin D., Wood W. G., Pinkerton J. A., Jr, Koontz P. G., Jr Intestinal vascular malformations. Surgery. 1979 Sep;86(3):377–385. [PubMed] [Google Scholar]
- Franklin R., McSwain B. Juvenile polyps of the colon and rectum. Ann Surg. 1972 Jun;175(6):887–891. doi: 10.1097/00000658-197206010-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Giger M., Häcki W. H., Bühler H., Hammer B., De Peyer R. Seltene Blutungsquellen im Duodenum, wie Morbus von Willebrand, Morbus Osler, Brunnerom und Leiomyom. Schweiz Rundsch Med Prax. 1982 Mar 2;71(9):360–364. [PubMed] [Google Scholar]
- Gryboski J. D., Kocoshis S. A., Seashore J. H., Gudjonsson B., Drennan J. C. "Body-brace" oesophagitis, a complication of kyphoscoliosis therapy. Lancet. 1978 Aug 26;2(8087):449–451. doi: 10.1016/s0140-6736(78)91446-0. [DOI] [PubMed] [Google Scholar]
- Gryboski J. D., Spiro H. M. Prognosis in children with Crohn's disease. Gastroenterology. 1978 May;74(5 Pt 1):807–817. [PubMed] [Google Scholar]
- Gryboski J. D. The value of upper gastrointestinal endoscopy in children. Dig Dis Sci. 1981 Jul;26(7 Suppl):17S–21S. doi: 10.1007/BF01300801. [DOI] [PubMed] [Google Scholar]
- Gryboski J., Hillemeier C. Inflammatory bowel disease in children. Med Clin North Am. 1980 Nov;64(6):1185–1202. doi: 10.1016/s0025-7125(16)31563-2. [DOI] [PubMed] [Google Scholar]
- Hunter G. C., Malone J. M., Moore W. S., Misiorowski R. L., Chvapil M. Vascular manifestations in patients with Ehlers-Danlos syndrome. Arch Surg. 1982 Apr;117(4):495–498. doi: 10.1001/archsurg.1982.01380280075015. [DOI] [PubMed] [Google Scholar]
- Iglehart J. D., Ferguson B. J., Shingleton W. W., Sabiston D. C., Jr, Silva J. S., Fetter B. F., McCarty K. S., Jr An ultrastructural analysis of breast carcinoma presenting as isolated axillary adenopathy. Ann Surg. 1982 Jul;196(1):8–13. doi: 10.1097/00000658-198207000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Janik J. S., Culham J. A., Filler R. M., Shandling B., Stringel G. Balloon embolization of a bleeding gastroduodenal artery in a 1-year-old child. Pediatrics. 1981 May;67(5):671–674. [PubMed] [Google Scholar]
- Jona J. Z., Belin R. P., Burke J. A. Lymphoid hyperplasia of the bowel and its surgical significance in children. J Pediatr Surg. 1976 Dec;11(6):997–1006. doi: 10.1016/s0022-3468(76)80080-2. [DOI] [PubMed] [Google Scholar]
- Karmali M. A., Fleming P. C. Campylobacter enteritis in children. J Pediatr. 1979 Apr;94(4):527–533. doi: 10.1016/s0022-3476(79)80004-9. [DOI] [PubMed] [Google Scholar]
- Lam S. K., Ong G. B. Duodenal ulcers: early and late onset. Gut. 1976 Mar;17(3):169–179. doi: 10.1136/gut.17.3.169. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Liebman W. M. Gastric acid secretion and serum gastrin levels in children with recurrent abdominal pain, gastric and duodenal ulcers. J Clin Gastroenterol. 1980 Sep;2(3):243–246. doi: 10.1097/00004836-198009000-00007. [DOI] [PubMed] [Google Scholar]
- Lindenauer S. M., Tank E. S. Surgical aspects of Henoch-Schönlein's purpura. Surgery. 1966 Jun;59(6):982–987. [PubMed] [Google Scholar]
- Luk G. D., Bynum T. E., Hendrix T. R. Gastric aspiration in localization of gastrointestinal hemorrhage. JAMA. 1979 Feb 9;241(6):576–578. [PubMed] [Google Scholar]
