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Case report
peer-reviewed

Near-Fatal Gastrointestinal Hemorrhage in a Child with Medulloblastoma on High Dose Dexamethasone



Abstract

A four-year-old female was admitted to a university-based children's hospital with a newly-diagnosed posterior fossa tumor. She was started on famotidine and high-dose dexamethasone and underwent gross total resection of a medulloblastoma. She was continued on dexamethasone and famotidine. She exhibited postoperative posterior fossa syndrome and was started on enteral feeds via the nasoduodenal tube. She had small gastrointestinal bleeds on postoperative days eight, 11, and 18, and was found to have a well-circumscribed posterior duodenal ulcer. On postoperative day 19, she suffered a massive life-threatening gastrointestinal bleed requiring aggressive resuscitation with blood products. She required an emergent laparotomy due to ongoing blood loss and she was found to have posterior duodenal wall erosion into her gastroduodenal artery. She recovered and subsequently began delayed chemotherapy. This case demonstrates a rare and life-threatening complication of high-dose dexamethasone therapy in the setting of posterior fossa pathology despite stress ulcer prophylaxis. We present a historical perspective with the review of the association between duodenal and intracranial pathology and the usage of high-dose dexamethasone in such cases.



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Case report
peer-reviewed

Near-Fatal Gastrointestinal Hemorrhage in a Child with Medulloblastoma on High Dose Dexamethasone


Author Information

Derek Yecies Corresponding Author

Department of Neurosurgery, Stanford University School of Medicine

Daniel Tawfik

Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital

Jennifer Damman

Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital

Chad Thorson

Division of Pediatric Surgery, Department of Surgery, Stanford University Stanford University School of Medicine and Lucile Packard Children’s Hospital

David S. Hong

Division of Pediatric Neurosurgery, Department of Neurosurgery, Stanford University School of Medicine and Lucile Packard Children’s Hospital

Gerald A. Grant

Department of Neurosurgery, Stanford University School of Medicine

Rachel Bensen

Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital

Mihaela Damian

Division of Pediatric Critical Care, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.


Case report
peer-reviewed

Near-Fatal Gastrointestinal Hemorrhage in a Child with Medulloblastoma on High Dose Dexamethasone


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Case report
peer-reviewed

Near-Fatal Gastrointestinal Hemorrhage in a Child with Medulloblastoma on High Dose Dexamethasone

  • Author Information
    Derek Yecies Corresponding Author

    Department of Neurosurgery, Stanford University School of Medicine

    Daniel Tawfik

    Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital

    Jennifer Damman

    Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital

    Chad Thorson

    Division of Pediatric Surgery, Department of Surgery, Stanford University Stanford University School of Medicine and Lucile Packard Children’s Hospital

    David S. Hong

    Division of Pediatric Neurosurgery, Department of Neurosurgery, Stanford University School of Medicine and Lucile Packard Children’s Hospital

    Gerald A. Grant

    Department of Neurosurgery, Stanford University School of Medicine

    Rachel Bensen

    Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital

    Mihaela Damian

    Division of Pediatric Critical Care, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: July 07, 2017

    DOI

    10.7759/cureus.1442

    Cite this article as:

    Yecies D, Tawfik D, Damman J, et al. (July 07, 2017) Near-Fatal Gastrointestinal Hemorrhage in a Child with Medulloblastoma on High Dose Dexamethasone . Cureus 9(7): e1442. doi:10.7759/cureus.1442

    Publication history

    Received by Cureus: June 16, 2017
    Peer review began: June 21, 2017
    Peer review concluded: June 29, 2017
    Published: July 07, 2017

    Copyright

    © Copyright 2017
    Yecies et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

A four-year-old female was admitted to a university-based children's hospital with a newly-diagnosed posterior fossa tumor. She was started on famotidine and high-dose dexamethasone and underwent gross total resection of a medulloblastoma. She was continued on dexamethasone and famotidine. She exhibited postoperative posterior fossa syndrome and was started on enteral feeds via the nasoduodenal tube. She had small gastrointestinal bleeds on postoperative days eight, 11, and 18, and was found to have a well-circumscribed posterior duodenal ulcer. On postoperative day 19, she suffered a massive life-threatening gastrointestinal bleed requiring aggressive resuscitation with blood products. She required an emergent laparotomy due to ongoing blood loss and she was found to have posterior duodenal wall erosion into her gastroduodenal artery. She recovered and subsequently began delayed chemotherapy. This case demonstrates a rare and life-threatening complication of high-dose dexamethasone therapy in the setting of posterior fossa pathology despite stress ulcer prophylaxis. We present a historical perspective with the review of the association between duodenal and intracranial pathology and the usage of high-dose dexamethasone in such cases.



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Create a free account to continue reading this article.

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Derek Yecies, M.D.

Department of Neurosurgery, Stanford University School of Medicine

For correspondence:
dyecies@stanford.edu

Daniel Tawfik

Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital

Jennifer Damman

Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital

Chad Thorson

Division of Pediatric Surgery, Department of Surgery, Stanford University Stanford University School of Medicine and Lucile Packard Children’s Hospital

David S. Hong

Division of Pediatric Neurosurgery, Department of Neurosurgery, Stanford University School of Medicine and Lucile Packard Children’s Hospital

Gerald A. Grant

Department of Neurosurgery, Stanford University School of Medicine

Rachel Bensen

Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital

Mihaela Damian

Division of Pediatric Critical Care, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital

Derek Yecies, M.D.

Department of Neurosurgery, Stanford University School of Medicine

For correspondence:
dyecies@stanford.edu

Daniel Tawfik

Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital

Jennifer Damman

Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital

Chad Thorson

Division of Pediatric Surgery, Department of Surgery, Stanford University Stanford University School of Medicine and Lucile Packard Children’s Hospital

David S. Hong

Division of Pediatric Neurosurgery, Department of Neurosurgery, Stanford University School of Medicine and Lucile Packard Children’s Hospital

Gerald A. Grant

Department of Neurosurgery, Stanford University School of Medicine

Rachel Bensen

Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital

Mihaela Damian

Division of Pediatric Critical Care, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital