AUCTORES
Globalize your Research
Review Article | DOI: https://doi.org/10.31579/2690-1919/212
* Department of Pediatric Surgery, İzmir Faculty of Medicine, Sağlık Bilimleri University, İzmir Tepecik Health and Research Center, İzmir- TURKEY.
*Corresponding Author: Volkan Sarper Erikci, Kazım Dirik Mah. Mustafa Kemal Cad. Hakkıbey apt. No: 45 D.10 35100 Bornova-İzmir, Turkey.
Citation: Volkan S. Erikci. (2022). An Overvıew of Lower Gastroıntestınal Bleedıng ın Infants and Toddlers: A Revıew Artıcle. J Clinical Research and Reports, 10(1); DOI:10.31579/2690-1919/212
Copyright: © 2022, Volkan Sarper Erikci. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 26 October 2021 | Accepted: 16 December 2021 | Published: 03 January 2022
Keywords: lower gastrointestinal bleeding; infants and toddlers; etiology; weight loss; meckel’s diverticulum; treatment
Lower gastrointestinal bleeding (LGIB) in infants and toddlers is commonly encountered in clinical practice. There are several factors producing LGIB in these children and are usually managed with regard to the underlying pathology that produces LGIB. Although majority of these bleeding episodes is self limited, certain infants and toddlers with LGIB may necessitate prompt management including urgent surgical intervention. In this review article it is aimed to review the etiology, epidemiology, clinical manifestations and principles of treatment of LGIB in infants and toddlers under the light of relevant literature.
Lower gastrointestinal bleeding (LGIB) in infants and toddlers is commonly encountered in daily clinical practice [1-5]. LGIB is defined as blood in the stool derived from lesions originating from any location in the gastrointestinal tract distal to the ligament of Treitz which determines the duodenojejunal junction. Of the children presenting to the hospital with rectal bleeding, approximately one-third have LGIB and the remaining have either bleeding originating from upper gastrointestinal tract or bleeding with unclear etiology [6]. Hopefully only 5-10 percent of these cases show findings of severe gastrointestinal bleeding necessitating prompt management [1, 6]. Stools in these children may be in the form of hematochezia as bright red or pink, melena as tar-like substance or blood may not be visible by eye indicating occult bleeding which can be detected by laboratory tests. In this review article it is aimed to overview common causes of LGIB in infants and toddlers together with therapeutic options in the management and the literature on this issue is also reviewed for readers.
There are several etiological factors for LGIB in infants and toddlers (one month to 2 years of age). These are depicted in (Table 1).
Anal fissures Allergic colitis Intussusception Meckel’s diverticulum Lymphonodular hyperplasia Gastrointestinal duplication cysts Coagulopathy Eosinophilic gastrointestinal disease Infantile and very early-onset inflammatory disease |
Table 1: The most common causes of LGIB in infants and toddlers.
Anal fissures
Infants and toddlers usually present with constipation associated with anal fissures following the introduction of solid foods or cow’s milk into the diet, during toilet training or at the time of entry to school. Most of the previous reports have documented that constipation with anal fissure formation is the most common cause of LGIB in toddlers and school age children [7-9]. The diagnosis of anal fissure is easy by everting the anal canal the fissure can easily be seen at the usual position of 6 or 12 o’clock at supine position. If the medical history of the infant reveals painful defecation together with straining, straining associated with witholding of feces during defecation manoeuvres, observation of streaks of red blood on the surface of feces, it is likely that the child has anal fissure. Management of constipation by dietery regulations and medications together with sitz baths and topical therapy including analgesics is all that is needed for cure of the disease.
Allergic colitis
This entity is also called as milk or soy protein induced colitis. Prolonged vomiting and bloody diarrhea are classic symptoms of cow’s milk allergy in infants. If untreated, with the progression of the disease, dehydration may be seen especially in infants younger than 3 months of age [10]. In severe and untreated cases with a long history malabsorption, protein-loosing enteropathy and failure to thrive may result. Hopefully usual course of the disease is self limited and does not cause weight loss or failure to thrive. Food allergy usually resolves within 6-18 months of age.
