How is pediatric gastrointestinal (GI) bleeding treated?

Updated: Dec 19, 2018
  • Author: Wayne Wolfram, MD, MPH; Chief Editor: Robert K Minkes, MD, PhD  more...
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Answer

Provide hydration and volume support in patients with gastrointestinal (GI) bleeding. Transfusion may be required.

If an acute bleed is suspected and there is hemodynamic instability, access with 2 large-bore intravenous (IV) catheters must be obtained.

Patients with severe GI bleeds should be admitted to the pediatric ICU.

For variceal bleeds, GI consultants may endoscopically control active hemorrhage with sclerotherapy, an elastic ligature (for esophageal varices or for hemorrhoids), or (in rare cases) a transjugular intrahepatic portosystemic shunt (TIPS).

Failure to control bleeding may require the placement of a Sengstaken-Blakemore balloon for temporary tamponade if endoscopic treatment fails or is not possible at the time due to the massive bleeding.

Significant GI bleeding that cannot be controlled (eg, due to duodenal ulcers or varices in the proximal GI tract, vascular malformations, nonreducible points of intussusception) by using the previously mentioned techniques may require surgical intervention, such as laparoscopy.

Patients with first-time occurrences of nonsignificant amounts of bleeding who are discharged should be followed by their primary care pediatrician for further episodes. Again, most of these cases are benign and self-limiting.

Children who present with upper or lower GI hemorrhage to hospitals without a pediatric ICU should be transferred to such a facility when sufficiently stable.

Age-specific treatment and management strategies are discussed below.

Go to Upper Gastrointestinal Bleeding for complete information on this topic.


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