Recently, a rare, complex, life-threatening bleeding condition in a 10-month-old infant was successfully treated at a suburban Mumbai hospital. As per details shared with the press, the baby had been vomiting blood, and passing dark brown stools and had recorded four such episodes intermittently at the age of two months. A series of comprehensive evaluations including liver function tests and an upper GI endoscopy was carried out but the tests did not reveal any abnormalities.
As per a paper published in the Italian Journal of Paediatrics, gastrointestinal bleeding (GIB) "is a common condition in children and managing GIB in children requires a "systematic approach, a comprehensive clinical assessment and appropriate diagnostic procedures."
This includes accurately discerning true blood from other substances that might mimic bleeding and identifying the location and severity of the bleeding. The cause of the bleeding can be varied and multiple and that is why it is a challenge to figure out the exact cause in each case. For instance, in this case, doctors initially thought the bleeding could be a result of CMPA - that is milk protein allergy, and suggested the baby be given only soy milk and not dairy. However, it did not help.
A significant breakthrough came when the mother reported that the baby had repeated coughing episodes before vomiting blood, noted doctors at Narayana Health SRCC Children's Hospital where the baby was admitted.
A bronchoscopy led to the discovery of a small swelling near the base of the tongue, along with traces of blood in the airways. An MRI scan further identified this swelling as a thyroglossal cyst, while a CT pulmonary angiography revealed the actual source of the bleeding—a small cavity in the upper part of the left lung with an actively bleeding blood vessel, the doctors associated with the case, explained.
The Interventional Radiologist at the hospital performed an embolisation procedure, which is a minimally invasive procedure to block the bleeding vessel in the lungs, ensuring the infant's safe recovery.
Speaking on the rarity of the case, Dr Aditya Kulkarni, Consultant- Paediatric Gastroenterology and Hepatology, Narayana Health SRCC Children’s Hospital said that the main challenge was that the bleeding did not originate from the digestive tract, as was initially suspected. "The child was swallowing blood from the airways, which led to the appearance of dark stools. Respiratory causes for blood vomiting are highly uncommon and required extensive investigation. Performing a delicate embolisation procedure in a baby of this age demanded precision and expertise.”
Following the procedure, the baby was discharged after a seven-day hospital stay after she did not report further episodes of coughing blood.
