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Kocic M, Rasic P, Marusic V, Prokic D, Savic D, Milickovic M, Kitic I, Mijovic T, Sarajlija A. Age-specific causes of upper gastrointestinal bleeding in children. World J Gastroenterol 2023; 29:6095-6110. [PMID: 38186684 PMCID: PMC10768410 DOI: 10.3748/wjg.v29.i47.6095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/05/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023] Open
Abstract
The etiology of upper gastrointestinal bleeding (UGIB) varies by age, from newborns to adolescents, with some of the causes overlapping between age groups. While particular causes such as vitamin K deficiency and cow's milk protein allergy are limited to specific age groups, occurring only in neonates and infants, others such as erosive esophagitis and gastritis may be identified at all ages. Furthermore, the incidence of UGIB is variable throughout the world and in different hospital settings. In North America and Europe, most UGIBs are non-variceal, associated with erosive esophagitis, gastritis, and gastric and duodenal ulcers. In recent years, the most common causes in some Middle Eastern and Far Eastern countries are becoming similar to those in Western countries. However, variceal bleeding still predominates in certain parts of the world, especially in South Asia. The most severe hemorrhage arises from variceal bleeding, peptic ulceration, and disseminated intravascular coagulation. Hematemesis is a credible indicator of a UGI source of bleeding in the majority of patients. Being familiar with the most likely UGIB causes in specific ages and geographic areas is especially important for adequate orientation in clinical settings, the use of proper diagnostic tests, and rapid initiation of the therapy. The fundamental approach to the management of UGIB includes an immediate assessment of severity, detecting possible causes, and providing hemodynamic stability, followed by early endoscopy. Unusual UGIB causes must always be considered when establishing a diagnosis in the pediatric population because some of them are unique to children. Endoscopic techniques are of significant diagnostic value, and combined with medicaments, may be used for the management of acute bleeding. Finally, surgical treatment is reserved for the most severe bleeding.
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Affiliation(s)
- Marija Kocic
- Department of Gastroenterology, Hepatology and Nutrition, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
| | - Petar Rasic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
| | - Vuk Marusic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Dragan Prokic
- Department of Gastroenterology, Hepatology and Nutrition, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Djordje Savic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Maja Milickovic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Ivana Kitic
- Department of Gastroenterology, Hepatology and Nutrition, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Tanja Mijovic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
| | - Adrijan Sarajlija
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
- Pediatric Day Care Hospital Department, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Eastern Sarajevo, Foča 73300, Bosnia and Herzegovina
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A sudden hemorrhage in the esophageal duplication cyst: A rare cause of acute dysphagia in an adult. Ann Med Surg (Lond) 2022; 80:104199. [PMID: 36045858 PMCID: PMC9422192 DOI: 10.1016/j.amsu.2022.104199] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/24/2022] Open
Abstract
A 42-year-old male pediatrics physician was admitted with a history of acute chest pain and sudden severe dysphagia to solids and liquids. He denied any history of abdominal pain, vomiting, dyspnea, nausea weight loss. He could not even swallow saliva. The patient denied any history of drug abuse. A computed tomographic scan of the chest (CT)showed a posterior mediastinal mass inseparable from the esophagus and descending aorta. Magnetic resonant imaging (MRI)scan revealed a cystic mass full of blood inseparable from the esophagus and adherent to the aorta. The mass was resected entirely through the left thoracotomy; post-operative recovery was uneventful; dysphagia resolved as the post-operative contrast swallow study showed a free flow of contrast to the stomach patient resumed his regular diet. A 42 years old male presented with chest discomfort and acute dysphagia. CT scan and MRI showed hemorrhagic large posterior mediastinal cystic mass compressing the esophagus. Oral contrast study showed obstruction of lower esophagus. Complete surgical excision was done with uneventful outcome.