- Markisz J. A., Front D., Royal H. D., Sacks B., Parker J. A., Kolodny G. M. An evaluation of 99mTc-labeled red blood cell scintigraphy for the detection and localization of gastrointestinal bleeding sites. Gastroenterology. 1982 Aug;83(2):394–398. [PubMed] [Google Scholar]
- Mayer I. E., Hersh T. Endoscopic diagnosis of hereditary hemorrhagic telangiectasia. J Clin Gastroenterol. 1981 Dec;3(4):361–365. doi: 10.1097/00004836-198112000-00011. [DOI] [PubMed] [Google Scholar]
- McCauley R. G., Leonidas J. C., Bartoshesky L. E. Blue rubber bleb nevus syndrome. Radiology. 1979 Nov;133(2):375–377. doi: 10.1148/133.2.375. [DOI] [PubMed] [Google Scholar]
- Mestre J. R., Andres J. M. Hereditary hemorrhagic telangiectasia causing hematemesis in an infant. J Pediatr. 1982 Oct;101(4):577–579. doi: 10.1016/s0022-3476(82)80709-9. [DOI] [PubMed] [Google Scholar]
- Mohammed R., Hearns J. B., Crean G. P. Gastric acid secretion in children with duodenal ulceration. Scand J Gastroenterol. 1982 Mar;17(2):289–292. doi: 10.3109/00365528209182055. [DOI] [PubMed] [Google Scholar]
- Moody F. G., Cheung L. Y., Simons M. A., Zalewsky C. Stress and the acute gastric mucosal lesion. Am J Dig Dis. 1976 Feb;21(2):148–154. doi: 10.1007/BF01072062. [DOI] [PubMed] [Google Scholar]
- NUSBAUM M., BAUM S., BLAKEMORE W. S., FINKELSTEIN A. K. DEMONSTRATION OF INTRA-ABDOMINAL BLEEDING BY SELECTIVE ARTERIOGRAPHY. VISUALIZATION OF CELIAC AND SUPERIOR MESENTERIC ARTERIES. JAMA. 1965 Feb 1;191:389–390. doi: 10.1001/jama.1965.03080050035009. [DOI] [PubMed] [Google Scholar]
- Naylor E. W., Lebenthal E. Gardner's syndrome. Recent developments in research and management. Dig Dis Sci. 1980 Dec;25(12):945–959. doi: 10.1007/BF01308046. [DOI] [PubMed] [Google Scholar]
- Nord K. S., Rossi T. M., Lebenthal E. Peptic ulcer in children: the predominance of gastric ulcers. Am J Gastroenterol. 1981 Feb;75(2):153–157. [PubMed] [Google Scholar]
- Parikh N., Sebring E. S., Polesky H. F. Evaluation of bloody gastric fluid from newborn infants. J Pediatr. 1979 Jun;94(6):967–969. doi: 10.1016/s0022-3476(79)80237-1. [DOI] [PubMed] [Google Scholar]
- Raffensperger J. G., Luck S. R. Gastrointestinal bleeding in children. Surg Clin North Am. 1976 Apr;56(2):413–424. doi: 10.1016/s0039-6109(16)40886-8. [DOI] [PubMed] [Google Scholar]
- Riddlesberger M. M., Jr, Lebenthal E. Nodular colonic mucosa of childhood: normal or pathologic? Gastroenterology. 1980 Aug;79(2):265–270. [PubMed] [Google Scholar]
- Ritchie W. P., Jr Acute gastric mucosal damage induced by bile salts, acid, and ischemia. Gastroenterology. 1975 Apr;68(4 Pt 1):699–707. [PubMed] [Google Scholar]
- Robb J. D., Thomas P. S., Orszulok J., Odling-Smee G. W. Duodenal ulcer in children. Arch Dis Child. 1972 Oct;47(255):688–696. doi: 10.1136/adc.47.255.688. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rutherford R. B., Akers D. R. Meckel's diverticulum: a review of 148 pediatric patients, with special reference to the pattern of bleeding and to mesodiverticular vascular bands. Surgery. 1966 Apr;59(4):618–626. [PubMed] [Google Scholar]
