Lower gastrointestinal bleeding is a rare condition in childhood pathology. The incidence of this disorder in the general population of Bulgarian children is unknown. We report a case of a 7-year-old child with diagnosed hemophilia A and high titer of factor VIII inhibitor; the patient was admitted into the Department of Pediatrics and Medical Genetics for rectorrhagia after falling onto his buttocks while playing. Colonoscopy showed submucosal hematoma 25 cm from the anocutaneous line occluding the intestinal lumen with a lesion of the overlying mucosa as long as 20 mm. If a patient presents with rectorrhagia, timely and carefully planned colonoscopy could identify the source of bleeding, determine the severity of bleeding and the size of hematoma, and assess the need for surgical intervention. The reported case supports the modern view that patients with inhibitor hemophilia should not be denied interventional procedure or surgical intervention for fear of uncontrolled bleeding.

Background: The three major approaches for Ramstedt pyloromyotomy – right upper quadrant incision, supraumbilical incision and laparoscopic method, are often compared, with some preference given to the supraumbilical approach. It becomes widely adopted in many centers around the world. Aim: To analyse the early results of the supraumbilical incision in treatment of hypertrophic pyloric stenosis and to test a hypothesis that this technique may be valuable in our clinical conditions. Materials and methods: Within a ten-month period five children with hypertrophic pyloric stenosis were selected (using single random sample) for pyloromyotomy via supraumbilical incision and another five children - via Robertson incision. This technique consists of semi lunar cutting in the upper half of umbilicus, extended cranially in the midline. After a Ramstedt pyloromyotomy, linea alba is sutured and the reshaped skin is sutured in semilunar manner around the umbilicus. The scar was estimated with Patient and Observer Scar Assessment Scale. Results: The operations were performed by pediatric surgeons with different experience and with basic equipment. The operative time was 5-10 min longer for the supraumbilical incision. The pyloromyotomy led to a definitive healing, with timely feeding and discharging, without any complication. The quality of the scar was significantly better after the supraumbilical incision. Conclusion: Supraumbilical incision is reliable and related to low complication rates. It leaves better scar than the Robertson incision and is an excellent alternative in search for less invasive techniques.