Introduction: Esophageal and gastric variceal hemorrhage in pediatric patients with portal hypertension significantly increases risk of death. Many of the treatment options to manage gastric variceal bleeds in adults are not well studied, technically challenging, or have a high rebleeding rate in pediatrics. This limits available treatment options for pediatric gastric variceal bleeds, posing challenges in emergent cases.

Method: We present a case in which gastric oversew of a bleeding variceal ulcer was used to establish hemostasis, allowing hemodynamic stability and bridge to transplant in a pediatric patient. The 21 m.o patient presented with life-threatening gastrointestinal hemorrhage from portal hypertension in the setting of advanced chronic liver disease from biliary atresia. Recurrent massive upper gastrointestinal bleeding required repeated emergent endoscopies for intervention with sclerotherapy. During endoscopy, inability to adequately ventilate the patient required conversion to open surgery for enterotomy with subsequent evacuation of large clot burden and retained air. Continued hemorrhage and review of prior imaging led to the discovery of a large gastric variceal ulcer. Surgical oversew of the posterior gastric wall to tamponade the ulcerated bleeding varix was performed.

Results: Hemostasis was immediately established after the posterior gastric wall was oversewn. Following the procedure, the patient did not have recurrence of bleeding and remained hemodynamically stable prior to liver transplant.

Conclusion: This case highlights the utility of gastric oversew for treatment of life-threatening gastric variceal hemorrhage in the pediatric population.