Intussusception
Intussusception is the most common cause of intestinal obstruction in infants between 6-36 months of age. Majority of children with intussusception are younger than 2 years. Intussusception in this age group is usually idiopathic without any lead point whereas older children present with different kinds of lead point producing intussusception like a polyp, Meckel’s diverticulum. Typically the infants may awaken from sleep with abdominal pain and draw up their legs into the abdomen. Colicky abdominal pain is the usual finding in these children. The stool usually contains gross or occult blood in most of the children and as the disease progresses the characteristic “currant jelly” appearance may be seen in the stool. Eventually the child becomes apathetic and a sausage shaped mass may be palpable. Ultrasonography is the method of choice in diagnosing the intussusception in majority of cases and it also permits reduction of intussusception during the study. If ultrasonographic findings are inconclusive for the diagnosis of intussusception, a water soluble contrast enema under fluoroscopic guidence may be an alternative means of imaging study for both diagnosis and treatment. These children should be managed promptly beginning with intravenous fluid and electrolyte infusion, nasogastric decompression. If any restrictive circumstances do not exist like intestinal perforation, reduction of intussusception by aforementioned radiological methods should be performed urgently. Surgical intervention may be necessary in whom the intussusception can not be reduced radiologically or a complication like intestinal perforation occurs.
Meckel’s diverticulum
Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract. It is a true diverticulum containing all layers of the bowel wall (11). Most cases of Meckel’s diverticulum are asymptomatic and those cases that contain ectopic gastric mucosa are generally associated with bleeding which is painless in general. The diagnosis of a bleeding diverticulum is by Meckel’s scintigraphy which has asensitivity of 85-97%. The treatment of Meckel’s diverticulum is resection of diverticulum.
Infectious colitis
There are several pathogens which can cause LGIB during infancy. Most common of these are Salmonella, Shigella, Campylobacter, E. coli 0157:H7, and Clostridioides difficile. Especially immunocompromised children may be effected by potantial pathogens including Mycobacteria and Aeromonas hydrophilia although Aeromonas infection typically presents with nonbloody diarrhea but in some cases diarrhea containing blood may also be seen during the disease process. Occasionally Neisseria gonorrhea, Chlamydia trachomatis, and Plesiomonas shigelloides can occasionally produce bloody stools. The diagnosis of infectious colitis is usually made by isolating the microorganism from the stool or blood. These children usually present with rectal bleeding accompanied by fever, abdominal pain, tenesmus and small pieces of small bloody stools. The treatment of infants with infectious colitis depends on the underlying pathogenic agent that produces infectious colitis and these children should be treated accordingly.
Lymphoid nodular hyperplasia
This is one of the most common causes of LGIB in infants and toddlers and is an unlikely source of rectal bleeding in older children [12]. These lesions are characterized by multiple, yellowish lymphoid follicles in children who undergo endoscopic examination of gastrointestinal tract. Although most authors consider these lesions to be a normal finding others believe that they are due to an immunologic response of body to a variety of stimulants [13-17]. Lymphoid nodular hyperplasia is usually asymptomatic and resolves spontaneously but sometimes needs dietary restriction and occasional steroid medication [18].
Gastrointestinal duplication cysts
Gastrointestinal duplication cysts can be found at any level of the gastrointestinal tract and often do not communicate with the intestinal lumen. Almost half of the gastrointestinal duplication cysts contain gastric mucosa and may form fistulas between colon and stomach which may be the source of LGIB in infants. Although not so often, gastric duplication cyst that contains ectopic mucosa may produce a communication between stomach and colon producing LGIB. In addition when it communicates with the intestinal lumen it may also produce LGIB necessitating hospital admission. Treatment option of LGIB produced by gastrointestinal duplication cysts depends on the anatomic location of the duplication cysts and should be managed surgically
Other causes
Other causes of LGIB in infants and toddlers include very early-onset inflammatory bowel disease, coagulopathy, brisk upper gastrointestinal bleeding, vascular malformations, gastric or duodenal ulcers and other rare causes of LGIB. Gastrointestinal bleeding related to any of these pathologies should be managed by eliminating the causative factors that produce blood in the stool together with an appropriate treatment modality.
In conclusion, LGIB in infants and toddlers can be a presenting symptom of various underlying disease states. Although minority of infants and toddlers show severe bleeding signs, a systematic approach for diagnosis of underlying lesions and a prompt management including sometimes surgical intervention is paramount. The medical providers should keep causative factors of LGIB in infants and toddlers and a rapid pediatric surgery consultancy is recommended. These children should receive appropriate treatment immediately.
The author certifies that he has no affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.
During this study, no financial or spiritual support was received neither from any pharmaceutical company that has a direct connection with the research subject, nor from a company that provides or produces medical instruments and materials which may negatively affect the evaluation process of this study.
Idea/concept, design, control and processing, analysis and/or interpretation, literature review, writing the article, critical review, references and materials by Volkan Sarper Erikci.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
