ENDOSCOPIC HEMOSTASIS IN A NEONATE WITH BLEEDING DUODENAL ULCER WITH VISIBLE VESSEL

L Babu, MR Riley, K Jacobson, M Phang, CC Barker

Department of Gastroenterology and Pediatrics, BC Children's Hospital, Vancouver, British Columbia

Duodenal ulcer (DU) in a healthy term neonate is an uncommon cause of upper gastrointestinal bleeding. Outcome is good in most cases. Safety and efficacy of therapeutic endoscopy in neonates is not well described. We report a case of a bleeding DU with a visible vessel treated successfully with heater probe thermo-coagulation.
The patient was a 41 weeks gestation infant delivered by caesarian section to a 38 year old primiparous mother of Philipino origin for failure to progress. Apgar scores were 8 and 9 at 1 and 5 minutes respectively and the birth weight was 3585 grams. Umbilical cord blood gases were normal. He was well and breastfeeding until day 2 of life when he vomited fresh blood. On examination he was hemodynamically stable and otherwise normal. Breast exam of the mother revealed a cracked nipple, however, the bedside Apt-Downey test revealed the vomited blood to be of neonatal origin. Intravenous fluids, ranitidine and antibiotics were started as a precaution. His coagulation and electrolyte profiles were normal. On day 3 he had another bout of hematemesis and hematochezia. Hemoglobin dropped from 157 g/L to 116 g/L (15-25g/L) with a normal white cell count of 17.64 ´ 10⁹/L (9-30 ´ 10⁹/L) and a normal platelet count of 284 ´ 10⁹/L.
Flexible upper endoscopy found an ulcer 3 millimeters in diameter with surrounding exudate and visible vessel centrally in the duodenal cap. Heaterprobe (Olympus, NY, and USA) coagulation with 5 pulses of 15 Joules applied to the center and edges of the crater achieved hemostasis. The post procedure hospital stay was uneventful and the infant was discharged on day 6.
Heater probe thermo-coagulation in this infant was safe and effective.