Gastrointestinal bleeding due to pseudoaneurysms in children

Transcatheter arterial embolization for acute nonvariceal upper Gastrointestinal bleeding in children: a single-center retrospective study

OBJECTIVE

This study aims to provide a preliminary report on the outcomes of transcatheter arterial embolization (TAE) in pediatric patients with acute nonvariceal upper gastrointestinal bleeding (NVUGIB) to establish optimal practices for this intervention and explore its potential value in improving the management of pediatric patients.

METHODS

A retrospective analysis was conducted on children with NVUGIB who underwent TAE at a single institutional center between February 2022 and April 2024. Comprehensive data were collected, including patient demographics, clinical manifestations, diagnostic and therapeutic procedures, intraoperative findings, and follow-up outcomes.

RESULTS

A total of 266 cases with NVUGIB were admitted to the institutional center, with 14 cases (5.26%) undergoing TAE. There were 10 males and 4 females. The average age was 7.21 ± 4.77 years old, and the average hospital stay was 13.14 ± 8.69 days. Nine cases (64.29%) had hematochezia, 2 cases (14.29%) had hematemesis, 3 cases (21.42%) had both hematochezia and hematemesis. Six cases (42.86%) had no significant medical history, 3 cases (21.42%) had previous Helicobacter pylori infections, 2 cases (14.29%) had previous lymphomas, and 1 case (7.14%) each had immune disorders, gastroenteritis, and fever. The mean preoperative minimum hemoglobin level was 57.85 ± 21.25 g/L. All cases underwent gastroenteroscopy before TAE. Ten cases (71.43%) had duodenal bulb ulcers, 3 cases (21.43%) had duodenal ulcers, and 1 case (7.14%) had multiple ulcers in the gastric antrum. Bleeding was visible on endoscopy in 6 cases (Forrest Classification Ib,42.86%) (Table 2; Fig. 2), which were treated. All cases underwent TAE, and the timing of TAE averaged 4.29 ± 4.53 days. The responsible vessel was identified intraoperatively in all cases: gastroduodenal artery in 7 cases (50%) and pancreaticoduodenal artery in 7 cases (50%). A pseudoaneurysm was found in 2 cases (14.29%). Embolization of the responsible vessel was performed in all cases, using platinum coils alone in 8 cases (57.14%) and platinum coils combined with gelatin sponge in 6 cases (42.8%). All cases were followed up for an average of 13.69 ± 8.77 months, and no recurrence was detected.

CONCLUSION

TAE represents a promising intervention for pediatric patients with acute NVUGIB. Nevertheless, optimal timing, embolization techniques, and selection of embolizing agents necessitate further comprehensive investigation.

Endovascular treatment of traumatic pseudoaneurysm of the ileal branch of the superior mesenteric artery in a 9-year-old girl: Case report and literature review

RATIONALE

Visceral artery aneurysm is a rare and potentially fatal vascular condition that typically affects the superior mesenteric or inferior mesenteric arteries, the splenic, hepatic, and celiac arteries, as well as their branches. Visceral artery aneurysms can usually be treated using endovascular intervention, open surgery, or percutaneous thrombin injection.

PATIENT CONCERNS

A 9-year-old girl was admitted to our trauma center with abdominal and bilateral leg pain after a car accident involving a head-on collision.

DIAGNOSIS

Abdominal computed tomography (CT) showed bowel herniation through a muscle defect in the left lateral abdominal wall. There was a small amount of fluid around the liver and spleen, mild thickening of the small bowel wall, and infiltration in the small bowel mesentery, indicating the possibility of small bowel injury.

INTERVENTIONS

Emergent exploratory laparotomy was performed. After resection of the ischemic parts of the terminal ileum and sigmoid colon, intestinal continuity was reestablished. Primary repair was performed on a traumatic left lateral abdominal wall hernia. She recovered well postoperatively without any complications. A follow-up abdominal CT scan after 2 months showed a pseudoaneurysm of the ileal branch of the superior mesenteric artery. Despite the absence of any gastrointestinal symptoms, the pseudoaneurysm was treated by endovascular intervention using numerous coils because of the significant risk of delayed rupture or massive bleeding.

OUTCOMES

Follow-up abdominal CT scan after 6 months showed complete occlusion and resorption of the pseudoaneurysm.

LESSONS

Although it is technically challenging, endovascular coil embolization may be a feasible technique in children with traumatic visceral artery pseudoaneurysms without complications.