Acute gastrointestinal bleeding in children is a potentially life-threatening medical emergency that requires prompt evaluation and muldisiciplinary management. 

We report the case of a three-year-old boy with no prior medical history, who was brought to the Emergency Room due to sudden pallor and lethargy. According to the mother, the child experienced a sudden intense abdominal pain followed by ematemesis, along with a single melena episode. Twenty-four hours earlier, he had vomited food content without other gastrointestinal symptoms. The patient had a history of several recent respiratory infections but no trauma or ingestion of toxic substances.

On examination, he presented with altered Pediatric Assessment Triangle parameters, including tachypnea, tachycardia, hypotension, pallor, and lethargy. The inicial laboratory analysis revealed severe anemia (Hb 6 g/dL). Urgent gastroscopy showed a pale mucosa but without visible lesions. In the fundus and body, mild oozing bleeding was observed originating from multiple diffuse points. After irrigation, no mucosal abnormalities were identified that could explain the bleeding, which recurred following the lavage.

The patient was admitted to the Pediatric Intensive Care Unit for close monitoring, receiving IV proton pump inhibitors and tranexamic acid. Given the endoscopic findings and normal coagulation tests, the family was re-interviewed, revealing that the child had received multiple daily doses of oral ibuprofen over the past two weeks. After 24 hours, he was transferred to the general pediatric ward, remaining clinically stable with adequate oral intake, and was discharged on day five.