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Phlebectasia Of The Jejunum In A Child - Abstract

Alison Campbell, Anna Radford, Alastair Macdonald, David Horton, Sanja Besarovic, Ramnik Patel


Abstract

A 12 year old boy presented with repeat episodes of lower gastrointestinal bleeding. We outline the pitfalls encountered en route to making the correct diagnosis and undergoing definitive surgery. Although not a classical presentation, his symptoms initially responded to therapy for ulcerative colitis (UC), confirmed clinically and on histology. However, he was readmitted with lower gastrointestinal bleeding. Repeat colonoscopy was grossly normal except a small polyp, and histology suggested UC. It was not until, on the third presentation with a precipitant hemoglobin drop, that capsule enteroscopy in conjunction with CT angiography was performed, and the site of blood loss identified. Surgical resection of the affected jejunum was curative and histology confirmed the diagnosis. Identifying the site of small bowel bleeding can be challenging due to its inaccessibility, length, vigorous contraction and overlying loops. Phlebectasia is a rare cause of gastrointestinal bleeding in children. Our case highlights the importance of keeping an open mind and a multimodality approach to investigating ongoing obscure gastrointestinal bleeding in children.

Keywords: congenital vascular malformation, intestinal, phlebectasia, children, gastrointestinal bleeding, capsule enteroscopy, CT angiography, ulcerative colitis

 

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