Successful treatment of a bleeding duodenal ulcer using an over-the-scope clip in a five-year-old patient

Abstract

Upper gastrointestinal bleeding (UGIB) is a serious or even life-threatening event. In childhood, gastroduodenal ulcer dis­ease is the second most common cause of UGIB after erosive gastritis. Risk factors for ulceration include Helicobacter pylori (H. pylori) infection and use of non-steroidal anti-inflammatory drugs. Patients in shock and on artificial pulmonary ventilation are also at increased risk. In addition to H. pylori, infections with Cytomegalovirus, Herpes simplex virus, or tuberculosis may contribute to the development of peptic ulceration. Ulceration may be a manifestation of Crohn‘s dis­ease, Zollinger-Ellison syndrome, and other less common dis­eases. A case report of a 5-year-old boy with two attacks of melena, collapse and vomiting of blood is presented. Endoscopically, an ulceration of the duodenal bulb was found with a stump of a blood vessel at the base (Forrest IIa). Primary treatment with standard endoclips inserted through the working channel of the endoscope (TTS clip –  through-the-scope clip) failed, as did treatment with the thermal method using argon-plasma coagulation. Successful treatment of the ulcer was achieved only with the use of an over-the-scope clip (OTSC). In addition to commentary on the use of OTSC in children, the etiology of the patient‘s problems is discussed, from H. pylori infection, to the influence of ongoing intercurrent infections with the administration of nonsteroidal anti-inflammatory drugs as a risk factor, and in terms of the development of UGIB, to rare and infrequent causes.