Esophageal varices presenting as lower GI bleed in an infant: a rare presentation

GI Bleeding is a common problem encountered in the emergency department and in the primary care settings. Lower GI Bleeding is relatively rare as compared to upper GI bleeding. Common causes of lower GI Bleeding are Polyp (32.5%), chronic nonspecific colitis (20.7%), lymphoid nodular hyperplasia (20%), Proctitis (18.2%), Solitary rectal ulcer (10%), Inflammatory bowel disease (6.5%).Among the various causes of lower GI Bleeding, esophageal varices is a rare cause. One such case presented to us with lower GI bleeding, on further evaluation was found to having esophageal varices due to portal hypertension. Child improved after conservative and definitive management.

Stromal Tumor of the Jejunum Complicated by Hemorrhagic Shock-A Case Report.

Stromal tumors of the small bowel, commonly known as GIST (Gastrointestinal Stromal Tumors) are mesenchymal tumors of uncertain prognosis. They develop in the wall of the digestive tract. They are usually asymptomatic, incidentally discovered during endoscopy or during surgery. Identifying gastrointestinal stromal tumor is facilitated by a relatively specific marker, c-kit. Diagnosis is confirmed by histological examination of the surgical specimen. They pose two problems first is to confirm the diagnosis and second problem is to assess their evolutionary potential and customize the therapeutic management. We report the case of a patient aged 34 years with no history of prior illness. He was admitted a year ago in the emergency room in a state of hemorrhagic shock due to lower gastro intestinal (GI) bleeding for three days. The patient underwent conservative therapy with I.V fluids and blood transfusions. An endoscopic assessment consisting of upper and lower GI(UGIE and colonoscopy) was done but that did not reveal any abnormalities. Surgical exploration revealed a tumor 1 meter distal to the ligament of Treitz. Rest of the exploration was unremarkable. The tumor along with small bowel was resected and end anastomosis was performed. The postoperative course was uneventful. Histological study of the surgical specimen confirmed that this was a stromal tumor with low potential of malignancy. The staging did not reveal any secondary lesions. Stromal tum often asymptomatic, lower GI bleeding is an exceptional way of presentation. Complete resection of the tumor is the treatment of choice. The recent development of targeted therapies and molecular biology is a new hope in the treatment of these tumo review the diagnostic and therapeutic aspects of this disease, and explain that hemorrhagic shock can be due to jejunal stromal tumor.

Diagnostic Approach of Lower GI Bleeding in Children / 대한소아소화기영양학회지

Lower GI bleeding is one of the common and difficult problems in the practice of general pediatrics. Causes of bleeding are various but somewhat age-specific in children. A specific diagnosis can usually be made with a accurate history taking, physical examination, included rectal exam, simple laboratory investigations, and appropriate diagnostic studies. Further evaluations can be unnecessary if the patient have a small amount of bleeding and stable vital sign. But precise investigation included abdominal sonography, endoscopy, Meckel's scan, and bleeding scan, are needed on a case by case. Treatment should be directed at the underlying cause. In most children, bleeding ceases spontaneously, and only supportive therapy is necessary. If there is evidence of hypovolemia, the patient must be hemodynamically stabilized, active bleeding stopped, and recurrent bleeding prevented. This review included age-specific cases such as Allergic proctocolitis, Meckel's diverticulum, Juvenile polyps, Henoch-scholein purpura, and Crohn disease, of lower gastrointestinal bleeding in children. Also it will assist the physician in determining appropriate assessment and treatment for children with lower GI bleeding through the usual cases.