Iwama Itaru, Yoshida Masashi, Hara Tomoko, Nambu Ryusuke
Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan.
Front Pediatr. 2021 Dec 8;9:780356. doi: 10.3389/fped.2021.780356. eCollection 2021.
Melena, or tarry black stool, is not a rare symptom encountered in pediatric clinical practice, and the bleeding source varies from the upper gastrointestinal tract to the small intestine. Endoscopy is effective in identifying bleeding, but it does not always identify the source of bleeding. Endoscopic examination in children is commonly challenging, and there are no detailed reports about the causes of melena in children. This observational study aimed to validate the cause of melena in children and to investigate more effective and less burdensome examination methods. We retrospectively reviewed the clinical records of 55 patients who underwent examination for melena. In this research, 38 patients had underlying diseases such as malignancy and severe mental and physical disorders. The bleeding source was identified in 39 patients. The most common final diagnosis was duodenal ulcer ( = 22), and the other diagnoses were gastric ulcer, esophagitis, and esophageal varices. The upper gastrointestinal tract was the most common source of bleeding ( = 34). In five patients, the bleeding source was the small intestine. Vomiting, abnormal abdominal ultrasonography findings, and a hemoglobin level of ≤ 3 g/dL than the lower normal limit were significant factors indicating that the bleeding source can be found on esophagogastroduodenoscopy. The upper gastrointestinal tract was the most common bleeding source of melena in children. As in adults, esophagogastroduodenoscopy is the primary endoscopic method of choice. Furthermore, small bowel capsule endoscopy may be useful in identifying the bleeding source in children without upper gastrointestinal lesions.
黑便，即柏油样便，是儿科临床实践中并不罕见的症状，出血来源从上消化道到小肠不等。内镜检查对识别出血有效，但并不总能确定出血源。儿童的内镜检查通常具有挑战性，且尚无关于儿童黑便病因的详细报告。这项观察性研究旨在验证儿童黑便的病因，并探究更有效且负担更小的检查方法。我们回顾性分析了55例因黑便接受检查的患者的临床记录。在本研究中，38例患者患有诸如恶性肿瘤及严重身心障碍等基础疾病。39例患者的出血源得以确定。最常见的最终诊断为十二指肠溃疡（n = 22），其他诊断包括胃溃疡、食管炎和食管静脉曲张。上消化道是最常见的出血源（n = 34）。5例患者的出血源为小肠。呕吐、腹部超声检查结果异常以及血红蛋白水平低于正常下限3 g/dL是提示可通过食管胃十二指肠镜检查发现出血源的显著因素。上消化道是儿童黑便最常见的出血源。与成人一样，食管胃十二指肠镜检查是主要的内镜检查选择方法。此外，小肠胶囊内镜检查可能有助于识别无消化道上段病变的儿童的出血源。
