Tranexamic acid for bleeding in a child with extensive small bowel angiodysplasia

Abstract

Gastrointestinal (GI) angiodysplasia is a rare cause of lower GI bleeding in the paediatric population. This disease caused intermittent per-rectal bleeding and severe anemia in 2-year-old girl with Turner's syndrome. She was initially suspected to have Meckel's diverticulum and taken to the operation room for laparoscopy. A Meckel's diverticula was not found but an extensive distribution of abnormal vessels on the surface of the small bowel was noted from close to the duodeno-jejunal junction to the terminal ileum. GI angiodysplasia was suspected but the lesion was too extensive to be resected. It was also not clear if any specific area was the source of the current bleeding. After conversion to open surgery, an enterotomy was done in the mid portion of the affected bowel and an on table enteroscopy was done. This revealed a normal mucosal lining in the visualized areas and so was not contributory. Prior to closure of the enterotomy a doughnut of bowel was taken for histopathology. This confirmed small bowel angiodysplasia. She had one minor recurrence of lower GI bleeding 4 months later but has been well since then. This case sheds light on angiodysplasia as a cause of lower GI bleeding and we discuss its diagnostic and management options.

Keywords

• Gastrointestinal bleeding
• Angiodysplasia
• Small bowel bleeding