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Sample records for acute gastrointestinal bleeding

  1. [Acute gastrointestinal bleeding].

    Baumbach, Robert; Faiss, Siegbert; Cordruwisch, Wolfgang; Schrader, Carsten

    2016-04-01

    Acute gastrointestinal bleeding is a common major emergency (Internal medical or gastroenterological or medical), approximately 85 % of which occur in the upper GI tract. It is estimated that about a half of upper GI bleeds are caused by peptic ulcers. Upper GI bleeds are associated with more severe bleeding and poorer outcomes when compared to middle or lower GI bleeds. Prognostic determinants include bleeding intensity, patient age, comorbid conditions and the concomitant use of anticoagulants. A focused medical history can offer insight into the bleeding intensity, location and potential cause (along with early risk stratification). Initial measures should focus on rapid assessment and resuscitation of unstable patients. The oesophagogastroduodenoscopy (OGD) is the gold standard method for localizing the source of bleeding and for interventional therapy. Bleeding as a result of peptic ulcers is treated endoscopically with mechanical and / or thermal techniques in combination with proton pump inhibitor (PPI) therapy. When variceal bleeding is suspected, pre-interventional use of vasopressin analogues and antibiotic therapies are recommended. Endoscopically, the first line treatment of esophageal varices is endoscopic ligature therapy, whereas that for gastric varices is the use of Histoacryl injection sclerotherapy. When persistent and continued massive hemorrhage occurs in a patient with known or suspected aortic disease the possibility of an aorto-enteric fistula must be considered. PMID:27078246

  2. Interventional angiography in the diagnosis of acute lower gastrointestinal bleeding

    Interventional angiography with the use of indwelling arterial catheters, anticoagulants, vasodilators and fibrinolytic agents, complements conventional angiography in the diagnosis of acute lower gastrointestinal bleeding. These interventional techniques prolong, augment or reactive bleeding and, by enabling better timing of examinations, they increase the diagnostic efficacy of angiography. In the reported series of 63 patients with acute lower gastrointestinal hemorrhage, interventions increased the diagnostic yield of angiography for demonstration of extravasation from 32% to 65% and decreased the percentage of negative angiograms from 27% to 16%. Indications, techniques and risks of interventional angiography in the diagnosis of acute lower gastrointestinal bleeding are discussed. (orig.)

  3. Porcine survival model to simulate acute upper gastrointestinal bleedings.

    Prosst, Ruediger L; Schurr, Marc O; Schostek, Sebastian; Krautwald, Martina; Gottwald, Thomas

    2016-06-01

    The existing animal models used for the simulation of acute gastrointestinal bleedings are usually non-survival models. We developed and evaluated a new porcine model (domestic pig, German Landrace) in which the animal remains alive and survives the artificial bleeding without any cardiovascular impairment. This consists of a bleeding catheter which is implanted into the stomach, then subcutaneously tunnelled from the abdomen to the neck where it is exteriorized and fixed with sutures. Using the injection of porcine blood, controllable and reproducible acute upper gastrointestinal bleeding can be simulated while maintaining normal gastrointestinal motility and physiology. Depending on the volume of blood applied through the gastric catheter, the bleeding intensity can be varied from traces of blood to a massive haemorrhage. This porcine model could be valuable, e.g. for testing the efficacy of new bleeding diagnostics in large animals before human use. PMID:26306615

  4. Multidetector computed tomography in acute lower gastrointestinal bleeding

    John Palma

    2010-11-01

    Full Text Available John Palma, Marius Mihaila, Frank PilleulDépartement de Radiologie Digestive et des Urgences, Hôpital Edouard Herriot, Hospices Civils de Lyon, CHU, Lyon, FranceBackground: The aim of this study is to evaluate multidetector computed tomography (MDCT in acute massive lower gastrointestinal bleeding, with endoscopy and surgery as reference examinations.Methods: A single-center retrospective study involving 34 patients with acute massive lower gastrointestinal bleeding was carried out. All patients were evaluated by MDCT scan then endoscopic or surgical examinations. Sensitivity, specificity, and positive and negative predictive values of MDCT scan were calculated using the extravasation of the contrast agent as the main criterion.Results: Extravasation of the contrast agent was found in 30 of 34 patients (88%. The bleeding site seen on CT was always the same as on endoscopic or surgical examinations (100%. Sensitivity of MDCT scan was 94%, specificity 100%, positive predictive value 100%, and negative predictive value 50% (P < 0.001. Twelve diverticulum bleedings were seen on MDCT scan compared with 13 (92% on endoscopic or surgical examinations. Angiodysplasia was overestimated by MDCT scan.Conclusion: MDCT scan appears to be an excellent tool to find and localize the bleeding site in cases of acute massive lower gastrointestinal disease.Keywords: MDCT, acute lower gastrointestinal bleeding, extravasation, contrast agent

  5. Diagnostic accuracy of CT angiography in acute gastrointestinal bleeding

    Full text: The aim of the study was to carry out a systematic review determining the accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding. A search of published work in Medline and manual searching of reference lists of articles was conducted. Studies were included if they compared CT angiography to a reference standard of upper gastrointestinal endoscopy, colonoscopy, angiography or surgery in the diagnosis of acute gastrointestinal bleeding. Eight published studies evaluating 129 patients were included. Data were used to form 2x2 tables. Computed tomography angiography showed pooled sensitivity of 86% (95% confidence interval 78-92%) and specificity of 95% (95% confidence interval 76-100%), without showing significant heterogeneity (x2 = 3.5, P=0.6) and (x2 - 5.4, P = 0.6), respectively. Summary receiver operating characteristic analysis showed an area under the curve of 0.93. Computed tomography angiography is accurate in the diagnosis of acute gastrointestinal bleeding and can show the precise location and aetiology of bleeding, thereby directing further management. Strong recommendations for use of CT cannot be made from this review because of the methodological limitations and further large prospective studies are needed to define the role of CT in acute gastrointestinal bleeding.

  6. Transcatheter embolization for treatment of acute lower gastrointestinal bleeding

    Treatment of lower gastrointestinal bleeding was attempted in 13 patients by selective embolization of branches of the mesenteric arteries with Gelfoam. Bleeding was adequately controlled in 11 patients with active bleeding during the examination. One patient improved after embolization but bleeding recurred within 24 hours and in another patient the catheterization was unsuccessful. Five patients with diverticular hemorrhage were embolized in the right colic artery four times, and once in the middle colic artery. Three patients had embolization of the ileocolic artery because of hemorrhage from cecal angiodysplasia, post appendectomy, and leukemia infiltration. Three patients had the superior hemorrhoidal artery embolized because of bleeding from unspecific proctitis, infiltration of the rectum from a carcinoma of the bladder, and transendoscopic polypectomy. One patient was septic and bled from jejunal ulcers. Ischemic changes with infarction of the large bowel developed in two patients and were treated by partial semi-elective colectomy, three and four days after embolization. Four other patients developed pain and fever after embolization. Transcatheter embolization of branches of mesenteric arteries in an effective way to control acute lower gastrointestinal bleeding, but still has a significant rate of complications that must be seriously weighed against the advantages of operation. (orig.)

  7. Application of cyanoacrylate in difficult-to-arrest acute non-variceal gastrointestinal bleeding

    Kurek, Krzysztof; Baniukiewicz, Andrzej; Świdnicka-Siergiejko, Agnieszka; Dąbrowski, Andrzej

    2014-01-01

    Gastrointestinal bleeding is a common medical emergency. Although endoscopic treatment is effective in controlling non-variceal upper gastrointestinal bleeding, in cases of persistent bleeding radiological or surgical interventions are required. Application of cyanoacrylate for treatment of difficult-to-arrest non-variceal upper gastrointestinal bleeding is poorly investigated. We describe patients in whom cyanoacrylate for acute non-variceal gastrointestinal bleeding was used to stop the ble...

  8. Factors affecting hospital mortality in acute upper gastrointestinal bleeding

    Alam Mohammed

    2000-01-01

    Full Text Available This retrospective analysis studied the records of 564 consecutive patients admitted to Gastrointestinal Bleeding Unit of Riyadh Medical Complex with acute upper gastrointestinal bleeding over a 2-year period (May 1996-April 1998. The purpose of the study was to analyze the mortality with an aim to identify the risk factors affecting mortality in these patients. Majority of patients were men (82% and Saudis (54%. Their mean age was 52.46 + 17.8 years. Esophageal varices (45% were the main causes of bleeding followed by duodenal ulcers (24%. Overall mortality in this series was 15.8% (89 patients. Comorbid diseases were responsible for death in 68 (76% patients, whereas, bleeding was considered to be directly responsible for death in 21 (24% patients. On analysis of data from this study, old age (>60 years, systolic pressure < 90 mm Hg on admission, comorbid disease, variceal bleeding and Child′s grade C in patients with chronic liver disease were associated with adverse outcome.

  9. [Gastrointestinal bleeding].

    Lanas, Ángel

    2015-09-01

    In the Digestive Disease Week in 2015 there have been some new contributions in the field of gastrointestinal bleeding that deserve to be highlighted. Treatment of celecoxib with a proton pump inhibitor is safer than treatment with nonselective NSAID and a proton pump inhibitor in high risk gastrointestinal and cardiovascular patients who mostly also take acetylsalicylic acid. Several studies confirm the need to restart the antiplatelet or anticoagulant therapy at an early stage after a gastrointestinal hemorrhage. The need for urgent endoscopy before 6-12 h after the onset of upper gastrointestinal bleeding episode may be beneficial in patients with hemodynamic instability and high risk for comorbidity. It is confirmed that in Western but not in Japanese populations, gastrointestinal bleeding episodes admitted to hospital during weekend days are associated with a worse prognosis associated with delays in the clinical management of the events. The strategy of a restrictive policy on blood transfusions during an upper GI bleeding event has been challenged. Several studies have shown the benefit of identifying the bleeding vessel in non varicose underlying gastric lesions by Doppler ultrasound which allows direct endoscopic therapy in the patient with upper GI bleeding. Finally, it has been reported that lower gastrointestinal bleeding diverticula band ligation or hemoclipping are both safe and have the same long-term outcomes. PMID:26520197

  10. Endovascular treatment of nonvariceal acute arterial upper gastrointestinal bleeding

    Andersen, Poul Erik; Duvnjak, Stevo

    2010-01-01

    Transcatheter arterial embolization as treatment of upper nonvariceal gastrointestinal bleeding is increasingly being used after failed primary endoscopic treatment. The results after embolization have become better and surgery still has a high mortality. Embolization is a safe and effective...... procedure, but its use is has been limited because of relatively high rates of rebleeding and high mortality, both of which are associated with gastrointestinal bleeding and non-gastrointestinal related mortality causes. Transcatheter arterial embolization is a valuable minimal invasive method in the...

  11. Superselective transarterial embolization for the management of acute gastrointestinal bleeding

    Lee, In Kyoung; Kim, Young Min; Kim, Jeong; Shin, Sang Soo; Yoon Woong; Kim, Jae Kyu; Park, Jin Gyoon [Chonnam National University Hospital, Gwangju (Korea, Republic of); Cho, Chol Kyoon; Kang, Heoung Keun [Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of)

    2006-03-15

    We wanted to evaluate the safety and effectiveness of superselective transarterial embolization for the management of gastrointestinal bleeding. We evaluated 97 of 115 patients who had undergone diagnostic angiography and transarterial embolization for gastrointestinal bleeding from February 2001 to July 2004, and they subsequently underwent superselective transarterial embolization. Their ages ranged from 17 to 88 years (mean age: 58.5 years), and 73 were men and 24 were women. The etiologies were a postoperative condition (n=31), ulcer (n=23), Mallory-Weiss syndrome (n=3), trauma (n=3), pseudoaneurysm from pancreatitis (n=3), diverticula (n=2), inflammatory bowel disease (n=2), tumor (n=2), Behcet's disease (n=2), hemobilia (n=1), and unknown origin (n=25). The regions of bleeding were the esophagus (n=3), stomach and duodenum (n=41), small bowel (n=38) and colon (n=15). All the patients underwent superselective transarterial embolization using microcoils, gelfoam or a combination of microcoils and gelfoam. Technical success was defined as devascularization of targeted vascular lesion or the disappearance of extravasation of the contrast media, as noted on the angiography after embolization. Clinical success was defined as the disappearance of clinical symptoms and the reestablishment of normal cardiovascular hemodynamics after transarterial embolization without any operation or endoscopic management. The technical success rate was 100%. The primary clinical success rate was 67% (65 of 97 patients). Of the 32 primary failures, fourteen patients underwent repeat embolization; of these, clinical success was achieved in all the patients and so the secondary clinical success rate was 81% (79 of 97 patients). Of the 18 patients with primary failures, five patients underwent operation, one patient underwent endoscopic management and the others died during the observation period due to disseminated coagulopathy or complications of their underlying diseases. During

  12. The role of nuclear medicine in acute gastrointestinal bleeding

    Robinson, P. (Saint James' s Hospital, Leeds (United Kingdom). Dept. of Radiology)

    1993-10-01

    In most patients with upper gastrointestinal (GI) bleeding, endoscopy will locate the site and cause of bleeding, and also provide an opportunity for local therapy. The cause of lower GI bleeding is often difficult to attribute, even when pathology is found by colonoscopy or barium enema. Nuclear medicine techniques can be used to identify the site of bleeding in those patients in whom the initial diagnostic procedures are negative or inconclusive. Methods using transient labelling of blood (e.g. [sup 99]Tc[sup m]-sulphur colloid) produce a high target-to-background ratio in positive cases, give quick results and localize bleeding sites accurately, but depend upon bleeding being active at the time of injection. Techniques using stable blood labelling (e.g. [sup 99]Tc[sup m]-labelled red blood cells) may be positive even with intermittent bleeding but may take several hours to produce a result and are less precise in localization. The most useful application is in patients with recurrent or prolonged bleeding, those with inconclusive endoscopy or barium studies, and those who are high-risk surgical candidates. (author).

  13. Acute Upper Gastro-Intestinal Bleeding in Morocco: What Have Changed?

    Timraz, A.; Khannoussi, W.; Ajana, F. Z.; W. Essamri; Benelbarhdadi, I.; Afifi, R.; M. Benazzouz; Essaid, A.

    2011-01-01

    Objective. In the present study, we aimed to investigate epidemiological, clinical, and etiological characteristics of acute upper gastro-intestinal bleeding. Materials and Methods. This retrospective study was conducted between January 2003 and December 2008. It concerned all cases of acute upper gastroduodenal bleeding benefited from an urgent gastro-intestinal endoscopy in our department in Morocco. Characteristics of patients were evaluated in terms of age, gender, medical history, presen...

  14. Acute gastrointestinal bleeding: detection of source and etiology with multi-detector-row CT

    Scheffel, Hans; Pfammatter, Thomas; Marincek, Borut; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Wildi, Stefan [University Hospital Zurich, Department of Visceral and Transplant Surgery, Zurich (Switzerland); Bauerfeind, Peter [University Hospital Zurich, Division of Gastroenterology, Zurich (Switzerland)

    2007-06-15

    This study was conducted to determine the ability of multi-detector-row computed tomography (CT) to identify the source and etiology of acute gastrointestinal bleeding. Eighteen patients with acute upper (n = 10) and lower (n = 8) gastrointestinal bleeding underwent 4-detector-row CT (n = 6), 16-detector-row CT (n = 11), and 64-slice CT (n = 1) with an arterial and portal venous phase of contrast enhancement. Unenhanced scans were performed in nine patients. CT scans were reviewed to determine conspicuity of bleeding source, underlying etiology, and for potential causes of false-negative prospective interpretations. Bleeding sources were prospectively identified with CT in 15 (83%) patients, and three (17%) bleeding sources were visualized in retrospect, allowing the characterization of all sources of bleeding with CT. Contrast extravasation was demonstrated with CT in all 11 patients with severe bleeding, but only in 1 of 7 patients with mild bleeding. The etiology could not be identified on unenhanced CT scans in any patient, whereas arterial-phase and portal venous-phase CT depicted etiology in 15 (83%) patients. Underlying etiology was correctly identified in all eight patients with mild GI bleeding. Multi-detector-row CT enables the identification of bleeding source and precise etiology in patients with acute gastrointestinal bleeding. (orig.)

  15. Angiographically Negative Acute Arterial Upper and Lower Gastrointestinal Bleeding: Incidence, Predictive Factors, and Clinical Outcomes

    Kim, Jin Hyoung; Shin, Ji Hoon; Yoon, Hyun Ki; Chae, Eun Young; Myung, Seung Jae; Ko, Gi Young; Gwon, Dong Il; Sung, Kyu Bo [Asan Medical Center, Seoul (Korea, Republic of)

    2009-08-15

    To evaluate the incidence, predictive factors, and clinical outcomes of angiographically negative acute arterial upper and lower gastrointestinal (GI) bleeding. From 2001 to 2008, 143 consecutive patients who underwent an angiography for acute arterial upper or lower GI bleeding were examined. The angiographies revealed a negative bleeding focus in 75 of 143 (52%) patients. The incidence of an angiographically negative outcome was significantly higher in patients with a stable hemodynamic status (p < 0.001), or in patients with lower GI bleeding (p = 0.032). A follow-up of the 75 patients (range: 0-72 months, mean: 8 {+-} 14 months) revealed that 60 of the 75 (80%) patients with a negative bleeding focus underwent conservative management only, and acute bleeding was controlled without rebleeding. Three of the 75 (4%) patients underwent exploratory surgery due to prolonged bleeding; however, no bleeding focus was detected. Rebleeding occurred in 12 of 75 (16%) patients. Of these, six patients experienced massive rebleeding and died of disseminated intravascular coagulation within four to nine hours after the rebleeding episode. Four of the 16 patients underwent a repeat angiography and the two remaining patients underwent a surgical intervention to control the bleeding. Angiographically negative results are relatively common in patients with acute GI bleeding, especially in patients with a stable hemodynamic status or lower GI bleeding. Most patients with a negative bleeding focus have experienced spontaneous resolution of their condition.

