ABSTRACT
Small intestinal bleeding often poses diagnostic and therapeutic challenges in the care of pediatric patients. This chapter reviews the diagnostic modalities most often used for evaluation, and discusses etiologies of and therapy for small intestinal bleeding in children. Meckel diverticulum is likely to be the most common cause of small intestinal bleeding in children, and is an anomalous remnant of the vitelline duct. Bleeding from Meckel diverticulum is the result of mucosal ulceration due to the secretions of ectopic gastric or pancreatic tissue located in the diverticulum itself. Intestinal duplication cysts arise from the mesenteric border of the bowel, and are typically located in the small intestine, particularly at the terminal ileum. Small intestinal bleeding may occur in children with anastomotic ulcers resulting from previous small bowel resections. Adenomatous polyps and hamartomatous polyps can present with small intestinal bleeding, but frequently the colonic involvement dominates the presentation.
