Gastrointestinal Bleeding

Learn symptoms, causes, management of paediatric gastrointestinal bleeding, and when to contact a paediatric surgeon in Singapore.

What Is Gastrointestinal Bleeding?

Gastrointestinal (GI) bleeding refers to any bleeding that occurs in the digestive tract, from the mouth to the anus. In children, this can be a frightening emergency that requires immediate medical attention. The bleeding can come from anywhere along the digestive system: the oesophagus, stomach, small intestine, or colon.
GI bleeding is classified into two main categories based on location:
Upper GI Bleeding: Bleeding from the oesophagus, stomach, or upper small intestine (above the ligament of Treitz). This requires upper GI bleeding paediatric treatment and often presents differently from lower GI bleeding.
Lower GI Bleeding: Bleeding from the lower small intestine, colon, rectum, or anus. This needs lower GI bleeding treatment and has its own set of causes in children.
Understanding where the bleeding originates helps guide GI bleeding diagnosis and treatment decisions.

Common Symptoms of Gastrointestinal Bleeding in Children

Contact us immediately if your child has blood in the stool, severe abdominal pain, persistent vomiting, inability to pass stool or gas, and signs of dehydration or blood loss (pale, weak, dizzy).
These symptoms may require urgent paediatric diagnosis and possible Meckel's diverticulum surgery.

Hematemesis (Vomiting Blood) - Upper GI Bleeding Sign

Hematemesis indicates bleeding from the upper digestive tract:

Bright red blood in vomit suggests active bleeding
Coffee-ground appearance (dark and grainy vomit) indicates blood that has been partially digested by stomach acid
Large or small amounts, depending on severity
Often accompanied by nausea

Melena (Black, Tarry Stools) - Upper GI Bleeding Sign

Melena also suggests upper GI bleeding:

Black, tarry, sticky stools with a distinctive foul odour
Dark colour results from blood being digested as it passes through the intestines
Usually indicates bleeding from the stomach or the upper small intestine
Means blood has been present for several hours
May not be noticed immediately by parents

Hematochezia (Bright Red or Maroon Stools) - Lower GI Bleeding Sign

Hematochezia typically indicates lower GI bleeding:

Bright red blood in or on the stool
Maroon-colored stools if bleeding is from the right colon
Blood mixed with stool or coating the outside
Blood-streaked toilet paper
Can range from small to large amounts

Other Symptoms

Depending on the amount and speed of bleeding:

Weakness and fatigue from blood loss and anaemia
Pale skin and lips indicating anemia
Dizziness or lightheadedness, especially when standing
Rapid heartbeat as the body tries to compensate
Shortness of breath with significant blood loss
Abdominal pain or cramping (location varies by cause)
Fainting or loss of consciousness in severe cases (medical emergency)
Cold, clammy skin with severe blood loss

Babies and toddlers can't tell you they don't feel well, so watch for irritability and fussiness, refusal to eat or drink, lethargy or decreased activity, pale appearance, and rapid breathing.
Any GI bleeding in children warrants immediate medical attention to identify the source and stop the bleeding.

What Causes Gastrointestinal Bleeding in Children?

The causes of GI bleeding differ significantly between children and adults. Understanding paediatric-specific causes is essential for proper GI bleeding diagnosis.

Causes of Upper GI Bleeding in Children

Esophagitis: Inflammation of the oesophagus from gastroesophageal reflux disease (GERD), infections, or medications. Acid damages the oesophageal lining, causing erosions that bleed.
Gastritis: Inflammation of the stomach lining from infections, stress, medications, or allergic conditions. This causes superficial bleeding that may present as hematemesis or melena.
Peptic Ulcers: Less common in children than adults, but can occur from H. pylori infection, NSAID medication use, or stress (especially in critically ill children). Open sores in the stomach can bleed significantly.
Mallory-Weiss Tears: Forceful vomiting or retching can cause tears in the oesophageal lining, leading to small to moderate hematemesis.
Oesophageal or Gastric Varices: Dilated veins in the oesophagus or stomach due to liver disease or portal hypertension.
Foreign Body Ingestion: Swallowed objects (coins, batteries, sharp objects) can cause injury and bleeding. Button batteries are particularly dangerous and require emergency removal.
Vascular Malformations: Abnormal blood vessels in the upper GI tract that can bleed spontaneously.

Causes of Lower GI Bleeding in Children

Anal Fissures: This is the most common cause of small amounts of bright red blood in infants and toddlers. Small tears in the anus from constipation or hard stools cause bleeding and pain with bowel movements.
Infectious Colitis: Bacterial infections (Salmonella, Shigella, Campylobacter, E. coli) or parasites can cause bloody diarrhoea. This often comes with fever, cramping, and frequent stools.
Milk Protein Allergy: Common in infants, causing inflammation of the colon and blood-streaked stools. Usually occurs in the first few months of life with formula or breast milk.
Intussusception: Telescoping of one part of the intestine into another, causing obstruction and bleeding. Classic presentation is intermittent severe pain, vomiting, and currant jelly stools (blood and mucus). Medical emergency requiring urgent lower GI bleeding paediatric treatment.
Meckel's Diverticulum: A congenital pouch in the small intestine that can cause painless, large-volume rectal bleeding. This often presents as hematochezia in young children.
Inflammatory Bowel Disease (IBD): Crohn's disease or ulcerative colitis causes chronic inflammation and ulceration. This is more common in older children and presents with bloody diarrhoea, abdominal pain, and weight loss.
Polyps: Benign growths in the colon are common in children ages 2-10, causing painless rectal bleeding, often coating the outside of stool.
Henoch-Schönlein Purpura (HSP): An inflammatory condition affecting blood vessels that can cause GI bleeding along with rash and joint pain.
Vascular Malformations: Abnormal blood vessels anywhere in the GI tract can bleed.