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Chaudhary V, Rana SS, Sharma V, Sharma AR, Nada R, Gupta R, Dutta U, Singh K, Bhasin DK. Esophageal duplication cyst in an adult masquerading as submucosal tumor. Endosc Ultrasound 2014; 2:165-7. [PMID: 24949388 PMCID: PMC4062263 DOI: 10.7178/eus.06.0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 04/21/2013] [Indexed: 01/05/2023] Open
Abstract
Gastrointestinal duplications usually manifest in children and may involve the esophagus in 20% cases. Esophageal duplication cysts are a rare cause of dysphagia in adults. We report the case of a 35-year-old male who presented to us with progressive dysphagia of 6 months duration. Contrast enhanced computed tomography showed a soft-tissue lesion in right lateral wall of distal thoracic esophagus. On endoscopic ultrasound, a heterogeneously echotextured lesion with anechoic component present at intramural location in the lower esophagus was noted. The patient underwent surgical excision of the lesion and histopathology confirmed the diagnosis of esophageal duplication cyst.
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Affiliation(s)
- Vinita Chaudhary
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder Singh Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Raj Sharma
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritambhra Nada
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Gupta
- Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kartar Singh
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Kumar Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Rathod J, Disawal A, Taori K, Agrawal M, Gaur PP, Jadhav V, Prasad K, Wankhede K. Communicating tubular duplication of upper esophagus-a rare occurrence. J Clin Imaging Sci 2011; 1:33. [PMID: 21966630 PMCID: PMC3177425 DOI: 10.4103/2156-7514.82245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 05/17/2011] [Indexed: 01/07/2023] Open
Abstract
Duplications of esophagus are commonly classified into two types, tubular and cystic. Tubular duplication of esophagus is a rare occurrence and is much less common than cystic duplication of foregut. Most esophageal duplications are located in the lower third of the esophagus. A cervical esophageal duplication is extremely rare. Esophageal duplications have been reported twice as commonly on the right as on the left. We report a case of incidental finding identified on computed tomography of communicating tubular esophageal duplication involving the left side of the upper esophagus in a tuberculosis patient that was subsequently confirmed on barium swallow test.
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Affiliation(s)
- Jawahar Rathod
- Department of Radiodiagnosis, Government Medical College and Hospital, Nagpur, India
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Huang Y, Wang D, Liu X, Wang W, Zhang Z. Communicating esophageal tubular duplication in a newborn infant. J Pediatr Surg 2011; 46:1655-7. [PMID: 21843739 DOI: 10.1016/j.jpedsurg.2011.04.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Revised: 04/10/2011] [Accepted: 04/29/2011] [Indexed: 01/07/2023]
Abstract
We describe a communicating esophageal duplication in a newborn infant, without any other associated congenital anomalies. The diagnosis of esophageal duplication was achieved by a contrast study of the esophagus with diatrizoate and computed tomographic scan. Surgical excision of the esophageal duplication was carried out. At the 1-year follow-up examination, the patient was doing well.
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Affiliation(s)
- Ying Huang
- Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, PR China
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Sherer DM, Timor-Tritsch IE, Dalloul M, Zinn H, Sokolovski M, Kheyman M, Yu S, Abulafia O. Prenatal sonographic findings of an isolated cervical esophageal duplication cyst. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:405-407. [PMID: 19244082 DOI: 10.7863/jum.2009.28.3.405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- David M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, 445 Lenox Rd, Box 24, Brooklyn, NY 11203-2098 USA.
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Develay-Morice JE, Rathat G, Duyme M, Hoffet M, Fredouille C, Couture A, Allal H, Deschamps F, Frandji-Barbier N, Marès P. Échographie de l'œsophage fœtal : aspect physiologique et application au dépistage anténatal d'une atrésie œsophagienne. ACTA ACUST UNITED AC 2007; 35:249-57. [PMID: 17336572 DOI: 10.1016/j.gyobfe.2007.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Accepted: 01/15/2007] [Indexed: 11/18/2022]
Abstract
The thoracic part of a fetal esophagus is generally overlooked by usual prenatal ultrasonography. However, screening it might improve the detection rate of esophageal malformations for which prenatal diagnosis remains far from accurate. In this article, we describe the technique which makes it possible to get a precise image of a fetal thoracic esophagus in its more sensitive part: between the trachea and the aorta. After describing the appearance of a healthy thoracic esophagus, we will show how this technique can be used for prenatal detection of esophagus malformations. For this purpose, we provide the case report of a prenatal diagnosis of esophagus atresia with esotracheal fistula.
