Stress Induced Gastric Ulcers: Presenting as Massive Rectal Bleeding in a Newborn

Severe gastrointestinal bleeding in newborn period is a serious but uncommon phenomenon that has a broad differential diagnosis. Primary duodenal ulcers are rare in children but stress induced ulceration in stomach occurs more often in neonatal period due to birth asphyxia, prolonged labour, cesarean deliveries, instrumentations, respiratory distress syndrome and sepsis. These present as acute onset of gastrointestinal bleeding commonly as altered gastric aspirate, hematemesis or malena. We report a case of a neonate with stress induced gastric bleeding following birth asphyxia who presented with massive gastrointestinal bleed manifesting as hematemesis and massive rectal bleeding. Resuscitation with multiple blood transfusion and parenteral use of ranitidine controlled the bleeding. Stress induced gastric ulcers should be suspected in a neonate presenting with massive gastrointestinal bleeding after difficult delivery and birth asphyxia.