Obscure gastrointestinal bleeding in pediatrics.

Abstract

Abstract

Gastrointestinal bleeding varies in severity and frequency depending on the age. It can present as hematemesis, melena, or hematochezia.

There is also a gastrointestinal bleeding of obscure origin that is related to polyps, vascular malformations, Crohn's disease, and Meckel's diverticulum. It is not usual to find reports of digestive bleeding of obscure origin in children and in practice its evaluation could delay treatment due to the lack of standardized guidelines. 

We present the case of a 4-year-old girl, with no past medical history, who was referred for having melena and vomits of food content of 24 hours of evolution. On physical examination, she presented generalized paleness, normal vital signs, without hemodynamic compromise. Exams showed moderate anemia.

The stool study reported positive blood. Upper gastrointestinal endoscopy and colonoscopy were performed without finding evidence of bleeding. After the procedure, the melena persisted, so it was classified as gastrointestinal bleeding of obscure origin and an evaluation was requested by pediatric surgery with the suspicion of Meckel's diverticulum. Technetium 99-m scintigraphy was normal.

She continued to present melena and a capsule endoscopy was considered, but due to technical and economic limitations, they continued with an exploratory laparoscopy that found a Meckel´s diverticulum whose histopathological report showed intestinal and gastric epithelium. After the procedure, melenas stopped. After 6 days, she was discharged without complications. A low threshold is required to proceed with laparotomy in the case of a negative endoscopy; but planning and multidisciplinary discussion are essential to individualize each case.