Understanding the cause of GI bleeding in children is essential for proper treatment and preventing recurrence.

Consequences of Untreated Gastrointestinal Bleeding in Children

GI bleeding in children can have serious consequences if not immediately evaluated and treated.

Acute Blood Loss and Shock

Rapid and significant GI bleeding can lead to hypovolemic shock, decreased oxygen delivery to vital organs, and organ damage (kidneys, brain, heart). This can lead to death in severe, untreated cases.
Children can deteriorate quickly, making urgent GI bleeding paediatric treatment critical.

Anemia

Chronic or recurrent bleeding causes iron deficiency anaemia, fatigue and weakness affecting daily activities, poor growth, and cognitive difficulties in school. Your child’s development will be delayed if anaemia is prolonged.

Delayed Diagnosis of Serious Conditions

Without a proper GI bleeding diagnosis, serious underlying conditions may be missed:

Inflammatory bowel disease progresses without treatment
Peptic ulcers worsen and can perforate
Vascular malformations continue bleeding
Tumours (rare in children but possible) grow
Intussusception leads to bowel death

Complications from Specific Causes

Intussusception: Without treatment within 24-48 hours, the telescoped bowel loses blood supply, dies, and can perforate, causing life-threatening peritonitis.
Oesophageal varices: Bleeding episodes can be massive and life-threatening, requiring emergency intervention.
Foreign bodies: Button batteries can cause severe injury within hours, leading to perforation, bleeding, and death of tissue.
Severe infections: Bloody diarrhoea from certain bacteria can lead to kidney failure or sepsis.

This is why any GI bleeding in your child requires immediate medical evaluation, and treatment should not be delayed, even in cases with few symptoms.

How to Treat Gastrointestinal Bleeding

Treatment depends on the location, cause, and severity of bleeding. At The Little Surgery, we provide expert evaluation, appropriate testing, and necessary surgical interventions for both upper and lower GI bleeding.

Stabilisation and Diagnosis

For any GI bleeding in children, initial priorities are assessment of severity and resuscitation. We check your child’s vital signs (heart rate, blood pressure, breathing rate), level of consciousness, skin colour, amount of blood loss, and signs of shock.
IV line, fluid resuscitation, blood transfusion, and oxygen supply may be given. Vital signs are continuously monitored.
Once stable, identifying the source and cause of bleeding is crucial. A history and physical examination is performed, along with laboratory tests to check blood count, coagulation, stool, and liver and kidney function. We use imaging studies, including GI series, x-rays, CT, and ultrasound, to visualise the oesophagus, stomach, and intestines. For suspected upper GI bleeding, an endoscopy is done; for suspected lower GI bleeding, a colonoscopy is done.

Non-Surgical GI Bleeding Paediatric Treatment

Many causes of GI bleeding can be managed medically without surgery.

Acid-related Conditions (Ulcers, Gastritis, Esophagitis): Proton pump inhibitors (PPIs) are given to reduce stomach acid. H2 blockers decrease acid production, and sucralfate coats and protects ulcers.
Variceal Bleeding: Medications can reduce portal pressure and constrict blood vessels.
Infectious Colitis: Antibiotics, probiotics, and supportive care with hydration.
Milk Protein Allergy: Usually resolved with dietary changes for mother and baby.
Inflammatory Bowel Disease: Anti-inflammatory medications, immunosuppressants, and nutritional therapy.
Anal Fissures: Can be managed with stool softeners, high-fibre diets, topical ointments, and sitz baths.

Surgical GI Bleeding Paediatric Treatment

Some causes of GI bleeding in children require surgical intervention:

Intussusception: If not reduced by enema, surgery is needed. Laparoscopic or open surgery can manually reduce and check bowel viability.
Meckel's Diverticulum: Surgical removal of the diverticulum if bleeding or causing obstruction.
Perforated Ulcer: Emergency surgery to repair the perforation.
Severe Bleeding: Surgery to identify and stop the bleeding source.
Intestinal Obstruction with Bleeding: Surgery to relieve obstruction.

Why Choose The Little Surgery for GI Bleeding Paediatric Treatment

We provide comprehensive care for GI bleeding in children, including expert evaluation, stabilisation, testing, medical management, and surgical treatment when needed for both upper and lower GI bleeding.

Experienced Paediatric Surgeon

Dr. Ong Lin Yin has over 20 years of experience in paediatric surgery, including the treatment of GI bleeding in children. As the former Head of Paediatric Surgery at KK Women's and Children's Hospital, she has managed numerous cases with both non-surgical and surgical interventions.

Comprehensive Care

We provide thorough GI bleeding diagnosis, including detailed history and examination, imaging and laboratory studies, and determination of appropriate GI bleeding treatment based on cause and severity. For children with acute complications, we provide urgent stabilisation and emergency surgery.

Family Support

We understand that GI bleeding is frightening for children and parents. We provide clear explanations of your child’s condition, detailed discussions on surgery, compassionate support throughout treatment, and a long-term partnership in your child's care.
As a mother herself, Dr. Ong understands family concerns and ensures you feel informed and comfortable.

Contact The Little Surgery Today

If your child has signs of gastrointestinal bleeding, we can provide immediate medical attention.
Contact The Little Surgery today and take the first step toward ensuring your child's health and happiness.