  16. Usefulness of CT angiography in diagnosing acute gastrointestinal bleeding:A meta-analysis

    2010-01-01

    AIM: To analyze the accuracy of computed tomography (CT) angiography in the diagnosis of acute gastrointestinal (GI) bleeding. METHODS: The MEDLINE, EMBASE, Cancerlit, Cochrane Library database, Sciencedirect, Springerlink and Scopus, from January 1995 to December 2009, were searched for studies evaluating the accuracy of CT angiography in diagnosing acute GI bleeding. Studies were included if the ycompared CT angiography to a reference standard of upper GI endoscopy, colonoscopy, angiography or surgery in ...

  17. Effect of Transfusion Strategy in Acute Non-variceal Upper Gastrointestinal Bleeding

    Fabricius, Rasmus; Svenningsen, Peter; Hillingsø, Jens; Svendsen, Lars Bo; Sillesen, Martin

    2016-01-01

    BACKGROUND: Acute non-variceal upper gastrointestinal bleeding (NVUGIB) is a common cause of admissions as well as aggressive transfusion of blood products. Whether the transfusion strategy in NVUGIB impacts on hemostasis is unknown and constitutes the focus of this study. METHOD: Retrospective...

  18. Nonvariceal upper gastrointestinal bleeding

    Burke, Stephen J.; Weldon, Derik; Sun, Shiliang [University of Iowa, Department of Radiology, Iowa, IA (United States); Golzarian, Jafar [University of Iowa, Department of Radiology, Iowa, IA (United States); University of Iowa, Department of Radiology, Carver College of Medicine, Iowa, IA (United States)

    2007-07-15

    Nonvariceal upper gastrointestinal bleeding (NUGB) remains a major medical problem even after advances in medical therapy with gastric acid suppression and cyclooxygenase (COX-2) inhibitors. Although the incidence of upper gastrointestinal bleeding presenting to the emergency room has slightly decreased, similar decreases in overall mortality and rebleeding rate have not been experienced over the last few decades. Many causes of upper gastrointestinal bleeding have been identified and will be reviewed. Endoscopic, radiographic and angiographic modalities continue to form the basis of the diagnosis of upper gastrointestinal bleeding with new research in the field of CT angiography to diagnose gastrointestinal bleeding. Endoscopic and angiographic treatment modalities will be highlighted, emphasizing a multi-modality treatment plan for upper gastrointestinal bleeding. (orig.)

  19. PROPOSAL OF A CLINICAL CARE PATHWAY FOR THE MANAGEMENT OF ACUTE UPPER GASTROINTESTINAL BLEEDING

    Matheus Cavalcante FRANCO

    2015-12-01

    Full Text Available Background - Upper gastrointestinal bleeding implies significant clinical and economic repercussions. The correct establishment of the latest therapies for the upper gastrointestinal bleeding is associated with reduced in-hospital mortality. The use of clinical pathways for the upper gastrointestinal bleeding is associated with shorter hospital stay and lower hospital costs. Objective - The primary objective is the development of a clinical care pathway for the management of patients with upper gastrointestinal bleeding, to be used in tertiary hospital. Methods - It was conducted an extensive literature review on the management of upper gastrointestinal bleeding, contained in the primary and secondary information sources. Results - The result is a clinical care pathway for the upper gastrointestinal bleeding in patients with evidence of recent bleeding, diagnosed by melena or hematemesis in the last 12 hours, who are admitted in the emergency rooms and intensive care units of tertiary hospitals. In this compact and understandable pathway, it is well demonstrated the management since the admission, with definition of the inclusion and exclusion criteria, passing through the initial clinical treatment, posterior guidance for endoscopic therapy, and referral to rescue therapies in cases of persistent or rebleeding. It was also included the care that must be taken before hospital discharge for all patients who recover from an episode of bleeding. Conclusion - The introduction of a clinical care pathway for patients with upper gastrointestinal bleeding may contribute to standardization of medical practices, decrease in waiting time for medications and services, length of hospital stay and costs.

  20. The Management of Acute Upper Gastrointestinal Bleeding: A Comparison of Current Clinical Guidelines and Best Practice

    Alison A. Taylor

    2014-12-01

    Full Text Available Acute upper gastrointestinal bleeding (AUGIB is the most common GI emergency, responsible for up to 70,000 hospital admissions in the UK and around 4,000 deaths. The latest UK national audit highlighted inconsistencies in both the management and service provision. Several national and international professional bodies have produced evidence-based recommendations on the management of AUGIB. We carried out a review of the guidance documentation published by four expert bodies including the National Institute of Clinical Excellence, the Scottish Intercollegiate Guidelines Network, the American College of Gastroenterology, and those published in the Annals of Internal Medicine. Consensus is still yet to be reached for initiating blood products in the emergency situation, with some evidence suggesting that liberal transfusion could exacerbate bleeding severity, although there is a lack of large randomised trials. It is widely agreed that prompt endoscopy within 24 hours improves outcomes, but evidence suggests that lowering this threshold confers no additional benefit. Use of proton pump inhibitors both pre and post-endoscopy for non-variceal bleeds is also advocated by professional bodies, with substantial evidence that it reduces the risk of re-bleeding. For patients with suspected oesophageal or gastric variceal bleeding, prophylactic antibiotics and vasopressin analogues are recommended, although guidelines vary on specific regimens. Recent UK and international guidelines provide a useful framework to guide management of patients who present to the emergency department with suspected AUGIB; however, their advice varies in some key areas due to a lack of large randomised trials as supporting evidence.

  1. Detection and localization of acute upper and lower gastrointestinal (GI) bleeding with arterial phase multi-detector row helical CT

    Jaeckle, T.; Stuber, G.; Hoffmann, M.H.K.; Jeltsch, M.; Schmitz, B.L.; Aschoff, A.J. [University Hospital of Ulm, Diagnostic and Interventional Radiology, Ulm (Germany)

    2008-07-15

    The purpose of this study was to evaluate the accuracy of multi-detector row helical CT (MDCT) for detection and localization of acute upper and lower gastrointestinal (GI) hemorrhage or intraperitoneal bleeding. Thirty-six consecutive patients with clinical signs of acute bleeding underwent biphasic (16- or 40-channel) MDCT. MDCT findings were correlated with endoscopy, angiography or surgery. Among the 36 patients evaluated, 26 were examined for GI bleeding and 10 for intraperitoneal hemorrhage. Confirmed sites of GI bleeding were the stomach (n = 5), duodenum (n = 5), small bowel (n = 6), large bowel (n = 8) and rectum (n = 2). The correct site of bleeding was identifiable on MDCT in 24/26 patients with GI bleeding. In 20 of these 24 patients, active CM extravasation was apparent during the exam. Among the ten patients with intraperitoneal hemorrhage, MDCT correctly identified the bleeding source in nine patients. Our findings suggest that fast and accurate localization of acute gastrointestinal and intraperitoneal bleeding is achievable on MDCT. (orig.)

  2. Detection and localization of acute upper and lower gastrointestinal (GI) bleeding with arterial phase multi-detector row helical CT

    The purpose of this study was to evaluate the accuracy of multi-detector row helical CT (MDCT) for detection and localization of acute upper and lower gastrointestinal (GI) hemorrhage or intraperitoneal bleeding. Thirty-six consecutive patients with clinical signs of acute bleeding underwent biphasic (16- or 40-channel) MDCT. MDCT findings were correlated with endoscopy, angiography or surgery. Among the 36 patients evaluated, 26 were examined for GI bleeding and 10 for intraperitoneal hemorrhage. Confirmed sites of GI bleeding were the stomach (n = 5), duodenum (n = 5), small bowel (n = 6), large bowel (n = 8) and rectum (n = 2). The correct site of bleeding was identifiable on MDCT in 24/26 patients with GI bleeding. In 20 of these 24 patients, active CM extravasation was apparent during the exam. Among the ten patients with intraperitoneal hemorrhage, MDCT correctly identified the bleeding source in nine patients. Our findings suggest that fast and accurate localization of acute gastrointestinal and intraperitoneal bleeding is achievable on MDCT. (orig.)

