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[Recurrent hemorrhage from a duodenal ulcer in a 5-year-old healthy boy. A case report]
1Klinik und Poliklinik für Kinderchirurgie, Universitätsklinikum Carl Gustav Carus, Technischen Universität Dresden.
Insights
Peptic ulcers are rare in children, but this case highlights a huge duodenal ulcer in a 5-year-old boy. Fibrin sealant injection successfully stopped bleeding, suggesting a potential treatment for pediatric peptic ulcer disease.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Surgery
Background:
- Peptic ulcer disease is uncommon in infants and children.
- Gastrointestinal bleeding in children can present diagnostic challenges.
Observation:
- A 5-year-old boy presented with recurrent bloody stools, initially misdiagnosed due to the appearance of bleeding.
- A large duodenal ulcer was identified via delayed gastroscopy.
- The patient had no other known diseases or preceding symptoms.
Findings:
- Bleeding from the duodenal ulcer was definitively controlled with a single injection of fibrin sealant.
- Helicobacter pylori infection and hormone-producing tumors were ruled out.
- A stressful psycho-social situation was noted in the child's environment.
Implications:
- Pediatric peptic ulcer disease should be considered in cases of unexplained abdominal pain or gastrointestinal bleeding in children.
- Fibrin sealant injection therapy shows promise for managing pediatric peptic ulcers.
- The role of psycho-social stress in pediatric peptic ulcer pathogenesis warrants further investigation.
Abstract:
Peptic ulcers in infants are rare. We report a 5-year-old boy who was admitted with recurrent bleeding from a huge duodenal ulcer. There were no concomitant disease and no preceding symptoms discovered. The only clinical symptom was bloody stool of light red color what led to diagnostic problems. Upper gastrointestinal bleeding was not considered initially. Short transit time through the gut may suggest a bleeding source within the lower intestine. Gastroscopy was performed delayed. Injection therapy of the ulcer once using fibrin sealant was followed by definite cessation of bleeding. Helicobacter pylori was not found. Hormone producing tumors could be excluded. There was a psycho-social situation of stress recognizable for the infant. The pathogenic mechanism of peptic ulceration due to psycho-social stress is unknown and somewhat doubtful at all. Peptic ulcer disease in infants and children should more often be considered when dealing with diffuse abdominal pain or with gastrointestinal bleeding.