Non-Steroidal Anti-Inflammatory Drug-Induced Severe Upper Gastrointestinal Bleeding in an Infant: A Case Report

Abstract

Severe upper gastrointestinal bleeding (UGIB) in children is a medical emergency that poses a challenge to the paediatrician. Severe UGIB following acute use of Nonsteroidal anti-inflammatory drugs (NSAIDs) is rare and can be life-threatening. This is a report of an 8-month-old male who presented with acute fever and vomiting of blood three hours before hospital presentation. He had earlier received NSAIDs (ibuprofen at 10mg/kg/dose). He subsequently had massive haematochezia within one hour of presentation. The packed cell volume drop exceeded 10% (27% to 16%) within 6 hours, accompanied by the development of a haemic murmur. Upper gastrointestinal endoscopy performed about 36 hours after presentation showed massive duodenal ulcers with multiple duodenal vessels oozing blood. The infant was successfully managed with multiple blood transfusions, omeprazole, tranexamic acid, antibiotics and multiple endoscopic haemostasis. This case illustrates the potential for severe upper gastrointestinal bleeding following the use of NSAIDs in infants. Caregivers should be educated on the dangers of self-medication with over-the-counter medications, especially NSAIDs.