  3. Detection of acute gastrointestinal bleeding by intra-arterial scintigraphy: an experimental study and preliminary clinical experience

    The purpose of this animal and clinical study was to compare intra-arterial (IA) scintigraphy with angiography in the localization of gastrointestinal (GI) bleeding. After sedation with intramuscularly administered ketamine, lower GI bleeding was induced in ten rabbits. Using inguinal cut-down, an arterial femoral 3F catheter was placed in the proximal mesenteric artery. Following abdominal incision to expose the bowel, lower GI bleeding was caused by incising the antimesenteric border of the small bowel wall. Initial angiography was performed, and this was followede by Tc-99m pertechnetate IA scintigarphy. Tc-99m RBC IA scintigraphy involved two patients who had undergone selective mesenteric arterial catheterizaion for the evaluation of acute lower GI bleeding. Ten rabbits, bleeding at a mean rate of 0.7g/min, were studied. IA scintigraphy was superior to angiography in four cases and equal in six. The sensitivity of angiography was 40%(4/10), and IA scintigraphy 80%(8/10). In one patient, Tc-99m RBC was administered directly into the superior mesenteric artery and ulcer bleeding in the transverse colon was identified. PRior to conventional angiography, the bleeding had been occult. In a second patient, in whom angiography had revealed a hypervascular mass, selective injection of Tc-99m RBC into the superior mesenteric artery revealed tumor(leiomyoma) bleeding in the jejunum. Selective IA scintigraphy was valuable for detecting intestinal bleeding, occult during conventional studies and may be useful for detecting acute bleeding at the time of negative angiography.=20

  4. Detection of acute gastrointestinal bleeding by means of technetium-99m in vivo labelled red blood cells

    Prognosis of gastrointestinal (GI) bleeding depends on the timely and accurate detection of the source of bleeding and sequential surgical or endoscopy therapy. Scintigraphy with red blood cells (RBCs) in vivo labelled by means of technetium-99m hastened detection of source of GI bleeding and improved management of the particular disease. Gastrointestinal endoscopy is the method of choice for the diagnostics of bleeding from upper tract and large bowel. For diagnostics of bleeding from the small bowel we can use scintigraphy with in vivo labelled autological red blood cells if pushenteroscopy, intra-operative enteroscopy or angiography are not available. 31 patients (13 men, 18 women, aged 20-91, mean 56 years) underwent this investigation from 1998 till 2001 at the Department of Nuclear Medicine. All patients had melaena or enterorrhagia associated with acute anaemia. Gastroscopy, colonoscopy, enteroclysis or X-ray angiography did not detect the source of bleeding. Twenty-one patients had positive scintigraphy with in vivo labelled RBCs - 9 patients were already positive on dynamic scintigraphy, and 12 patients were positive on static images. Scintigraphy with in vivo labelled RBCs was negative in 10 patients. GI bleeding stopped spontaneously in these 10 patients with negative scintigraphy. These patients did not undergo intra-operative enteroscopy or surgery. The final diagnosis of the 21 patients with positive scintigraphy was determined in 16 patients by push-enteroscopy (6 patients), intra-operative enteroscopy (6 patients) or by surgery (4 patients). Of these 16 patients the correct place of bleeding was determined by scintigraphy with labelled RBCs in 11 (69%) patients. Final diagnoses of our 16 patients with positive scintigraphy with autological labelled RBCs were: bleeding small bowel arteriovenous malformation (6 patients), uraemic enteritis with bleeding erosions in ileum and jejunum (2 patients), Osler-Rendu- Weber disease (1 patient), pseudocyst of

  5. Acute upper gastrointestinal bleeding in octogenarians: Clinical outcome and factors related to mortality

    George J Theocharis; Vassiliki Arvaniti; Stelios F Assimakopoulos; Konstantinos C Thomopoulos; Vassilis Xourgias; Irini Mylonakou; Vassiliki N Nikolopoulou

    2008-01-01

    AIM: To evaluate the aetiology, clinical outcome and factors related to mortality of acute upper gastrointestinal bleeding (AUGIB) in octogenarians.METHODS: We reviewed the records of all patients over 65 years old who were hospitalised with AUGIB in two hospitals from January 2006 to December of 2006. Patients were divided into two groups: Group A (65-80 years old) and Group B (>80 years old).RESULTS: Four hundred and sixteen patients over 65 years of age were hospitalized because of AUGIB. Group A included 269 patients and Group B147 patients. Co-morbidity was more common in octogenarians (P=0.04). The main cause of bleeding was peptic ulcer in both groups. Rebleeding and emergency surgery were uncommon in octogenarians and not different from those in younger patients. In-hospital complications were more common in octogenarians (P=0.05) and more patients died in the group of octogenarians compared to the younger age group (P=0.02). Inability to perform endoscopic examination (P=0.002), presence of high risk for rebleeding stigmata (P=0.004), urea on admission (P=0.036), rebleeding (P=0.004) and presence of severe co-morbidity (P<0.0001) were related to mortality. In multivariate analysis, only the presence of severe co-morbidity was independently related to mortality (P=0.032).CONCLUSION: While rebleeding and emergency surgery rates are relatively low in octogenarians with AUGIB, the presence of severe co-morbidity is the main factor of adverse outcome.

  6. Endoscopic management of acute gastrointestinal bleeding in children: Time for a radical rethink.

    Thomson, Mike; Belsha, Dalia

    2016-02-01

    Currently we are no nearer than 10 or 20years ago providing a safe, adequate, and effective round-the-clock endoscopic services for acute life-threatening gastrointestinal bleeding in children. Preventable deaths are occurring still, and it is a tragedy. This is owing to a number of factors which require urgent attention. Skill-mix and the ability of available endoscopists in the UK are woeful. Manpower is spread too thinly and not concentrated in centers of excellence, which is necessary given the relative rarity of the presentation. Adult gastroenterologists are increasingly reticent regarding their help in increasingly litigious times. Recent work on identification of those children likely to require urgent endoscopic intervention has mirrored scoring systems that have been present in adult circles for many years and may allow appropriate and timely intervention. Recent technical developments such as that of Hemospray® may lower the threshold of competency in dealing with this problem endoscopically, thus allowing lives to be saved. Educational courses, mannequin and animal model training are important but so will be appropriate credentialing of individuals for this skill-set. Assessment of competency will become the norm and guidelines on a national level in each country mandatory if we are to move this problem from the "too difficult" to the "achieved". It is an urgent problem and is one of the last emergencies in pediatrics that is conducted poorly. This cannot and should not be allowed to continue unchallenged. PMID:26703435

  7. Diagnosis of gastrointestinal bleeding: A practical guide for clinicians

    Bong; Sik; Matthew; Kim; Bob; T; Li; Alexander; Engel; Jaswinder; S; Samra; Stephen; Clarke; Ian; D; Norton; Angela; E; Li

    2014-01-01

    Gastrointestinal bleeding is a common problem encountered in the emergency department and in the primary care setting. Acute or overt gastrointestinal bleeding is visible in the form of hematemesis, melena or hematochezia. Chronic or occult gastrointestinal bleeding is notapparent to the patient and usually presents as positive fecal occult blood or iron deficiency anemia. Obscure gastrointestinal bleeding is recurrent bleeding when the source remains unidentified after upper endoscopy and colonoscopic evaluation and is usually from the small intestine. Accurate clinical diagnosis is crucial and guides definitive investigations and interventions. This review summarizes the overall diagnostic approach to gastrointestinal bleeding and provides a practical guide for clinicians.

  8. The value of multidetector-row computed tomography for localization of obscure acute gastrointestinal bleeding

    Purpose: There are no simple guidelines on when to perform multidetector-row computed tomography (MDCT) for diagnosis of obscure acute gastrointestinal bleeding (AGIB). We used a risk scoring system to evaluate the diagnostic power of MDCT for patients with obscure AGIB. Materials and methods: Ninety-two patients with obscure AGIB who were referred for an MDCT scan after unsuccessful endoscopic treatment at presentation were studied. We recorded clinical data and calculated Blatchford score for each patient. Patients who required transfusion more than 500 mL of blood to maintain the vital signs were classified as high-risk patients. Two radiologists independently reviewed and categorized MDCT signs of obscure AGIB. Discordant findings were resolved by consensus. One-way ANOVA was used to compare clinical data between two groups; kappa statistics were used to estimate agreement on MDCT findings between radiologists. Results: Of the 92 patients, 62 (67.4%) were classified as high-risk patients. Blatchford scores of high-risk patients were significantly greater than those of low-risk patients. Sensitivity for MDCT diagnosing obscure AGIB was 81% in high-risk patients, as compared with 50% in the low-risk. When used in conjunction with selection of the cut-off value of 13 in Blatchford scoring system, the sensitivity and specificity of MDCT were 70.9% and 73.7%, respectively. Contrast extravasation was the most specific sign of AGIB (k = .87), recognition of which would have improved diagnostic accuracy. Conclusions: With the aid of Blatchford scoring system for evaluating the disease severity, MDCT can localize the bleeders of obscure AGIB more efficiently.

  9. Use of /sup 99m/Tc-DTPA for detection and localization of site of acute gastrointestinal bleeding

    Abdel-Dayem, H.; Owuwanne, A.; Nawaz, K.; Kouris, K.; Higazy, E.; Mahajan, K.; Ericsson, S.; Awdeh, M.