- SPENCER R. GASTROINTESTINAL HEMORRHAGE IN INFANCY AND CHILDHOOD: 476 CASES. Surgery. 1964 May;55:718–734. [PubMed] [Google Scholar]
- STANLEY-BROWN E. G., STEVENSON S. S. MASSIVE GASTROINTESTINAL HEMORRHAGE IN THE NEWBORN INFANT. Pediatrics. 1965 Mar;35:482–483. [PubMed] [Google Scholar]
- Sherman N. J., Clatworthy H. W., Jr Gastrointestinal bleeding in neonates: a study of 94 cases. Surgery. 1967 Oct;62(4):614–619. [PubMed] [Google Scholar]
- Simonian S. J., Stratoudakis A., Lawerence M., Mungas J., Blackstone M. O. Nonsurgical control of massive acute gastric mucosal hemorrhage with antacid neutralization of gastric content. Surg Clin North Am. 1976 Feb;56(1):21–27. doi: 10.1016/s0039-6109(16)40832-7. [DOI] [PubMed] [Google Scholar]
- Soltero M. J., Bill A. H. The natural history of Meckel's Diverticulum and its relation to incidental removal. A study of 202 cases of diseased Meckel's Diverticulum found in King County, Washington, over a fifteen year period. Am J Surg. 1976 Aug;132(2):168–173. doi: 10.1016/0002-9610(76)90043-x. [DOI] [PubMed] [Google Scholar]
- Stuart M. J., Gross S. J., Elrad H., Graeber J. E. Effects of acetylsalicylic-acid ingestion on maternal and neonatal hemostasis. N Engl J Med. 1982 Oct 7;307(15):909–912. doi: 10.1056/NEJM198210073071502. [DOI] [PubMed] [Google Scholar]
- Stuart M. J., Spitzer R. E., Coppe D. Abnormal platelet and vascular prostaglandin synthesis in an infant with hemolytic uremic syndrome. Pediatrics. 1983 Jan;71(1):120–124. [PubMed] [Google Scholar]
- Sunaryo F. P., Boyle J. T., Ziegler M. M., Heyman S. Primary nonspecific ileal ulceration as a cause of massive rectal bleeding. Pediatrics. 1981 Aug;68(2):247–250. [PubMed] [Google Scholar]
- Tauscher J. W., Bryant D. R., Gruenther R. C. False positive scan for Meckel diverticulum. J Pediatr. 1978 Jun;92(6):1022–1023. doi: 10.1016/s0022-3476(78)80393-x. [DOI] [PubMed] [Google Scholar]
- Tedesco F. J., Goldstein P. D., Gleason W. A., Keating J. P. Upper gastrointestinal endoscopy in the pediatric patient. Gastroenterology. 1976 Apr;70(4):492–494. [PubMed] [Google Scholar]
- Tochen M. L., Campbell J. R. Colitis in children with the hemolytic-uremic syndrome. J Pediatr Surg. 1977 Apr;12(2):213–219. doi: 10.1016/s0022-3468(77)80010-9. [DOI] [PubMed] [Google Scholar]
- Tyson K. R., Schuster S. R., Shwachman H. Portal hypertension in cystic fibrosis. J Pediatr Surg. 1968 Apr;3(2):271–277. doi: 10.1016/0022-3468(68)90011-0. [DOI] [PubMed] [Google Scholar]
- Walker V., Taylor W. H. Secretion of pepsins and hydrogen ions in the stomach of children undergoing cardiac surgery. Pediatr Res. 1980 May;14(5):709–714. doi: 10.1203/00006450-198005000-00002. [DOI] [PubMed] [Google Scholar]
- Whitington P. F., Friedman A. L., Chesney R. W. Gastrointestinal disease in the hemolytic-uremic syndrome. Gastroenterology. 1979 Apr;76(4):728–733. [PubMed] [Google Scholar]
- Wilson J. F., Lahey M. E., Heiner D. C. Studies on iron metabolism. V. Further observations on cow's milk-induced gastrointestinal bleeding in infants with iron-deficiency anemia. J Pediatr. 1974 Mar;84(3):335–344. doi: 10.1016/s0022-3476(74)80713-4. [DOI] [PubMed] [Google Scholar]