title: Successful coil embolization for life-threatening hemorrhage in childhood leukemia induction therapy.
abstract: An 11-year-old boy was experienced severe life-threatening hemorrhage from a branch of the superior mesenteric artery (SMA) after acute lymphoblastic leukemia induction therapy. The patient had a history of attention deficit hyperactivity disorder (ADHD), diagnosed at 3 years of age. Subsequent to discontinuing his psychotropic medication, the patient's mental status deteriorated and treatment with midazolam for 3 weeks was necessary to allow the completion of the leukemia induction regimen. On day 51, although there was no indication of thrombocytopenia or a coagulation disorder, the patient began to hemorrhage suddenly from anal with resulting hypovolemic shock, and large-volume blood transfusion was initiated. Although upper and lower endoscopy failed to determine the location of the hemorrhage, angiography enabled us to determine that it was a branch of the SMA (the middle colic artery #6), and selective arterial embolization was used to arrest the bleeding. There could have been underlying causes, such as, a probable malformation or aneurysm in that area, although there was no indication before or after the event. This is a rare case of arterial hemorrhage from a branch of the SMA that occurred in a pediatric patient idiopathically during the induction therapy of leukemia.
authors.affiliation: Department of Pediatrics, Nippon Medical School, Tokyo, Japan. shuros0905@gmail.com
authors.forename: Jun
authors.initials: J
authors.lastname: Hayakawa
authors.forename: Takahiro
authors.initials: T
authors.lastname: Ueda
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Ozaki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Wakita
authors.forename: Miho
authors.initials: M
authors.lastname: Maeda
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Fukunaga
mesh_terms: D002648:Child; D004621:Embolization, Therapeutic / Q000379:methods*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007938:Leukemia / Q000628:therapy*; D008297:Male; D017538:Mesenteric Artery, Superior; D020360:Neoadjuvant Therapy / Q000009:adverse effects