    1988-05-01

    Intravenously injected /sup 99m/Tc-DTPA was evaluated in 64 patients for its efficiency in detecting and localizing sites of acute upper and lower gastrointestinal (G.I.) bleeding. These studies were correlated with endoscopic and surgical findings. There were 34 bleeders and 30 non bleeders giving a sensitivity of 90%, specificity of 82% and accuracy of 86%. Of these, 49 were upper G.I. studies (stomach 21 and duodenum 28) and 15 were lower G.I. studies (small intestine 8, large bowel 7). Of the 49 upper G.I. studies, 27 showed active bleeding while 22 showed no bleeding at the time of the study resulting in a sensitivity of 87.5%, specificity of 76% and accuracy of 82%. Of the 15 lower G.I. studies, 7 were bleeders while 8 were non bleeders. All the lower G.I. bleeding sites were accurately localized with the /sup 99m/Tc-DTPA. An incidental finding of these studies was the localization of /sup 99m/Tc-DTPA in the site of inflammatory and malignant lesions of the G.I. tract. Of the 64 studies, 18 inflammatory and malignant lesions were detected with the IV injected /sup 99m/Tc-DTPA; 10 were bleeders while 8 were non bleeders. Image subtraction of early from delayed images was helpful to differentiate bleeding from non bleeding cases in this last group of studies.

  10. The use of 99mTc-DTPA for detection and localization of site of acute gastrointestinal bleeding

    Intravenously injected 99mTc-DTPA was evaluated in 64 patients for its efficiency in detecting and localizing sites of acute upper and lower gastrointestinal (G.I.) bleeding. These studies were correlated with endoscopic and surgical findings. There were 34 bleeders and 30 non bleeders giving a sensitivity of 90%, specificity of 82% and accuracy of 86%. Of these, 49 were upper G.I. studies (stomach 21 and duodenum 28) and 15 were lower G.I. studies (small intestine 8, large bowel 7). Of the 49 upper G.I. studies, 27 showed active bleeding while 22 showed no bleeding at the time of the study resulting in a sensitivity of 87.5%, specificity of 76% and accuracy of 82%. Of the 15 lower G.I. studies, 7 were bleeders while 8 were non bleeders. All the lower G.I. bleeding sites were accurately localized with the 99mTc-DTPA. An incidental finding of these studies was the localization of 99mTc-DTPA in the site of inflammatory and malignant lesions of the G.I. tract. Of the 64 studies, 18 inflammatory and malignant lesions were detected with the IV injected 99mTc-DTPA; 10 were bleeders while 8 were non bleeders. Image subtraction of early from delayed images was helpful to differentiate bleeding from non bleeding cases in this last group of studies. (orig.)

  11. Pharmaco-induced vasospasm therapy for acute lower gastrointestinal bleeding: A preliminary report

    Liang, Huei-Lung, E-mail: hlliang@vghks.gov.tw [Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (China); National Yang-Ming University, Taipei, Taiwan (China); Chiang, Chia-Ling [Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (China); Chen, Matt Chiung-Yu [Department of Radiology, Yuan' s General Hospital, Kaohsiung. Taiwan (China); Lin, Yih-Huie; Huang, Jer-Shyung; Pan, Huay-Ben [Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (China); National Yang-Ming University, Taipei, Taiwan (China)

    2014-10-15

    Purpose: To report a novel technique and preliminary clinical outcomes in managing lower gastrointestinal bleeding (LGIB). Materials and methods: Eighteen LGIB patients (11 men and 7 women, mean age: 66.2 years) were treated with artificially induced vasospasm therapy by semi-selective catheterization technique. Epinephrine bolus injection was used to initiate the vascular spasm, and followed by a small dose vasopressin infusion (3–5 units/h) for 3 h. The technical success, clinical success, recurrent bleeding and major complications of this study were evaluated and reported. Results: Sixteen bleeders were in the superior mesenteric artery and 2 in the inferior mesenteric artery. All patients achieved successful immediate hemostasis. Early recurrent bleeding (<30 days) was found in 4 patients with local and new-foci re-bleeding in 2 (11.1%) each. Repeated vasospasm therapy was given to 3 patients, with clinical success in 2. Technical success for the 21 bleeding episodes was 100%. Lesion-based and patient-based primary and overall clinical successes were achieved in 89.4% (17/19) and 77.7% (14/18), and 94.7% (18/19) and 88.8% (16/18), respectively. None of our patients had complications of bowel ischemia or other major procedure-related complications. The one year survival of our patients was 72.2 ± 10.6%. Conclusions: Pharmaco-induced vasospasm therapy seems to be a safe and effective method to treat LGIB from our small patient-cohort study. Further evaluation with large series study is warranted. Considering the advanced age and complex medical problems of these patients, this treatment may be considered as an alternative approach for interventional radiologists in management of LGIB.

  12. Do statins protect against upper gastrointestinal bleeding?

    Gulmez, Sinem Ezgi; Lassen, Annmarie Touborg; Aalykke, Claus; Dall, Michael; Andries, Alin; Andersen, Birthe Søgaard; Hansen, Jane Møller; Andersen, Morten; Hallas, Jesper

    2009-01-01

    AIMS: Recently, an apparent protective effect of statins against upper gastrointestinal bleeding (UGB) was postulated in a post hoc analysis of a randomized trial. We aimed to evaluate the effect of statin use on acute nonvariceal UGB alone or in combinations with low-dose aspirin and other...

  13. Localization of bleeding using 4-row detector-CT in patients with clinical signs of acute gastrointestinal hemorrhage

    Purpose: There is no gold-standard regarding the diagnostic work-up and therapy of an acute gastrointestinal (GI) hemorrhage. In most cases endoscopy provides the diagnosis but in a low percentage this modality is not feasible or negative. Purpose of this study was to evaluate the role of multi-phase Multi-Slice-Computertomography (MSCT) as a modality to diagnose and locate the site of acute GI hemorrhage in case of unfeasible or technically difficult endoscopy. Materials and methods: 58 patients, presenting with clinical signs of lower GI hemorrhage, were examined through a 24-month period. Preliminary endoscopy was either negative or unfeasible. Images were obtained with a four-detector row CT with an arterial (4 x 1 mm collimation, 0.8 mm increment, 1.25 mm slice width, 120 kV, 165 mAs) and portal venous series (4 x 2,5 mm collimation, 2 mm increment, 3 mm slice width, 120 kV, 165 mAs). Time interval between endoscopy and CT varied between 30 minutes and 3 hours. The results of the MSCT were correlated with clinical course and surgical or endoscopical treatment. Results: 20 of the 58 patients (34%) undergoing MSCT had a bleeding site identified, thus providing decisive information for the following intervention. In case of a following therapeutic intervention there was 100% correlation regarding the bleeding site. In 38 of the 58 patients (66%), a bleeding site was not identified by MSCT. Twenty of these 38 patients (53%) were stable and required no further treatment. In 18 of these 38 patients further interventional therapy was required due to continuing hemorrhage and in all of those patients the bleeding site was detected by intervention. (orig.)

  14. Acute Middle Gastrointestinal Bleeding Risk Associated with NSAIDs, Antithrombotic Drugs, and PPIs: A Multicenter Case-Control Study

    Nagata, Naoyoshi; Niikura, Ryota; Yamada, Atsuo; Sakurai, Toshiyuki; Shimbo, Takuro; Kobayashi, Yuka; Okamoto, Makoto; Mitsuno, Yuzo; Ogura, Keiji; Hirata, Yoshihiro; Fujimoto, Kazuma; Akiyama, Junichi; Uemura, Naomi; Koike, Kazuhiko

    2016-01-01

    Background Middle gastrointestinal bleeding (MGIB) risk has not been fully investigated due to its extremely rare occurrence and the need for multiple endoscopies to exclude upper and lower gastrointestinal bleeding. This study investigated whether MGIB is associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin (LDA), thienopyridines, anticoagulants, and proton-pump inhibitors (PPIs), and whether PPI use affects the interactions between MGIB and antithrombo...

  15. Methods of Nuclear Medicine in gastrointestinal bleeding detection

    Several methods used in the diagnostic of gastrointestinal bleeding are presented. Two radioisotopic methods are considered the main ones: coloidal sulphur labeled with technetium-99m, more useful for low and acute bleeding and red blood cells labeled with technetium-99m, adequate for high and intermitent bleeding. (Author)

  16. A Therapeutic Dose of Ketoprofen Causes Acute Gastrointestinal Bleeding, Erosions, and Ulcers in Rats

    Shientag, Lisa J; Wheeler, Suzanne M; Garlick, David S.; Maranda, Louise S

    2012-01-01

    Perioperative treatment of several rats in our facility with ketoprofen (5 mg/kg SC) resulted in blood loss, peritonitis, and death within a day to a little more than a week after surgery that was not related to the gastrointestinal tract. Published reports have established the 5-mg/kg dose as safe and effective for rats. Because ketoprofen is a nonselective nonsteroidal antiinflammatory drug that can damage the gastrointestinal tract, the putative diagnosis for these morbidities and mortalit...

