Successful treatment of a bleeding duodenal ulcer using an over-the-scope clip in a five-year-old patient

Czech version

Authors: D. Klepárník ¹; L. Kunovský- ^{2 4}; P. Falt ²; B. Sobota ¹; M. Rohanová ¹; R. Drápalová ¹; L. Bakaj Zbrožková ⁵; E. Karásková ¹
Authors‘ workplace: Dětská klinika LF UP a FN Olomouc ¹; II. interní klinika – gastroenterologická a geriatrická LF UP a FN Olomouc ²; Chirurgická klinika LF MU a FN Brno ³; Gastroenterologické oddělení a digestivní endoskopie, LF MU a MOÚ, Brno ⁴; Radiologická klinika LF UP a FN Olomouc ⁵
Published in: Gastroent Hepatol 2025; 79(4): 299-304
Category: Case Report
doi: https://doi.org/10.48095/ccgh2025299

Overview

Upper gastrointestinal bleeding (UGIB) is a serious or even life-threatening event. In childhood, gastroduodenal ulcer disease is the second most common cause of UGIB after erosive gastritis. Risk factors for ulceration include Helicobacter pylori (H. pylori) infection and use of non-steroidal anti-inflammatory drugs. Patients in shock and on artificial pulmonary ventilation are also at increased risk. In addition to H. pylori, infections with Cytomegalovirus, Herpes simplex virus, or tuberculosis may contribute to the development of peptic ulceration. Ulceration may be a manifestation of Crohn‘s disease, Zollinger-Ellison syndrome, and other less common diseases. A case report of a 5-year-old boy with two attacks of melena, collapse and vomiting of blood is presented. Endoscopically, an ulceration of the duodenal bulb was found with a stump of a blood vessel at the base (Forrest IIa). Primary treatment with standard endoclips inserted through the working channel of the endoscope (TTS clip –⁠ through-the-scope clip) failed, as did treatment with the thermal method using argon-plasma coagulation. Successful treatment of the ulcer was achieved only with the use of an over-the-scope clip (OTSC). In addition to commentary on the use of OTSC in children, the etiology of the patient‘s problems is discussed, from H. pylori infection, to the influence of ongoing intercurrent infections with the administration of nonsteroidal anti-inflammatory drugs as a risk factor, and in terms of the development of UGIB, to rare and infrequent causes.

Keywords:

peptic ulceration – melena – hematemesis – children – endoscopy

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ORCID autorů

D. Klepárník 0009-0008-1027-6349,

L. Kunovský 0000-0003-2985-8759,

P. Falt 0000-0001-8843-4716,

M. Rohanová 0000-0002-0628-1486,

R. Drápalová 0009-0005-8707-0435,

E. Karásková 0000-0001-9580-2302.

Doručeno/ Submitted: 14. 7. 2025

Přijato/ Accepted: 30. 7. 2025

Korespondenční autorka

doc. MU Dr. Eva Karásková, Ph.D.

Dětská klinika