X-RAY ENDOVASCULAR OCCLUSION IN ACUTE ARTERIAL BLEEDINGS FROM UPPER PARTS OF THE GASTROINTESTINAL TRACT IN CHILDREN


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Abstract

Acute arterial bleeding from the upper gastrointestinal tract (GIT) is a rare and life-threatening condition in children. The main method of instrumental examination in gastrointestinal hemorrhage (GIH) is fibro-esophagogastroduodenoscopy. If endoscopic diagnostics and hemostasis are ineffective, there are used other diagnostic and surgical methods of the treatment, which are associated with a high incidence of complications and high lethality. Methods of X-ray endovascular surgery, such as embolization of the arteries of the gastrointestinal tract, are life-saving and allow avoid severe traumatic surgical intervention. However, reports about the implementation of these methods in children are rare. We examined and treated 12 children with massive upper arterial GIHs. In 6 children it was managed to stop bleeding with the help of conservative and endoscopic methods of hemostasis. In 6 patients, these methods were ineffective, and they were underwent X-ray endovascular occlusion (XREO) of the blood vessels of the digestive tract. In 5 cases, embolization helped stop the bleeding after the first procedure, one child needed a repeat procedure for another source of the localization. In 6 cases, spirals were used as an embolization material, an autohemulation and microemboli were used in a one child patient. There were no complications associated with X-ray endovascular intervention. XREO is a minimally invasive and highly effective method of stopping the massive upper arterial GIH and can be performed even in children in extremely serious condition.

About the authors

I. A. Komissarov

St. Petersburg State Pediatric Medical University

Author for correspondence.
Email: noemail@neicon.ru
Russian Federation

N. A. Borisova

Children Municipal Hospital No 1

Email: noemail@neicon.ru
Russian Federation

M. I. Komissarov

St. Petersburg State Pediatric Medical University

Email: noemail@neicon.ru
Russian Federation

I. Yu. Aleshin

St. Petersburg State Pediatric Medical University

Email: ivanaleshinspb@gmail.com
Russian Federation

References

  1. Grimaldi-Bensouda L., Abenhaim L., Michaud L. etal. Clinical features and risk factors for upper gastrointestinal bleeding in children: A case-crossover study. Eur. J. Clin. Pharmacol. 2010; 66(8): 831-7.
  2. Alomari A.I., Fox V., Kamin D., Afzal A., Arnold R., Chaudry G. Embolization of a bleeding Dieulafoy lesion of the duodenum in a child. Case report and review of the literature. J. Pediatr. Surg. 2013; 48(1): 39-41.
  3. Numan F. Percutaneous Transcatheter Embolization of Gastrointestinal Bleeding in a Child with Polyarteritis Nodosa. Polish J. Radiol. 2014; 79: 465-6.
  4. Chao H.C., Kong M.S., Lin S.J., Huang J.L. Gastrointestinal manifestation and outcome of Henoch-Schonlein purpura in children. Chang Gung Med. J. 2000; 23(3): 135-41.
  5. Neubrand T., Mistry R., Lefort R. Massive Gastrointestinal Bleed as Presentation for Previously Undiagnosed Coarctation of Aorta. Pediatr. Emer. Care. 2016; 32(4): 240-2.
  6. Hirose R., Yamada T., Hayashida Y. Massive bloody stools in two neonates caused by cow’s milk allergy. Pediatr. Surg. Int. 2006; 22(11): 935-8.
  7. Gibbons T.E., Sayed K., Fuchs G.J. Massive pan-gastrointestinal bleeding following cocaine use. World J. Pediatr. 2009; 5(2): 149-51.
  8. Lee N.M., Yun S.W., Chae S.A., Yoo B.H., Cha S.J., Kwak B.K. Perforated duodenal ulcer presenting with massive hematochezia in a 30-month-old child. World J. Gastroenterol. 2009; 15(38): 4853-5.
  9. Cochran E.B., Phelps S.J., Tolley E.A., Stidham G.L. Prevalence of, and risk factors for, upper gastrointestinal tract bleeding in critically ill pediatric patients. Crit. Care Med. 1992; 20(11): 1519-23.
  10. Singhi S., Jain P., Jayashree M., Lal S. Approach to a child with upper gastrointestinal bleeding. Indian J. Pediatr. 2013; 80(4): 326-33.
  11. Lirio R.A. Management of Upper Gastrointestinal Bleeding in Children: Variceal and Nonvariceal. Gastrointest Endosc. Clin. N. Am. 2016; 26(1): 63-73.
  12. Owensby S., Taylor K., Wilkins T. Diagnosis and management of upper gastrointestinal bleeding in children. J. Am. Board Fam. Med. 2015; 28(1): 134-45.
  13. Ünal F., Çakır M., Baran M., Duygulu Ş., Aydoğdu S. Application of endoscopic hemoclips for nonvariceal upper gastrointestinal bleeding in children. Turk. J. Gastroenterol. 2014; 25(2): 147-51.
  14. Boyle J.T. Gastrointestinal Bleeding in Infants and Children. Pediatr. Rev. 2008; 29(2): 39-51.
  15. Kamath V., Gunabushanam V., Hanna A., Siegel D., Sung C., Dolgin S.E. Life-threatening postoperative hemorrhage from hepatic artery pseudoaneurysm successfully treated by transcatheter embolization in a 5-year-old. J. Pediatr. Surg. 2012; 47(3): 585-7.
  16. Wang Y.L., Cheng Y.S., Liu L.Z., He Z.H., Ding K.H. Emergency transcatheter arterial embolization for patients with acute massive duodenal ulcer hemorrhage. World J. Gastroenterol. 2012; 18(34): 4765-70.
  17. Борисова Н.А., Комиссаров И.А., Гольбиц С.В., Комиссаров М.И., Ильин А.С., Алешин И.Ю. и др. Эмболизация бронхиальных артерий при остром лёгочном кровотечении у детей. Вестник хирургии им И.И. Грекова. 2015; 174(2): 63-9

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