Pediatric emergency medicine trisk 2065 2065
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develop bowel ischemia, perforation, and bleeding. Significant GI bleeding is
rare, but possible.
Gastrointestinal Vascular Malformations
GI vascular malformations are rare causes of GI bleeding in children and may
be seen as a part of a congenital syndrome, such as Klippel–Trenaunay–Weber
syndrome or blue rubber bleb nebus syndrome. Lesions may be solitary or
diffuse. Infantile hemangiomas may also occur in the GI tract and present with
bleeding. Acute hemorrhage is possible, however less likely than slow,
chronic blood loss. ED management of patients with GI bleeding from
vascular malformations is the same as for any patient with potentially
significant blood loss. After initial stabilization, referral to an appropriate
subspecialty consultation for definitive diagnosis and definitive treatment is
warranted.
Foreign Bodies
Swallowed foreign bodies can cause significant trauma and GI bleeding.
Eighty percent to 90% of ingested foreign bodies are able to pass without
intervention, even those with sharp edges ( Fig. 91.2 ). Approximately 10% to
20% must be removed endoscopically, and only approximately 1% requires
surgery. Removal by endoscopy is indicated if significant bleeding occurs or if
the foreign body is retained in the esophagus. Consideration for endoscopic
and/or surgical removal should be made if the foreign body is causing
symptoms (e.g., obstruction), involves multiple magnets, or is greater than 5
cm in length (see Chapter 32 Foreign Body: Ingestion and Aspiration ).
PANCREATITIS
Goals of Treatment
Pancreatitis can be difficult to diagnose in children and is often overlooked as
it is uncommon and no specific pathognomonic symptoms are associated with
the condition. The goal of ED management is to make an early diagnosis,
recognize any potential causative factors, and address any complications that
may be present at the time of presentation. Once identified, the goals of
medical treatment include fluid resuscitation, pain control, and treatment of
early complications such as hypovolemia, hypocalcemia, respiratory distress,
and infection.