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Affiliation(s)
- J-E Develay-Morice
- Service de Gynécologie-Obstétrique, CHU Carémeau, Place du Professeur-Robert-Debré, 30900 Nîmes, France
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Gul A, Tekoglu G, Aslan H, Cebeci A, Erol O, Unal M, Ceylan Y. Prenatal sonographic features of esophageal and ileal duplications at 18 weeks of gestation. Prenat Diagn 2005; 24:969-71. [PMID: 15612057 DOI: 10.1002/pd.1033] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We present a case of esophageal and ileal duplications at 18 weeks of gestation. Transabdominal ultrasonography of the fetus showed multiple cystic masses of 12 to 17 mm in diameter and continuity with each other in the abdomen and a unilocular cystic mass of 15 mm in diameter in the posterior mediastinum. The cystic mass filled the abdominal cavity with signs of intestinal obstruction. The thoracic cystic mass was tubular, sausage-shaped and behind the heart, which was displaced to the antero-lateral wall of the chest. Amniocentesis revealed a normal fetal karyotype 46,XY. Peristaltic movements in the abdominal cystic structure at 30 weeks of gestation suggested dilated intestinal loops. Follow-up ultrasound examinations showed polyhydramnios with amniotic fluid index of 30 cm and gradual enlargement of the cystic structures to 50 mm in the abdomen and 30 mm in the posterior mediastinum at 38 weeks of gestation. A male infant weighing 3900 g was delivered. Postnatal ultrasonographic examination and the findings of magnetic resonance imaging also suggested enteric duplication cysts. Prenatal diagnosis allowed prompt neonatal evaluation and surgical treatment of the esophageal and the ileal duplications, which was confirmed by pathological examination.
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Affiliation(s)
- Ahmet Gul
- Maternal and Fetal Unit, Department of Obstetrics and Gynecology, Istanbul SSK Bakirkoy Women and Children Hospital, Gencler cad., 30/2 Bakirkoy, 34740 Istanbul, Turkey.
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Kawahara H, Kamata S, Nose K, Oue T, Okada A, Wasada K, Murata Y. Congenital mediastinal cystic abnormalities detected in utero: report of two cases. J Pediatr Gastroenterol Nutr 2001; 33:202-5. [PMID: 11568525 DOI: 10.1097/00005176-200108000-00021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- H Kawahara
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
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Abstract
Gastrointestinal (GI) bleeding is an alarming problem in children. Although many causes of GI 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 GI bleeding in infants and children. The causes, diagnostic evaluation, and management are discussed, and differences with adult medicine are highlighted.
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Affiliation(s)
- V L Fox
- Harvard Medical School, Boston, Massachusetts, USA
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Yamataka A, Pringle KC. A case with duodenal duplication cyst: prenatal diagnosis and surgical management. Fetal Diagn Ther 1998; 13:39-41. [PMID: 9605615 DOI: 10.1159/000020799] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We report the first case of a subhepatic cystic mass diagnosed in utero that subsequently proved to be a duodenal duplication cyst. METHOD Conventional prenatal abdominal ultrasound. RESULTS On prenatal ultrasonography, the differential diagnosis was choledochal cyst, bowel duplication cyst, or omental cyst. CONCLUSION The prenatal detection of a cystic mass allowed close neonatal surveillance and timely surgical intervention prior to the onset of potentially serious complications.
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Affiliation(s)
- A Yamataka
- Department of Surgery, Wellington School of Medicine, University of Otago, New Zealand.
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