  17. Gastrointestinal Bleeding Secondary to Calciphylaxis.

    Gupta, Nancy; Haq, Khwaja F; Mahajan, Sugandhi; Nagpal, Prashant; Doshi, Bijal

    2015-01-01

    BACKGROUND Calciphylaxis is associated with a high mortality that approaches 80%. The diagnosis is usually made when obvious skin lesions (painful violaceous mottling of the skin) are present. However, visceral involvement is rare. We present a case of calciphylaxis leading to lower gastrointestinal (GI) bleeding and rectal ulceration of the GI mucosa. CASE REPORT A 66-year-old woman with past medical history of diabetes mellitus, hypertension, end-stage renal disease (ESRD), recently diagnosed ovarian cancer, and on hemodialysis (HD) presented with painful black necrotic eschar on both legs. The radiograph of the legs demonstrated extensive calcification of the lower extremity arteries. The hospital course was complicated with lower GI bleeding. A CT scan of the abdomen revealed severe circumferential calcification of the abdominal aorta, celiac artery, and superior and inferior mesenteric arteries and their branches. Colonoscopy revealed severe rectal necrosis. She was deemed to be a poor surgical candidate due to comorbidities and presence of extensive vascular calcifications. Recurrent episodes of profuse GI bleeding were managed conservatively with blood transfusion as needed. Following her diagnosis of calciphylaxis, supplementation with vitamin D and calcium containing phosphate binders was stopped. She was started on daily hemodialysis with low calcium dialysate bath as well as intravenous sodium thiosulphate. The clinical condition of the patient deteriorated. The patient died secondary to multiorgan failure. CONCLUSIONS Calciphylaxis leading to intestinal ischemia/perforation should be considered in the differential diagnosis in ESRD on HD presenting with abdominal pain or GI bleeding. PMID:26572938

  18. Scintigraphic detection of gastrointestinal bleeding: a review of current methods

    Recent experience with radionuclide imaging has provided the clinician with several techniques to noninvasively detect and locate sources of gastrointestinal hemorrhage. These tests can be rapidly performed and often in an ICU setting. One method used Tc-99m sulfur colloid which, in an animal model, has been shown to detect acute bleeding at rates as low as 0.1 ml/min. However, because the tracer remains in the blood for a short period of time, it may be suboptimal for identifying patients with intermittent bleeding. Tc-99m red cells is a tracer that remains within the blood and permits detection of both acute and intermittent bleeding. With tagged red cells, sites of bleeding from both the upper and lower gastrointestinal tract can be found. Both of these techniques can provide important information in the patient with suspected active gastrointestinal bleeding and aid the clinician in more effective management including the use of invasive diagnostic and therapeutic techniques

  19. The emergency treatment and nursing of acute upper gastrointestinal bleeding%急性上消化道出血的急救与护理体会

    朱承菊

    2011-01-01

    目的 探讨急性上消化道大出血的临床特点和护理对策.方法 总结分析186例急性上消道大出血的临床资料.结果 186例急性上消化道大出血,通过护理干预,痊愈157例,好转22例,死亡2例.结论 急性上消化道大出血临床常见,加强临床护理,预防各种并发症的发生,将大大降低病死率.%Objective To investigate the clinical features and nursing of acute upper gastrointestinal bleeding. Methods 168 patients with acute upper gastrointestinal bleeding were involved in our study, the clinical data was investigated With strict analysis. Results Among all the 168 patients, 157 patients recovered, 22 patients improved, 5 were sent to surgical treatment and 2 patients died. Conclusions Acute upper gastrointestinal bleeding is one of the most common medical emergencies. Intensive clinical nursing can prevent complications reduce the rate of fatality greatly.

  20. Mortality associated with gastrointestinal bleeding events: Comparing short-term clinical outcomes of patients hospitalized for upper GI bleeding and acute myocardial infarction in a US managed care setting

    C Mel Wilcox

    2009-03-01

    Full Text Available C Mel Wilcox1, Byron L Cryer2, Henry J Henk3, Victoria Zarotsky3, Gergana Zlateva41University of Alabama, Birmingham, AL, USA; 2University of Texas Southwestern Medical School, Dallas, TX; 3i3 Innovus, Eden Prairie, MN, USA; 4Pfizer, Inc., New York, NY, USA Objectives: To compare the short-term mortality rates of gastrointestinal (GI bleeding to those of acute myocardial infarction (AMI by estimating the 30-, 60-, and 90-day mortality among hospitalized patients.Methods: United States national health plan claims data (1999–2003 were used to identify patients hospitalized with a GI bleeding event. Patients were propensity-matched to AMI patients with no evidence of GI bleed from the same US health plan.Results: 12,437 upper GI-bleed patients and 22,847 AMI patients were identified. Propensity score matching yielded 6,923 matched pairs. Matched cohorts were found to have a similar Charlson Comorbidity Index score and to be similar on nearly all utilization and cost measures (excepting emergency room costs. A comparison of outcomes among the matched cohorts found that AMI patients had higher rates of 30-day mortality (4.35% vs 2.54%; p < 0.0001 and rehospitalization (2.56% vs 1.79%; p = 0.002, while GI bleed patients were more likely to have a repeat procedure (72.38% vs 44.95%; p < 0.001 following their initial hospitalization. The majority of the difference in overall 30-day mortality between GI bleed and AMI patients was accounted for by mortality during the initial hospitalization (1.91% vs 3.58%.Conclusions: GI bleeding events result in significant mortality similar to that of an AMI after adjusting for the initial hospitalization.Keywords: gastrointestinal, bleeding, mortality, acute myocardial infarction, claims analysis

  1. Outcome of Acute Upper Gastrointestinal Bleeding in Patients with Coronary Artery Disease: A Matched Case–control Study

    Kessarin Thanapirom; Wiriyaporn Ridtitid; Rungsun Rerknimitr; Rattikorn Thungsuk; Phadet Noophun; Chatchawan Wongjitrat; Somchai Luangjaru; Padet Vedkijkul; Comson Lertkupinit; Swangphong Poonsab; Thawee Ratanachu-ek; Piyathida Hansomburana; Bubpha Pornthisarn; Thirada Thongbai; Varocha Mahachai

    2016-01-01

    Background/Aim: The risk of upper gastrointestinal bleeding (UGIB) increases in patients with coronary artery disease (CAD) due to the frequent use of antiplatelets. There is some data reporting on treatment outcomes in CAD patients presenting with UGIB. We aim to determine the clinical characteristics and outcomes of UGIB in patients with CAD, compared with non-CAD patients. Patients and Methods: We conducted a prospective multi-center cohort study (THAI UGIB-2010) that enrolled 981 consecut...

  2. Intra-Arterial Treatment in Patients with Acute Massive Gastrointestinal Bleeding after Endoscopic Failure: Comparisons between Positive versus Negative Contrast Extravasation Groups

    Chang, Wei Chou; Liu, Chang Hsien; Hsu, Hsian He; Huang, Guo Shu; Hsieh, Tasi Yuan; Tsai, Shin Hung; Hsieh, Chung Bao; Yu, Chin Yung [Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (China); Tung, Ho Jui [Asia University, Taichung, Taiwan (CN)

    2011-10-15

    To determine whether treatment outcome is associated with visualization of contrast extravasation in patients with acute massive gastrointestinal bleeding after endoscopic failure. From January 2007 to December 2009, patients that experienced a first attack of acute gastrointestinal bleeding after failure of initial endoscopy were referred to our interventional department for intra-arterial treatment. We enrolled 79 patients and divided them into two groups: positive and negative extravasation. For positive extravasation, patients were treated by coil embolization; and in negative extravasation, patients were treated with intra-arterial vasopressin infusion. The two groups were compared for clinical parameters, hemodynamics, laboratory findings, endoscopic characteristics, and mortality rates. Forty-eight patients had detectable contrast extravasation (positive extravasation), while 31 patients did not (negative extravasation). Fifty-six patients survived from this bleeding episode (overall clinical success rate, 71%). An elevation of hemoglobin level was observed in the both two groups; significantly greater in the positive extravasation group compared to the negative extravasation group. Although these patients were all at high risk of dying, the 90-day mortality rate was significantly lower in the positive extravasation than in the negative extravasation (20% versus 42%, p < 0.05). A multivariate analysis suggested that successful hemo stasis (odds ratio [OR] = 28.66) is the most important predictor affecting the mortality in the two groups of patients. Visualization of contrast extravasation on angiography usually can target the bleeding artery directly, resulting in a higher success rate to control of hemorrhage.

  3. Hemospray Application in Nonvariceal Upper Gastrointestinal Bleeding

    Smith, Lyn A; Stanley, Adrian J; Bergman, Jacques J; Kiesslich, Ralf; Hoffman, Arthur; Tjwa, Eric T; Kuipers, Ernst J; von Holstein, Christer Stael; Oberg, Stefan; Brullet, Enric; Schmidt, Palle N; Iqbal, Tariq; Mangiavillano, Benedetto; Masci, Enzo; Prat, Frederic; Morris, Allan J

    2014-01-01

    Hemospray TM (TC-325) is a novel hemostatic agent licensed for use in nonvariceal upper gastrointestinal bleeding (NVUGIB) in Europe.......Hemospray TM (TC-325) is a novel hemostatic agent licensed for use in nonvariceal upper gastrointestinal bleeding (NVUGIB) in Europe....

