Coordinate with City Children’s Hospital and Dong Thap General Hospital in timely emergency treatment of children with dengue hemorrhagic fever with severe gastrointestinal bleeding

At 23:40, on December 30, 2021, the emergency department of the City Children’s Hospital received a 13-year-old LNH child, male, weighing 65kg (normally at this age, close to 34-40kg crutches), receiving treatment from the hospital. General Department of Dong Thap transferred with a diagnosis of hypovolemic shock due to gastrointestinal bleeding under complications of severe acute ischemia – TD ruptured Mackel’s diverticulum – Dengue hemorrhagic fever N4. Taking the medical history recorded that the child was sick for 4 consecutive days with high fever, no vomiting, no cough, poor appetite, and normal urination. Day 4: the child still had a fever, had poor appetite, complained of dull abdominal pain with bright red blood, so he was admitted to Dong Thap General Hospital, diagnosed with hypovolemic shock due to lower gastrointestinal bleeding, severe acute ischemic complications. – TD ruptured Mackel’s diverticulum, Lactate Ringer anti-shock fluid 90 ml/kg/9 hours, macromolecule 20 ml/kg/3 hours blood transfusion about 1.5 liters, fresh frozen plasma 200 ml, the child continued to have bowel movements Hematuria many times the volume of red blood cells Hct decreased to 12-14% (normally Hct in this age group is 38-45%, should consult with doctors at City Children’s Hospital, transfer to hospital. symptoms of peptic ulcer disease on admission lethargy, slow contact, pale lips/oxygen, SpO2 94% Light pulse 120 beats/min, cool extremities, blood pressure 100/75mmHg, perfusion poor skin blood, heart is regular, lungs are not rales, abdomen is soft and distended, liver is 2cm below right costal margin, pain is pressed, large amount of bright red blood in stool is about 500ml, Hct is only 10%, blood clotting function test is disordered Severe APTT lasting > 120 s, PT 25 s, fibrinogen < 0.8g/L, platelets 41000/microL (normal 150000-40000), diagnosed by doctors: hemorrhagic shock – severe gastrointestinal bleeding – severe Dengue hemorrhagic fever N4 – overweight. Children are treated: oxygen through cannula, anti-shock fluid, infusion of red sediment, fresh frozen plasma, frozen precipitate, platelets, vitamin K1 injection, infusion of drugs to reduce gastric secretion omeprazole, consultation with a gastroenterologist chemotherapy, general surgery, anesthesia resuscitation, surgical resuscitation, emergency endoscopy for children when hemodynamic status and coagulation disorders are stable, endoscopic results show normal pharynx and mucosa, esophageal mucosa, normal mucosal cardia, gastric mucosal aneurysm, mild hemorrhagic inflammation, normal mucosal body, normal mucosal antrum, little old brown blood, stagnation of blood in the duodenal bulb. bright red, perform irrigation with physiological saline, after irrigation, the back of duodenum D1 has a bright red oozing structure following the pulse of the artery 2mm in diameter on the 2x3cm ulcer, the procedure: pump 2 tubes of adrenaline diluted 1/10000 around the bleeding site, coordinate with surgery to stop bleeding ulcers. After gastrointestinal endoscopy with hemostasis, the child's blood pressure was stable, there was no more blood in the stool, the Hct was stable at 28-30%, the child continued to be treated in the intensive care unit.

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The results of emergency gastrointestinal endoscopy showed that the posterior wall of the D1 page had a 2x3cm slit, an artery with a diameter of 2mm that spewed blood continuously in rhythm, and was injected with hemostatic drugs and stitched by the doctors.

After endoscopic intervention to stop the bleeding of duodenal ulcer, the child’s pulse and blood pressure were stable, no further hematuria, continued treatment at the surgical resuscitation department.

Doctor of CK2 Nguyen Minh Tien
City Children’s Hospital

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