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Gastrointestinal bleeding due to pseudoaneurysms in children

Jayendra Seetharaman1, Rajanikant R Yadav2, Anshu Srivastava3

  • 1Department of Pediatric Gastroenterology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Raebareily Road, Lucknow, 226014, Uttar Pradesh, India.

European Journal of Pediatrics
|July 15, 2021
PubMed

Insights

Pediatric visceral artery pseudoaneurysms, often caused by liver abscess, trauma, or pancreatitis, present with gastrointestinal bleeding and are best diagnosed with computed tomography angiography. Radiological embolization is a safe and highly successful treatment for these cases in children.

Area of Science:

  • Pediatric Radiology
  • Interventional Radiology
  • Gastroenterology

Background:

  • Visceral artery pseudoaneurysm (PSA) is a rare cause of gastrointestinal bleeding.
  • Radiological embolization is the standard treatment for adults, but pediatric data is limited.

Purpose of the Study:

  • To analyze the causes, clinical presentation, and outcomes of radiological intervention for pseudoaneurysms in pediatric celiac artery (CA) or superior mesenteric artery (SMA) branches.

Main Methods:

  • Retrospective review of electronic records for children with PSA of CA or SMA branches.
  • Data collected included clinical/laboratory profiles, radiological interventions, and outcomes.
  • Computed tomography angiography (CTA) was used for diagnosis.

Main Results:

  • Eleven children (7-17 years) with PSA were studied.
  • Common etiologies included liver abscess (4), abdominal trauma (3), and pancreatitis (3).
  • CTA identified all PSAs, while Doppler ultrasound was less sensitive.
  • Radiological embolization (coil, glue) was performed in 9 patients with 100% success and no complications.
  • Follow-up showed 9 intervened patients were asymptomatic.

Conclusions:

  • Liver abscess, trauma, and pancreatitis are key causes of pediatric CA and SMA branch PSAs.
  • CTA is highly sensitive for diagnosing these pediatric pseudoaneurysms.
  • Minimally invasive radiological angio-embolization is a safe and effective treatment for children.

Keywords:
ChildrenHemobiliaHepatic arteryPseudoaneurysmRadiological embolization

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