  4. Analysis of Dosimetric Parameters Associated With Acute Gastrointestinal Toxicity and Upper Gastrointestinal Bleeding in Locally Advanced Pancreatic Cancer Patients Treated With Gemcitabine-Based Concurrent Chemoradiotherapy

    Nakamura, Akira [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan); Shibuya, Keiko, E-mail: kei@kuhp.kyoto-u.ac.jp [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan); Matsuo, Yukinori; Nakamura, Mitsuhiro; Shiinoki, Takehiro; Mizowaki, Takashi; Hiraoka, Masahiro [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan)

    2012-10-01

    Purpose: To identify the dosimetric parameters associated with gastrointestinal (GI) toxicity in patients with locally advanced pancreatic cancer (LAPC) treated with gemcitabine-based chemoradiotherapy. Methods and Materials: The data from 40 patients were analyzed retrospectively. Chemoradiotherapy consisted of conventional fractionated three-dimensional radiotherapy and weekly gemcitabine. Treatment-related acute GI toxicity and upper GI bleeding (UGB) were graded according to the Common Toxicity Criteria Adverse Events, version 4.0. The dosimetric parameters (mean dose, maximal absolute dose which covers 2 cm{sup 3} of the organ, and absolute volume receiving 10-50 Gy [V{sub 10-50}]) of the stomach, duodenum, small intestine, and a composite structure of the stomach and duodenum (StoDuo) were obtained. The planning target volume was also obtained. Univariate analyses were performed to identify the predictive factors for the risk of grade 2 or greater acute GI toxicity and grade 3 or greater UGB, respectively. Results: The median follow-up period was 15.7 months (range, 4-37). The actual incidence of acute GI toxicity was 33%. The estimated incidence of UGB at 1 year was 20%. Regarding acute GI toxicity, a V{sub 50} of {>=}16 cm{sup 3} of the stomach was the best predictor, and the actual incidence in patients with V{sub 50} <16 cm{sup 3} of the stomach vs. those with V{sub 50} of {>=}16 cm{sup 3} was 9% vs. 61%, respectively (p = 0.001). Regarding UGB, V{sub 50} of {>=}33 cm{sup 3} of the StoDuo was the best predictor, and the estimated incidence at 1 year in patients with V{sub 50} <33 cm{sup 3} of the StoDuo vs. those with V{sub 50} {>=}33 cm{sup 3} was 0% vs. 44%, respectively (p = 0.002). The dosimetric parameters correlated highly with one another. Conclusion: The irradiated absolute volume of the stomach and duodenum are important for the risk of acute GI toxicity and UGB. These results could be helpful in escalating the radiation doses using novel

  5. An unusual cause of gastrointestinal bleed

    C K Adarsh

    2014-01-01

    Full Text Available Gastrointestinal (GI bleed often brings the patient to the emergency medical service with great anxiety. Known common causes of GI bleed include ulcers, varices, Mallory-Weiss among others. All causes of GI bleed should be considered however unusual during the evaluation. Aortoenteric fistula (AEF is one of the unusual causes of GI bleed, which has to be considered especially in patients with a history of abdominal surgery in general and aortic surgery in particular.

  6. Gastrointestinal bleeding secondary to ulcer in duodenal diverticulosis

    The reasons more frequent of high gastrointestinal bleeding are the peptic gastric and duodenal, followed by acute erosions and the varicose veins in oesophagus and stomach. The diverticulosis of the small bowel is a very rare reason of gastrointestinal bleeding, must considerate in patients with bleeding without evident reason in oesophagus and stomach, the habitual is to diagnose this entity of accidental form in the course of endoscopic procedures, radiological or surgical. The complications associated with the diverticulosis duodenal are rare; it justifies supporting a not surgical attitude at first

  7. Gastrointestinal bleeding secondary to ulcer in duodenal diverticulosis

    The reasons more frequent of high gastrointestinal bleeding are the peptic gastric and duodenal, followed by acute erosion and the varicose veins in oesophagus and stomachs. The diverticulosis of the small bowel is a very rare reason of gastrointestinal bleeding, must considerate in patients with bleeding without evident reason in oesophagus and stomach the habitual is to diagnose this entity of occidental form in the course of endoscopic procedures, radiological of surgical. The complications associated with the diverticulosis duodenal are rare; it justifies supporting a not surgical attitude at first

  8. Role of videocapsule endoscopy for gastrointestinal bleeding

    Cristina Carretero; Ignacio Fernandez-Urien; Maite Betes; Miguel Mu(n)oz-Navas

    2008-01-01

    Obscure gastrointestinal bleeding (OGIB) is defined as bleeding of an unknown origin that persists or recurs after negative initial upper and lower endoscopies.Several techniques,such as endoscopy,arteriography,scintigraphy and barium radiology are helpful for recognizing the bleeding source;nevertheless,in about 5%-10% of cases the bleeding lesion cannot be determined.The development of videocapsule endoscopy (VCE) has permitted a direct visualization of the small intestine mucosa.We will analyze those techniques in more detail.The diagnostic yield of CE for OGIB varies from 38% to 93%,being in the higher range in those cases with obscure-overt bleeding.

  9. Excess long-term mortality following non-variceal upper gastrointestinal bleeding: a population-based cohort study

    Colin John Crooks; Timothy Richard Card; Joe West

    2013-01-01

    Editors' Summary Background Acute gastrointestinal bleeding is a potentially life-threatening abdominal emergency that remains a common cause of admission to hospital. Upper gastrointestinal bleeding (bleeding derived from a source above the ligament of Treitz, which connects the fourth portion of the duodenum to the diaphragm) is roughly four times as common as bleeding from the lower gastrointestinal tract and is a major cause of morbidity and mortality. Upper gastrointestinal bleeding is a...

  10. Scintigraphic detection and localization of gastrointestinal bleeding sites

    Successful management of acute gastrointestinal (GI) bleeding usually depends on accurate localization of the bleeding site. History and clinical findings are often misleading in determination of the site of hemorrhage. The widespread application of flexible endoscopy and selective arteriography now provide accurate diagnoses for the majority of patients bleeding from the upper GI tract, but lower GI bleeding still poses a serious diagnostic challenge. Endoscopy and barium studies are of limited value in examining the small bowel and colon in the face of active hemorrhage. Arteriography, although successful in many cases (3-5), has limitations. The angiographic demonstration of bleeding is possible only when the injection of contrast material coincides with active bleeding at a rate greater than 0.5 ml/min, and since lower GI bleeding is commonly intermittent rather than continuous, a high rate of negative angiographic examinations has been reported. The diagnosis of lower GI bleeding is usually easy to make. In contrast, localizing the site of bleeding may be extremely difficult. Using the techniques described the nuclear physician may be able to detect the bleeding site precisely. However, if the cautions detailed are not observed, the tracer studies will show GI bleeding, but not at the true bleeding site. This must be carefully understood and avoided. Done correctly, these tests can have a major impact on patient care

  11. Management of nonvariceal upper gastrointestinal bleeding

    E Wee

    2011-01-01

    Full Text Available Nonvariceal upper gastrointestinal bleeding is unique from variceal bleeding in terms of patient characteristics, management, rebleeding rates, and prognosis, and should be managed differently. The majority of nonvariceal upper gastrointestinal bleeds will not rebleed once treated successfully. The incidence is 80 to 90% of all upper gastrointestinal bleeds and the mortality is between 5 to 10%. The causes include nonacid-related ulceration from tumors, infections, inflammatory disease, Mallory-Weiss tears, erosions, esophagitis, dieulafoy lesions, angiodysplasias, gastric antral vascular ectasia, and portal hypertensive gastropathy. Rarer causes include hemobilia, hemosuccus pancreaticus, and aortoenteric fistulas. Hematemesis and melena are the key features of bleeding from the upper gastrointestinal tract, but fresh per rectal bleeding may be present in a rapidly bleeding lesion. Resuscitation and stabilization before endoscopy leads to improved outcomes. Fluid resuscitation is essential to avoid hypotension. Though widely practiced, there is currently insufficient evidence to show that routine red cell transfusion is beneficial. Coagulopathy requires correction, but the optimal international normalized ratio has not been determined yet. Risk stratification scores such as the Rockall and Glasgow-Blatchford scores are useful to predict rebleeding, mortality, and to determine the urgency of endoscopy. Evidence suggests that high-dose proton pump inhibitors (PPI should be given as an infusion before endoscopy. If patients are intolerant of PPIs, histamine-2 receptor antagonists can be given, although their acid suppression is inferior. Endoscopic therapy includes thermal methods such as coaptive coagulation, argon plasma coagulation, and hemostatic clips. Four quadrant epinephrine injections combined with either thermal therapy or clipping reduces mortality. In hypoxic patients, endoscopy masks allow high-flow oxygen during upper

  12. Scintigraphic demonstration of gastrointestinal bleeding due to mesenteric varices

    Hansen, M.E.; Coleman, R.E. (Duke Univ. Medical Center, Durham, NC (USA))

    1990-07-01

    Mesenteric varices can appear as massive, acute lower gastrointestinal bleeding. The small bowel or colon may be involved, varices usually developing at sites of previous surgery or inflammation in patients with portal hypertension. Two patients with alcoholic cirrhosis and protal hypertension presented with rectal bleeding. Tc-99m RBC studies demonstrated varices and extravasation into the adjacent bowel. The varices were documented by mesenteric angiography. Characteristic features of Tc-99m labeled RBC studies can identify mesenteric varices as the cause of intestinal bleeding and localize the abnormal vessels.

