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Superior mesenteric vein occlusion causing severe gastrointestinal haemorrhage in two paediatric cases
Anna L Fox1, Matthew Jones, Andrew Healey
1Department of Paediatric Gastroenterology, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK.
Insights
Superior mesenteric vein thrombosis is rare in children and can cause severe gastrointestinal bleeding, especially after complex abdominal surgery. Early diagnosis is crucial for affected pediatric patients.
Area of Science:
- Pediatric Surgery
- Vascular Surgery
- Gastroenterology
Background:
- Superior mesenteric vein thrombosis (SMVT) is infrequently reported in pediatric cases.
- Gastrointestinal bleeding has not been previously associated with pediatric SMVT.
Purpose of the Study:
- To report two rare cases of SMVT in children presenting with severe gastrointestinal bleeding.
- To highlight the association between complex prior abdominal surgery and the development of SMVT in pediatric patients.
Main Methods:
- Case report analysis of two pediatric patients with severe gastrointestinal bleeding.
- Diagnostic confirmation using computed tomography (CT) angiography and endoscopy.
- Review of surgical histories, focusing on complex abdominal procedures and anastomoses.
Main Results:
- Both patients presented with significant upper and/or lower gastrointestinal bleeding.
- SMVT was diagnosed in both cases, attributed to extensive prior abdominal surgeries and anastomoses.
- CT angiography and endoscopy confirmed the thrombotic events and identified collateral vessel formation.
Conclusions:
- Pediatric SMVT can manifest as severe gastrointestinal bleeding.
- Complex abdominal surgery and resulting anastomoses are potential risk factors for SMVT in children.
- Clinicians should consider SMVT in pediatric patients with severe gastrointestinal bleeding, particularly those with a history of complex abdominal surgery.
Abstract:
Reports about superior mesenteric vein thrombosis in childhood are very rare and have not been associated with gastrointestinal bleeding. We describe two cases of severe bleeding from the upper and lower gastrointestinal tract in children who had undergone complex abdominal surgery at considerable time before. The first child had a tracheoesophageal fistula, corrected by division, gastrostomy insertion, and repair of duodenal rupture. The child presented with severe bleeding from the gastrostomy site and was diagnosed with a thrombosis of the proximal superior mesenteric vein. The second child had a gastroschisis and duodenal atresia, and required duodenoplasty, gastrostomy insertion, hemicolectomy, and adhesiolysis. The child presented with intermittent severe lower gastrointestinal bleeding, resulting from collateral vessels at location of the surgical connections. He was diagnosed with a thrombosis of the superior mesenteric vein. In both children, the extensive previous surgery and anastomosis were considered the cause of the mesenteric thrombosis. CT angiography confirmed the diagnosis in both cases, in addition to characteristic findings on endoscopy. Paediatricians should suspect this condition in children with severe gastrointestinal bleeding, particularly in children with previous, complex abdominal surgery.
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