GASTROINTESTINAL BLEEDING IN INFANCY AND CHILDHOOD

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Gastrointestinal bleeding is an alarming problem in children. The total blood volume of a child is relatively small and can deplete rapidly, whereas resuscitation efforts are hindered by difficult venous access. Yet, mortality in children is quite low because of their robust physiology and general paucity of comorbid conditions and because of the attentive care usually afforded them. This experience contrasts sharply with significant mortality in elderly patients despite aggressive management.

Although many causes of gastrointestinal bleeding are common to children and adults, the frequency of specific causes differs greatly, and some lesions, such as necrotizing enterocolitis or allergic colitis, are unique to children. This article reviews the spectrum of gastrointestinal bleeding in infants and children. The causes, diagnostic evaluation, and management are discussed, and differences with adult medicine are highlighted.

Section snippets

Epidemiology

There are few quantitative data regarding the epidemiology of gastrointestinal bleeding in children. It is relatively uncommon but not rare. The incidence of upper gastrointestinal bleeding in ambulatory pediatric patients has not been reported. Published data are limited to the pediatric intensive care unit (ICU) population.31, 37, 112 One prospective ICU study112 reported an incidence of 6.4% (63 episodes in 984 patients). Only four (0.4%) episodes were considered life-threatening. Other

Epidemiology

Even though rectal bleeding is commonly encountered in clinical pediatric practice, the epidemiology of this problem is not well established in an ambulatory care setting. Teach and Fleisher192 reported the course of 104 children with rectal bleeding presenting to a tertiary care emergency department during a 10-month period. Rectal bleeding represented the chief complaint in 0.3% of all visits during this time period. Almost half of the children were younger than 1 year old. Allergic colitis

SMALL BOWEL HEMORRHAGE

Meckel's diverticulum, a congenital remnant of the vitellointestinal duct described by Meckel in 1809, is the most important source of small bowel hemorrhage in children.201 It obeys the rule of 2s: present in 2% of the population, located 2 feet from the ileocecal valve, and bleeding in children younger than 2 years of age. The diverticulum arises on the antimesenteric border of the ileum and is lined by ileal mucosa that frequently contains ectopic gastric or pancreatic tissue. Bleeding

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    Address reprint requests to Victor L. Fox, MD, Division of Gastroenterology and Nutrition, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115

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