Imaging and Radiological Interventional Techniques for Gastrointestinal Bleeding in Children

The role of laparoscopy in the diagnosis of intestinal vascular anomalies affecting two small infants

“…Twenty-five percent of cases are diagnosed in the first year of life [1]. Because the GIB observed in these cases is by nature intermittent, and a relatively brisk hemorrhage is needed for diagnosis, the usual investigations often fail to identify the source of the bleeding [4]. Therefore, detection and preoperative localization of vascular anomalies remains a challenging task, especially in small infants.…”

“…Therefore, detection and preoperative localization of vascular anomalies remains a challenging task, especially in small infants. Furthermore, in patients without similar cutaneous birthmarks and in those not affected by Rendu-Osler-Weber or Klippel-Trenaunay syndromes, these lesions may not be suspected early, as GIB in neonates and infants is caused mainly by necrotizing enterocolitis, Meckel's diverticulum, or intussusception [2][3][4][5]. Barium contrast studies are rarely useful in the identification and localization of vascular anomalies [4], and GI upper and lower endoscopy can detect lesions only in the foregut and hindgut [2].…”

“…More recently, 99m Tc-labeled red blood cells [3][4][5] became the preferred radionuclide tracer to detect the source of bleeding. The major drawbacks of the two techniques are low labeling efficiency and high background activity, which lower the ability to identify the anatomic site of Fig.…”

“…MRI scanning, however, is particularly useful in evaluating mass lesions, especially those involving the retroperitoneum, liver, or spleen, but it is less sensitive in cases of bowel lesions [1]. CT scanning is probably more accurate for the diagnosis of vascular anomalies involving portal or mesenteric veins [1,4].…”

“…In such instances it is difficult to keep up with the patient's blood loss by means of transfusions. Furthermore, angiography is quite invasive and potentially harmful in neonates and small infants, although it could also allow transcatheter treatment by vasoactive drug infusion (usually vasopressin) and/or embolization [4].…”