Chronic Bleeding Following Duhamel Procedure Due to Staple Line Ulcers

Excerpt

To the Editor: A child with Down’s syndrome and Hirschsprung disease underwent a Martin’s modification of Duhamel procedure using 75 mm-GIA™ staplers at 14 mo of age. Four days later, there was a small amount of hematochezia. The child was managed with antibiotics and discharged with a hemoglobin of 9.4 g/dl. Twelve days post-surgery, there was persistent hematochezia. Hemoglobin dropped to 6.6 g/dl. There was no suggestion of enterocolitis. Antibiotics and blood transfusion were given. The bleeding stopped after a few days. Colonoscopy was done 2 mo post-surgery since the bleeding recurred. The neorectum showed two linear staple-line ulcers covered by yellow exudates, continuously oozing blood at various point along the ulcer without visible vessels (Fig. 1). Endoscopic clips placed at the site of maximum oozing stopped the bleeding only for 2 d. Oral polyethylene glycol at 1 g/kg/d was started to decrease fecal stasis and mechanical effect of hard stools on the ulcers. The bleeding stopped after 2 wk. The child has been asymptomatic for 10 mo.

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