Laparoscopy for small-intestinal bleeding in children

Background and Purpose: The source of gastrointestinal bleeding in children is usually readily identifiable with a standard evaluation. Rarely, the source of bleeding is obscure and may be conditions such as intestinal duplication, Meckel's diverticulum, or Henoch-Schonlein purpura (HSP). Laparoscopy is an ideal modality to identify such obscure sources and may also allow definitive therapy at the time of evaluation. The authors describe their experience with this modality. Patients and Methods: In a 1-year period, 64 patients were evaluated for gastrointestinal bleeding. Laparoscopy was used for diagnosis and treatment when the source of bleeding could not be ascertained by physical examination and upper or lower tract endoscopy or both. Results: Upper tract endoscopy and colonoscopy failed to demonstrate a bleeding source in four patients. The source of bleeding was a Meckel's diverticulum in three patients. Two of these lesions were suspected preoperatively from Meckel's scans. The source of bleeding in the fourth patient was HSP that was not recognized preoperatively. Laparoscopy-assisted small-bowel resection was used in the patients with Meckel's diverticula. Diagnostic laparoscopy alone was used for the patient with HSP. Conclusion: Laparoscopy is a valuable tool in the diagnosis and treatment of obscure sources of gastrointestinal bleeding in children.