Pediatria pre prax 3/2021
Recurrent nasal and oral bleeding as a result of self-injury in a child – case report
Self-harm is an act of deliberate and conscious self-aggression without a targeted intention to die. In ENT clinical practice, we rarely encounter it. In the case report, we report on a 12-year-old patient who was repeatedly comprehensively examined for recurrent nasal and oral bleeding. We did not find an objective cause of the bleeding. During diagnostic examinations, we repeatedly loaded splints on the injured mucosa in the Kiesselbach locus, under which the injury always healed ad integrum. The child did not bleed during the splinting of the nasal cavity. However, it began to bleed unexplained from the mucous membrane of the inner surface of both lips and once indicated the presence of blood in the stool. We expressed suspicion at both ENT workplaces about the child’s self-harm, which the child denied and its parents also refused to accept it. We caught the child once bleeding from the nose with a needle in its hand trying to insert it into the mattress of the bed in front of an unexpected doctor. For the second time, child was caught by a department nurse with a needle in its oral cavity. Nevertheless, the parents still refuse pedopsychological help, the child occasionally bleeds from the nasal cavity and then visits the emergency medical service with it. The last time the child was hospitalized again after three years for recurrent nasal bleeding at a pediatric clinic, again without an objectively identifiable cause of the condition. It is known from the literature that in the group of self-harming children and adolescents the incidence of suicides is statistically 8 times higher than in the general population. It is therefore necessary in society to pay attention to increasing non-specific and specific prevention, in which it is necessary to create in the Slovak Republic, an appropriate legal framework for the intervening entity.
Keywords: self-injury, child, needle, mucosa injury, nasal and oral bleeding
