Binita M. Kamath, MBBChir; Robin Kaye, MD; Petar Mamula, MD Series Editors: David A. Piccoli, MD; Petar Mamula, MD


December 28, 2004


Gastrointestinal bleeding in a young child can be due to structural, vascular, inflammatory, or traumatic causes. The first priority is to determine whether the bleeding is from the upper or lower gastrointestinal tract. Initial evaluation must determine whether the child is hemodynamically stable. Thereafter, investigation of the source of the bleeding may include a nasogastric tube lavage, laboratory testing (liver function tests, prothrombin time), Meckel's scan, and upper and/or lower endoscopy. In challenging cases, a tagged red cell bleeding scan, radiologic studies such as CT or CT angiography, or invasive angiography may be necessary. The use of video capsule endoscopy is also increasing in the pediatric population. In general, invasive studies are limited to the most elusive cases.

In this patient, the fortuitous finding of fresh blood in the duodenum on repeat upper endoscopy pointed to the pancreatic duct and therefore a visceral artery aneurysm as the source of bleeding.


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