Massive Upper Gastrointestinal Bleeding in an Adolescent Patient: A Case Report

Gastrointestinal (GI) bleeding in pediatric patients arises from diverse etiologies that vary across age groups. Although it is an uncommon cause of life-threatening hemorrhagic shock, prompt recognition and management are essential. Owing to the infrequency of hemorrhagic shock from GI bleeding in pediatrics, emergency physicians may lack familiarity with its diagnosis and management. Furthermore, multiple etiologies may coexist and may not be detected during the initial esophagogastroduodenoscopy, increasing the risk of premature diagnostic closure.

A 17-year-old boy with a history of plaque psoriasis was transported by ambulance to the pediatric emergency department of an urban level one trauma center, presenting with copious hematemesis and hemodynamic instability. Initial resuscitation in the emergency department included blood transfusion, followed by admission to the pediatric intensive care unit. The first endoscopic evaluation by pediatric gastroenterology identified duodenal erosion; however, the patient experienced further large-volume bleeding out of proportion to these findings. A subsequent endoscopy revealed a Dieulafoy lesion, which was treated successfully. The patient was ultimately discharged home and has remained stable during long-term follow-up. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although severe GI bleeding in pediatric patients is uncommon, emergency physicians must quickly identify hemorrhagic shock across all age groups and be familiar with the broad differential diagnoses that vary by age. Initial management must prioritize airway protection and hemodynamic stabilization as a bridge to definitive intervention. Clinicians should recognize the limitations of endoscopic gastroduodenoscopy and consider the potential for concurrent sources of bleeding that may necessitate additional intervention. © 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, artificial intelligence training, and similar technologies.