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Late gastrointestinal bleeding and protein loss after distal small-bowel resection in infancy
R T Couper1, P R Durie, S E Stafford
1Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Children who had extensive small-bowel resection in infancy may develop recurrent gastrointestinal bleeding and anemia years later. This bleeding is linked to ulcers forming at the surgical connection site, a potential late complication.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Medicine
Background:
- Extensive small-bowel resection in infancy can lead to long-term complications.
- Recurrent gastrointestinal bleeding is a serious concern in these patients.
Purpose of the Study:
- To investigate the cause of recurrent gastrointestinal bleeding in children with a history of small-bowel resection.
- To identify potential late complications following infant small-bowel surgery.
Main Methods:
- Case series analysis of four children with recurrent gastrointestinal bleeding post-small-bowel resection.
- Diagnostic procedures included colonoscopy, laparotomy, and histology.
- Evaluation of treatment responses to medical and surgical interventions.
Main Results:
- Four children presented with iron deficiency anemia and gastrointestinal bleeding 4-12 years after resection for ileal atresia or gastroschisis.
- Ulcerative lesions were identified at surgical anastomoses in three patients.
- Medical therapies were ineffective; surgical resection provided temporary or no relief in two patients.
Conclusions:
- Recurrent gastrointestinal hemorrhage due to anastomotic ulceration is a significant late complication of infant small-bowel resection.
- The etiology of these anastomotic ulcers remains unknown.
- Further research is needed to understand and manage this complication.
Abstract:
Four children who underwent extensive small-bowel resection in infancy developed recurrent iron deficiency anemia due to gastrointestinal bleeding between 4 and 12 years later. The initial resections were required for multiple ileal atresia (n = 2) and gastroschisis (n = 2). Three patients have had melena and one had persistently guaiac-positive stools. Three patients had protein-losing enteropathy, and in one there was persistent hypoalbuminemia. Colonoscopy identified circumferential ulcerative lesions at the surgical anastomosis (n = 2) and at laparotomy another patient had well-defined linear ulcers close to the surgical anastomosis. Histology demonstrated focal ulceration with chronic inflammation, but did not show granulomata, crypt abscesses, or malignancy. Multiple imaging procedures and gastroduodenoscopy failed to identify an alternative bleeding source. Medical therapy including iron, antacids, sucralfate, H2 antagonists, and cholestyramine was ineffective. Two patients have undergone anastomotic resection. One experienced symptomatic recurrence 4 months after surgery. Repeat colonoscopy found ulceration at the new anastomosis with similar histology. The other patient remains asymptomatic 7 months postsurgery. Recurrent gastrointestinal hemorrhage due to anastomotic ulceration, of unknown etiology, appears to be a late complication of small-bowel resection in infancy.