An 11-month-old child with gastrointestinal hemorrhage, hemorrhagic shock, and COVID-19 infection successfully recovered and was discharged from the Guangdong Maternal and Child Health Care Hospital recently.
At 4 o'clock in the morning on January 8, with the sirens of an ambulance, a critically ill child came from Maoming, around 400 kilometers away from Guangzhou, and was immediately admitted to Pediatric Intensive Care Unit (PICU) of the hospital's Campus in Panyu District.
Having known the child's medical history, the PICU team made a careful diagnosis and treatment plan. Given the urgent condition, enhanced CT scan indicated the rupture and bleeding of the distal branch of gastroduodenal artery and blood accumulation in gastroduodenum.
The child's condition has improved.
The digestive endoscopy team completed gastrointestinal endoscopy, and a lump in the duodenal bulb was seen. There remained Dieulafoy disease, aneurysm and polyps in the duodenal bulb to be ruled out.
At 23:00 on the night of January 9, the child experienced massive gastrointestinal bleeding and hemorrhagic shock, the blood pressure dropped to 23/13mmHg almost instantly.
Even with continuous infusion of bags of red blood cells and plasma, it was difficult to stabilize the child's vital signs. Doctors immediately consulted with the Department of General Pediatric Surgery, and suggested interventional embolization to stop bleeding.
Mei Shiwei, director of the Department of Interventional Radiology of the hospital, arranged gastroduodenal arteriography + embolization for the patient.
When trying to insert the coil spring, the doctor saw the aneurysm was ruptured, as well as active bleeding. The bleeding site was clear. However, the blood pressure of the child dropped again. He urgently requested consultation from the general surgery for interventional treatment and endoscopic titanium clip placement to stop the bleeding.
Under blurred vision, it is highly challenging to stop bleeding with titanium clips. To save lives, infusion of blood products and vasoactive drugs can temporarily maintain the vital signs. Despite huge pressure, Mei Shiwei and his team once again tried to stop the bleeding with embolization. Finally, the embolization was completed and the child was transferred to the ward.
Multidisciplinary consultation meeting.
However, bleeding of the child's digestive tract has not stopped.
After returning to the ward, the child's hemoglobin decreased progressively. A multidisciplinary consultation including departments of surgery, imaging, digestion, and intervention has been quickly started.
Finally, duodenoplasty and vessel ligation have been conducted for the child. Fortunately, the bleeding stopped, the child's vital signs returned to stable, and was successfully removed from the ventilator 3 days after the operation.
Author | Hannah
Editor | Wing, Steven, Abby, Jerry
