Hemodynamic shock secondary to massive duodenal ulcus
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Anales
de
Pediatría
100
(2024)
70---71
www.analesdepediatria.org
IMAGES
IN
PAEDIATRICS
Hemodynamic
shock
secondary
to
massive
duodenal
ulcus

Shock
hemodinámico
secundario
a
ulcus
duodenal
masivo
Carmen
González-Lamu
̃
no
a
,
,
Irene
Robles
Álvarez
a
,
Cristina
González
Miares
a
,
Óscar
Balboa
Arregui
b
a
Unidad
de
Gastroenterología
pediátrica,
Servicio
de
Pediatría,
Complejo
Asistencial
Universitario
de
León,
León,
Spain
b
Radiología
Vascular
e
Intervencionista,
Servicio
de
Radiodiagnóstico,
Complejo
Asistencial
Universitario
de
León,
León,
Spain
Available
online
6
January
2024
A
boy
age
13
years
was
brought
to
hospital
by
the
medical
emergency
team
following
two
episodes
of
loss
of
conscious-
ness.
The
patient
had
vomited
stomach
contents
mixed
with
blood
between
both
episodes.
On
arrival,
he
was
unstable,
and
the
following
tests
were
ordered:
head
CT
scan,
complete
blood
count
and
panel,
and
upper
gastrointestinal
endoscopy
(UGIE).
The
latter
revealed
a
large,
excavated
defect
in
the
duodenal
bulb
(Forrest
Ib
lesion)
(
Fig.
1
)
and
oesophagitis
(Los
Angeles
grade
D).
Massive
bleeding
developed
during
the
proce-
dure,
prompting
performance
of
resuscitation
manoeuvres
and
injection
of
adrenaline
and
polidocanol
in
the
preserved
mucosa.
Due
to
the
persistence
of
bleeding,
we
performed
an
angiography
with
embolization
of
the
gastroduodenal
artery
(
Fig.
2
),
after
which
there
was
no
further
evidence
of
DOI
of
original
article:
https://doi.org/10.1016/j.anpedi.2023.09.012

Previous
meeting:
the
case
was
presented
as
an
oral
communica-
tion
at
the
II
Virtual
Scientific
Meeting
of
the
Sociedad
de
Pediatría
de
Asturias,
Cantabria
y
Castilla
y
León
(SCCALP),
held
online
on
November
4---5,
2021.
Corresponding
author.
E-mail
address:
cgonzalezla@saludcastillayleon.es
(C.
González-Lamu
̃
no).
Figure
1
Duodenal
ulcer
with
active
bleeding.
bleeding.
Treatment
with
high-dose
proton
pump
inhibitors
(PPIs)
was
initiated.
Further
evaluation
ruled
out
malignant
disease,
Helicobacter
pylori
was
not
detected
the
histo-
logical
examination,
and
the
basal
serum
concentration
of
gastrin
and
the
findings
of
the
single-photon
emission
CT
scan
were
normal.
The
patient
remained
in
treatment
for
7
months,
with
a
follow-up
UGIE,
after
discontinuation
of
PPI
treatment,
evincing
antral
gastritis
with
features
suggestive
of
H.
pylori
infection,
although
the
cultures
remained
negative.
Sero-
2341-2879/©
2023
Asociaci
́
on
Espa
̃
nola
de
Pediatr
́
ıa.
Published
by
Elsevier
Espa
̃
na,
S.L.U.
This
is
an
open
access
article
under
the
CC
BY-NC-ND
license
(
http://creativecommons.org/licenses/by-nc-nd/4.0/
).
Anales
de
Pediatría
100
(2024)
70---71
Figure
2
Visualization
of
irregularity
in
the
gastroduodenal
artery
wall
before
proceeding
to
the
gastroepiploic
artery.
Coil
embolization.
logic
testing
for
detection
of
H.
pylori
was
ordered
and
turned
out
positive.
Given
the
high
frequency
of
H.
pylori
associated
with
this
condition,
the
decision
was
made
to
start
empiric
eradication
therapy.
1
Giant
duodenal
ulcers
are
rare
but
potentially
severe
lesions
in
the
paediatric
age
group.
2
Infection
by
H.
pylori
is
the
most
frequent
cause,
and
should
be
tested
for
in
every
case.
3
References
1.
Cho
J,
Prashar
A,
Jones
NL,
Moss
SF.
Helicobacter
pylori
infection.
Gastroenterol
Clin
North
Am.
2021;50:261---82.
2.
Dohil
R,
Hassall
E.
Peptic
ulcer
disease
in
children.
Baillieres
Best
Pract
Res
Clin
Gastroenterol.
2000;14:53---73.
3.
Jones
NL,
Koletzko
S,
Goodman
K,
Bontems
P,
Cadranel
S,
Casswall
T,
et
al.
Joint
ESPGHAN/NASPGHAN
guidelines
for
the
management
of
Helicobacter
pylori
in
children
and
adolescents
(update
2016).
J
Pediatr
Gastroenterol
Nutr.
2017;64:991---1003.
71

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