Complex upper gastrointestinal bleeding: A case of combined peptic ulcer disease and ruptured gastroduodenal artery aneurysm in a pediatric patient

Abstract

Upper gastrointestinal (GI) bleeding in older children is generally caused by conditions like esophagitis, esophageal variceal rupture, and peptic ulcer disease. However, it is rare for bleeding to result from a ruptured vascular aneurysm of the gastroduodenal artery, particularly when associated with peptic ulcer disease. This report describes a case involving a 13-year-old male who presented with severe upper GI bleeding and hemodynamic instability, requiring blood transfusion. During an emergency upper GI endoscopy, a bleeding gastric ulcer classified as Forrest IIB was identified. The bleeding was managed initially with endoscopic hemostasis and surgical suturing. Despite these interventions, the patient experienced recurrent bleeding. Further investigation with contrast-enhanced computed tomography (CT) imaging revealed a vascular aneurysm in the gastroduodenal artery. The patient subsequently underwent successful endovascular embolization, as confirmed by digital subtraction angiography (DSA). Following this procedure, there were no further episodes of GI bleeding. This case highlights the critical need for thorough diagnostic evaluation using contrast-enhanced CT and endoscopy in managing complex GI bleeding cases. Early detection and appropriate intervention are essential, especially in pediatric patients where the cause of bleeding may be rare and severe.