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Massive gastrointestinal hemorrhage in children with posterior fossa tumors
Insights
Children with posterior fossa brain tumors can develop severe upper gastrointestinal bleeding. Prophylactic cimetidine and antacids are recommended to prevent this serious complication.
Area of Science:
- Pediatric Neurosurgery
- Gastroenterology
- Oncology
Background:
- Brain tumors are a significant concern in pediatric neurosurgery.
- Upper gastrointestinal hemorrhage is a rare but life-threatening complication.
- Posterior fossa tumors represent a specific subset of pediatric brain tumors.
Observation:
- Massive exsanguinating upper gastrointestinal hemorrhage occurred in 3 of 29 children with posterior fossa tumors within seven days of neurosurgery.
- The hemorrhage was associated with large posterior duodenal ulcers.
- No such bleeding events were observed in children with brain tumors in other locations.
Findings:
- Surgical intervention (oversewing ulcer, vagotomy-pyloroplasty) led to survival in all affected children.
- No recurrence of gastrointestinal bleeding was noted during follow-up (18-26 months).
Implications:
- Prophylactic use of cimetidine is advocated for children with posterior fossa tumors.
- Titration of gastric acidity with antacids is recommended.
- Early recognition and management are crucial for preventing mortality associated with this complication.
Abstract:
Over a 12-month period (September 1984 to September 1985), 64 children with newly diagnosed brain tumors were admitted to the Neurosurgical Service at The Children's Hospital of Philadelphia. Of these children, 29 had posterior fossa tumors. Of this population of children with posterior fossa tumors, three patients aged 4 months, 22 months, and 4 years old developed massive exsanguinating upper gastrointestinal hemorrhage within seven days of their primary neurosurgical procedure. In each instance, large posterior duodenal ulcers were encountered and were treated with oversewing of the duodenal ulcer and vagotomy-pyloroplasty. Follow-up currently ranges from 18 to 26 months. All three children have survived and none have had any gastrointestinal bleeding since then. Massive exsanguinating hemorrhage was not seen in children with brain tumors in locations other than the posterior fossa. In this population of patients, we advocate the use of prophylactic cimetidine and titration of gastric acidity with antacids.