S134 Pediatric Case of Massive Bleeding from a Steroral Ulcer With Angiodysplasia
Abstract
Case: Introduction: Stercoral colitis is a rare form of inflammatory colitis that usually occurs due to massive stagnation of fecal material, accompanied by intestinal distention, bleeding, and other typical and atypical complications, with further formation of the so-called fecaloma. In the practice of pediatric surgery and gastroenterology, as well as emergency medicine for children, patients with such symptoms are most often hospitalized under the preliminary diagnosis of "acute abdomen", and stercoral colitis is not diagnosed in routine pediatric practice. Case presentation: The case of a 7-year-old child (born in 2015) with complaints of abdominal pain, bloating, and rectal blood clots unrelated to bowel movements has been investigated. The patient has suffered from constipation from the ages of one to 3 years old. At the age of 3, the patient discovered bleeding. According to the medical record, a gradual improvement has been achieved in 2017, constipation was managed with lactulose. In 2019, the patient was re-diagnosed with the above complaints and hospitalized with a diagnosis of ulcerative colitis. But after the diagnostic colonoscopy investigation and clinical features of the disease, the patient has been diagnosed Stercoral colitis by surgeon. Further, following the gastroenterologist's recommendation, the patient was referred for a series of instrumental diagnostics to collect visual data. In the protocol of the ultrasound, the presence of an echocardiogram of a cavernous hemangioma of the lower and middle parts of the rectum was concluded. Further, according to MSCT data, a picture of venous malformation of the small pelvis and perineum was revealed, with varicose veins of the pudendal veins, veins of the rectum, the internal gluteal vein on the right, soft tissue veins of the perineum, with the presence of collaterals in the middle sacral vein. To eliminate the suspicions of oncology, an MRI was performed. MRI diagnostics revealed signs of diffuse changes in the walls of the rectum with multiple hemangiomas of the pelvic (left), and gluteal-femoral region (right) with suspected angiomatosis. Video colonoscopy revealed signs of lengthening of the colon loops, anal fissure, sphincteritis, linear oozing rectal stercoral ulcer. Four weeks after discharge, he had 6 episodes of bright red per rectal bleeding that progressively worsened. Emergency colonoscopy showed a blood-filled rectum with a 5mm actively bleeding linear ulcer 4cm from the anorectal junction. Hemostasis was achieved with epinephrine injections and hemostatic clips to the ulcer, and once stable, the patient was discharged. Conclusion: Complicated forms of stercorial colitis can be fatal and require immediate action. As revealed, chronic constipation with an atypical course and the presence of a symptom complex of ulcerative colitis can be a red signal for the gastroenterologist and surgeon. Diverticulosis and angiodysplasia are the 2 commonest causes of massive lower gastrointestinal (GI) bleeding. After resuscitation, urgent endoscopy can usually identify and treat the lesion. This approach will allow a quick step towards the therapeutic stage from the diagnostic stage, and as a result avoid more serious complications, such as intestinal perforation, peritonitis, and others.