How is lower gastrointestinal (GI) bleeding in children older than 2 years treated?

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

In patients with IBD, the occurrence of acute or persistent bleeding with resultant anemia, despite the use of maximal medical therapy, is considered to be an indication for surgery. Therapy for ulcerative colitis is a total proctocolectomy with an ileal pouch–anal pull-through. The goal of surgical treatment in Crohn disease is resection of all grossly diseased bowels with primary anastomosis, provided previous surgery (or the current resection) has not created a short-bowel situation.

Infectious diarrhea is suspected when lower GI bleeding occurs in association with profuse diarrhea. Recent antibiotic use raises suspicion for antibiotic-associated colitis and Clostridium difficile colitis. The former should be self-limited and should resolve after cessation of antibiotics, while Clostridium difficile colitis requires therapy with oral metronidazole or vancomycin. Escherichia coli and Shigella species are the two most common pathogens in infectious diarrhea. Treatment is supportive with antibiotic therapy, as indicated.

Vascular lesions include a wide variety of malformations, including hemangiomas, arteriovenous malformations, and vasculitis. If these lesions are located in the colon, colonoscopy may be diagnostic and therapeutic. However, brisk bleeding may obscure the visual field, making localization of the bleeding impossible. Arteriography assists in localizing the source and embolizing the feeding vessel.

Surgery is necessary when bleeding cannot be controlled using these techniques. Localization of hemorrhage in the small bowel is a challenge to surgeons and may require intraoperative endoscopy to find the lesion.


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