A Case of Duodenal Bleeding in a One-Year-Old Child in the Early Postoperative Period after the Surgical Correction of Congenital Heart Defect
Background. Gastrointestinal bleeding in children is a rather rare pathology. This especially applies to the bleeding in the postoperative period after surgical interventions that are not related to the pathology of the gastrointestinal tract. As a result, clinicians are not alert to the occurrence of such complications, which, in turn, can lead to late diagnosis and delay in the treatment of bleeding.
Case report. We present a clinical case of duodenal bleeding in a one-year-old child in the early postoperative period after radical repair of ventricular septal defect by patching the defect. Laboratory parameters on admission: hemoglobin 120 g/L, red blood cells 4.37×1012/L. On the first postoperative day, hemoglobin was 103 g/L, hematocrit was 33%. On the 5th day after the operation, the boy had a currant jelly stool. Hemostatic therapy was provided: transfusion of fresh frozen plasma at a dose of 10 mL/kg, single administration of tranexamic acid at a dose of 10 mg/kg. The bleeding was stopped. After hemostatic therapy, hemoglobin was 105 g/L, hematocrit was 31%. Within 24 hours, fibrogastroduode-noscopy was performed which revealed an ulcer of the duodenal bulb covered with fibrin. The boy was consulted by gastroenterologist. Pathogenetic therapy was prescribed: proton pump inhibitors, antacids, enveloping drugs. The child was discharged home in a satisfactory condition on the 15th day after the operation under the supervision of a district pediatrician, cardiologist, and gastroenterologist. Laboratory parameters at discharge: hemoglobin 91 g/L, red blood cells 3.3×1012/L.
Conclusion. The problem of gastrointestinal complications, including gastrointestinal bleeding in young children af-ter cardiac surgery, is extremely insufficiently covered in the scientific literature. Many questions remain unsolved re-garding the prevention, early diagnosis and treatment of bleeding, so research in this field remains relevant for both clinicians and scientists.
- Ferguson LP, GandiyaT, Kaselas C, Sheth J, Hasan A, Gabra HO. Gastrointestinal complications associated with the surgical treatment of heart disease in children. J Pediatr Surg. 2017;52(3):414-419. https://doi.org/10.1016/j.jpedsurg.2016.10.052
- Murni IK, Djer MM, Yanuarso PB, Putra ST, Advani N, Rachmat J, et al. Outcome of pediatric cardiac surgery and predictors of major complication in a developing country. Ann Pediatr Cardiol. 2019;12(1):38-44. https://doi.org/10.4103/apc.APC_146_17
- Ghanayem NS, Dearani JA, Welke KF, Béland MJ, Shen I, Ebels T. Gastrointestinal complications associated with the treatment of patients with congenital cardiac disease: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease. Cardiol Young. 2008;18(Suppl. 2):240-244. https://doi.org/10.1017/S1047951108002989
- Allen SJ. Gastrointestinal Complications and Cardiac Surgery. J Extra Corpor Technol. 2014;46(2):142-149.
- Ng LQ, Choo JTL, Fortier MV, Chiou FK. Variceal Hemorrhage in Two Children With Congenital Heart Disease and Long-Term Pulmonary Venous Obstruction. JPGN Rep. 2020 Dec 3;2(1):e028. https://doi.org/10.1097/PG9.0000000000000028
- Fox VL. Gastrointestinal bleeding in infancy and childhood. Gastroenterol Clin North Am. 2000;29(1):37-66. https://doi.org/10.1016/s0889-8553(05)70107-2
- Aran AA, Karam O, Nellis ME. Bleeding in Critically Ill Children—Review of Literature, Knowledge Gaps, and Suggestions for Future Investigation. Front Pediatr. 2021 Jan 27;9:611680. https://doi.org/10.3389/fped.2021.611680
- Nellis ME, Tucci M, Lacroix J, Spinella PC, Haque KD, Stock A, et al.; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network; and the Pediatric Critical Care Blood Research Network (BloodNet). Bleeding Assessment Scale in Critically Ill Children (BASIC): Physician-Driven Diagnostic Criteria for Bleeding Severity. Crit Care Med. 2019;47(12):1766-1772. https://doi.org/10.1097/CCM.0000000000004025
- Owensby S, Taylor K, Wilkins T. Diagnosis and Management of Upper Gastrointestinal Bleeding in Children. J Am Board Fam Med. 2015;28(1):134-145. https://doi.org/10.3122/jabfm.2015.01.140153
- Lirio RA. Management of Upper Gastrointestinal Bleeding in Children: Variceal and Nonvariceal. Gastrointest Endosc Clin N Am. 2016;26(1):63-73. https://doi.org/10.1016/j.giec.2015.09.003
- Tringali A, Thomson M, Dumonceau JM, Tavares M, Tabbers MM, Furlano R, et al. Pediatric gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Guideline Executive summary. Endoscopy. 2017;49(1):83-91. https://doi.org/10.1055/s-0042-111002
- Mills KI, Albert BD, Bechard LJ, Duggan CP, Kaza A, Rakoff-Nahoum S, et al. Stress ulcer prophylaxis versus placebo—a blinded randomized control trial to evaluate the safety of two strategies in critically ill infants with congenital heart disease (SUPPRESS-CHD). Trials. 2020 Jun 29;21(1):590. https://doi.org/10.1186/s13063-020-04513-w
- Abu El-Ella SS, El-Mekkawy MS, Mohamed Selim A. Stress ulcer prophylaxis for critically ill children: routine use needs to be re-examined. An Pediatr (Engl Ed). 2022;96(5):402-409. https://doi.org/10.1016/j.anpede.2021.03.001