Yachha S K, Khanduri A, Sharma B C, Kumar M
Department of Gastroenterology (Pediatric GE Section), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
J Gastroenterol Hepatol. 1996 Oct;11(10):903-7.
We prospectively evaluated 139 consecutive children presenting to the Sanjay Gandhi Postgraduate Institute of Medical Sciences (Lucknow, India) with gastrointestinal (GI) bleeding from January 1991 to November 1994. Our aims were to find out whether the causes of GI bleeding in a developing country differed from developed countries and how the application of newer diagnostic techniques would help in the diagnosis of GI bleeding. Barium studies, endoscopy, technetium-99m-labelled (erythrocytes and pertechnetate) scans, selective abdominal angiography using a digital subtraction technique and rectal endoscopic ultrasonography were performed. Upper GI bleeding (n = 75) was variceal in 71 (95%) children (extrahepatic portal venous obstruction in 65, cirrhosis in six) and non-variceal in four (5%) cases (Henoch-Schonlein purpura, idiopathic thrombocytopenic purpura, drug-induced gastric erosions and pseudoaneurysm of the gastroduodenal artery due to idiopathic chronic calcific pancreatitis). Causes of lower GI bleeding (n = 64) were colitis (27 cases; 42%), colorectal polyps (26 cases; 41%), enteric fever (n = 3), solitary rectal ulcer (n = 3), portal hypertensive colopathy (n = 2), colonic arteriovenous malformation (n = 1) and internal haemorrhoids (n = 1). One patient remained undiagnosed. Angiography performed in four children was diagnostic in two. In one child with massive lower GI bleeding from portal colopathy, the bleeding site (caecum) was localized by intra-operative colonoscopy, while in the other child with portal colopathy, rectal endoscopic ultrasonography was performed to substantiate the diagnosis. We conclude that the causes of upper GI bleeding in children in developing countries are different from those in developed countries (variceal bleeding due to extrahepatic portal venous obstruction is the most common cause, while peptic ulcer is rare). However, the spectrum of lower GI bleeding is similar to that of developed countries. Application of newer diagnostic techniques is helpful and safe in the identification of the cause of GI bleeding in children.
1991年1月至1994年11月期间，我们对连续就诊于印度勒克瑙市桑杰·甘地研究生医学科学研究所的139名患有胃肠道出血的儿童进行了前瞻性评估。我们的目的是查明发展中国家胃肠道出血的病因是否与发达国家不同，以及应用更新的诊断技术如何有助于胃肠道出血的诊断。我们进行了钡剂造影、内镜检查、锝-99m标记（红细胞和高锝酸盐）扫描、使用数字减法技术的选择性腹部血管造影以及直肠内镜超声检查。上消化道出血（n = 75）的患儿中，71例（95%）为静脉曲张出血（65例为肝外门静脉阻塞，6例为肝硬化），4例（5%）为非静脉曲张出血（过敏性紫癜、特发性血小板减少性紫癜、药物性胃糜烂以及特发性慢性钙化性胰腺炎导致的胃十二指肠动脉假性动脉瘤）。下消化道出血（n = 64）的病因包括结肠炎（27例；42%）、大肠息肉（26例；41%）、伤寒（n = 3）、孤立性直肠溃疡（n = 3）、门静脉高压性结肠病（n = 2）、结肠动静脉畸形（n = 1）和内痔（n = 1）。1例患者仍未确诊。对4名儿童进行的血管造影中，2例具有诊断价值。1名因门静脉结肠病导致大量下消化道出血的儿童，术中结肠镜检查确定了出血部位（盲肠）；另1名患有门静脉结肠病的儿童，进行了直肠内镜超声检查以证实诊断。我们得出结论，发展中国家儿童上消化道出血的病因与发达国家不同（肝外门静脉阻塞导致的静脉曲张出血是最常见病因，而消化性溃疡罕见）。然而，下消化道出血的范围与发达国家相似。应用更新的诊断技术有助于且安全地识别儿童胃肠道出血的病因。