  13. Bleeding rates necessary for detecting acute gastrointestinal bleeding with technetium-99m-labeled red blood cells in an experimental model

    Proponents of [/sup 99m/Tc]sulfur colloid for GI bleeding studies argue that, although labeled red blood cells are useful for intermittent bleeding, they are not capable of detecting low bleeding rates. Studies of dogs with experimental GI bleeding have indicated bleeding rates of 0.05 ml/min can be detected with [/sup 99m/Tc]sulfur colloid. Since similar data in the dog model were unavailable for /sup 99m/Tc-labeled red blood cells, we undertook this study. To simulate lower GI bleeding, catheters were inserted into the bowel lumen. Each dog's blood was labeled with /sup 99m/Tc using an in vitro technique. Venous blood was then withdrawn and re-infused into the lumen of the bowel using a Harvard pump. Fourteen dogs were studied, ten receiving a bleeding rate from 4.6-0.02 ml/min in the descending colon and four with proximal jejunal bleeds of 0.20-0.02 ml/min. Bleeding rates of 4.6-0.2 ml/min were detected within 10 min in the colon and bleeding rates as low as 0.04 ml/min were seen by 55 min. Slower bleeding rates were not detected. Similar findings were noted for proximal jejunal bleeds. Based on the time of appearance, a minimum volume of approximately 2-3 ml labeled blood was necessary to detect bleeding. We conclude that /sup 99m/Tc-labeled RBCs are sensitive for low bleeding rates in the dog model. The rates are comparable to those described for [/sup 99m/Tc]sulfur colloid in this experimental setting. The time of appearance of activity is related to the bleeding rate

  14. Red Blood Cell Transfusions and Iron Therapy for Patients Presenting with Acute Upper Gastrointestinal Bleeding: A Survey of Canadian Gastroenterologists and Hepatologists

    Fortinsky, Kyle J.; Razik, Roshan; Spiegle, Gillian; Gallinger, Zane R.; Grover, Samir C.; Pavenski, Katerina; Weizman, Adam V.; Kwapisz, Lukasz; Mehta, Sangeeta; Gray, Sarah

    2016-01-01

    Introduction. There is limited data evaluating physician transfusion practices in patients with acute upper gastrointestinal bleeding (UGIB). Methods. A web-based survey was sent to 500 gastroenterologists and hepatologists across Canada. The survey included clinical vignettes where physicians were asked to choose transfusion thresholds. Results. The response rate was 41% (N = 203). The reported hemoglobin (Hgb) transfusion trigger differed by up to 50 g/L. Transfusions were more liberal in hemodynamically unstable patients compared to stable patients (mean Hgb of 86.7 g/L versus 71.0 g/L; p iron to patients with UGIB who are anemic upon discharge. Conclusions. The transfusion practices of gastroenterologists in the management of UGIB vary widely and more high-quality evidence is needed to help assess the efficacy and safety of selected transfusion thresholds in varying patients presenting with UGIB. PMID:27446847

  15. Radionuclide detection of lower gastrointestinal bleeding sites

    A retrospective review of two years' experience with radionuclide screening to detect lower gastrointestinal bleeding sites was conducted at New York's Montefiore Medical Center. Of 82 studies performed in 63 patients, 13 identified active bleeding sites. Only three of eight angiograms obtained in these 13 patients were positive. Thirteen contrast angiograms were performed in the group of 50 patients with negative radionuclide studies of which ten were negative and one was equivocal. The results of this study suggest that the Tc-99m sulfur colloid study for active lower gastrointestinal (GI) bleeding is an effective screening procedure. Positive studies help determine which vessel to catheterize selectively if an angiogram is to be performed. If vascular ectasis is still suspected following a negative radionuclide study, contrast angiography can be more efficaciously performed on a nonemergent basis

  16. Lower Gastrointestinal Bleeding And Risk of Gastrointestinal Cancer

    Viborg, Søren; Søgaard, Kirstine Kobberøe; Farkas, Dóra Körmendiné; Nørrelund, Helene; Pedersen, Lars; Sørensen, Henrik Toft

    2016-01-01

    OBJECTIVES: Lower gastrointestinal (GI) bleeding is a well-known symptom of colorectal cancer (CRC). Whether incident GI bleeding is also a marker of other GI cancers remains unclear. METHODS: This nationwide cohort study examined the risk of various GI cancer types in patients with lower GI...... bleeding. We used Danish medical registries to identify all patients with a first-time hospital diagnosis of lower GI bleeding during 1995-2011 and followed them for 10 years to identify subsequent GI cancer diagnoses. We computed absolute risks of cancer, treating death as a competing risk, and calculated...... standardized incidence ratios (SIRs) by comparing observed cancer cases with expected cancer incidence rates in the general population. RESULTS: Among 58,593 patients with lower GI bleeding, we observed 2,806 GI cancers during complete 10-year follow-up. During the first year of follow-up, the absolute GI...

  17. Computed tomography angiography in patients with active gastrointestinal bleeding

    Gastrointestinal bleeding represents a common medical emergency, with considerable morbidity and mortality rates, and a prompt diagnosis is essential for a better prognosis. In such a context, endoscopy is the main diagnostic tool; however, in cases where the gastrointestinal hemorrhage is massive, the exact bleeding site might go undetected. In addition, a trained professional is not always present to perform the procedure. In an emergency setting, optical colonoscopy presents limitations connected with the absence of bowel preparation, so most of the small bowel cannot be assessed. Scintigraphy cannot accurately demonstrate the anatomic location of the bleeding and is not available at emergency settings. The use of capsule endoscopy is inappropriate in the acute setting, particularly in the emergency department at night, and is a highly expensive method. Digital angiography, despite its high sensitivity, is invasive, presents catheterization-related risks, in addition to its low availability at emergency settings. On the other hand, computed tomography angiography is fast, widely available and minimally invasive, emerging as a promising method in the diagnostic algorithm of these patients, being capable of determining the location and cause of bleeding with high accuracy. Based on a critical literature review and on their own experience, the authors propose a computed tomography angiography protocol to assess the patient with gastrointestinal bleeding. (author)

  18. Computed tomography angiography in patients with active gastrointestinal bleeding

    Reis, Fatima Regina Silva; D' Ippolito, Giuseppe, E-mail: fatima.rsreis@gmail.com [Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP (Brazil). Escola Paulista de Medicina; Cardia, P.P. [Hospital Vera Cruz, Campinas, SP (Brazil)

    2015-11-15

    Gastrointestinal bleeding represents a common medical emergency, with considerable morbidity and mortality rates, and a prompt diagnosis is essential for a better prognosis. In such a context, endoscopy is the main diagnostic tool; however, in cases where the gastrointestinal hemorrhage is massive, the exact bleeding site might go undetected. In addition, a trained professional is not always present to perform the procedure. In an emergency setting, optical colonoscopy presents limitations connected with the absence of bowel preparation, so most of the small bowel cannot be assessed. Scintigraphy cannot accurately demonstrate the anatomic location of the bleeding and is not available at emergency settings. The use of capsule endoscopy is inappropriate in the acute setting, particularly in the emergency department at night, and is a highly expensive method. Digital angiography, despite its high sensitivity, is invasive, presents catheterization-related risks, in addition to its low availability at emergency settings. On the other hand, computed tomography angiography is fast, widely available and minimally invasive, emerging as a promising method in the diagnostic algorithm of these patients, being capable of determining the location and cause of bleeding with high accuracy. Based on a critical literature review and on their own experience, the authors propose a computed tomography angiography protocol to assess the patient with gastrointestinal bleeding. (author)

  19. Outcome of non-variceal acute upper gastrointestinal bleeding in relation to the time of endoscopy and the experience of the endoscopist: A two-year survey

    Fabrizio Parente; Andrea Anderloni; Stefano Bargiggia; Venerina Imbesi; Emilio Trabucchi; Cinzia Baratti; Silvano Gallus; Gabriele Bianchi Porro

    2005-01-01

    AIM: To prospectively assess the impact of time of endoscopy and endoscopist's experience on the outcome of non-variceal acute upper gastrointestinal (GI) bleeding patients in a large teaching hospital.METHODS: All patients admitted for non-variceal acute upper GI bleeding for over a 2-year period were potentially eligible for this study. They were managed by a team of seven endoscopists on 24-h call whose experience was categorized into two levels (high and low) according to the number of endoscopic hemostatic procedures undertaken before the study. Endoscopic treatment was standardized according to Forrest classification of lesions as well as the subsequent medical therapy. Time of endoscopy was subdivided into two time periods: routine (8 a.m.-5 p.m.) and on-call (5 p.m.-8 a.m.). For each category of experience and time periods rebleeding rate, transfusion requirement, need for surgery, length of hospital stay and mortality we compared. Multivariate analysis was used to discriminate the impact of different variables on the outcomes that were considered.RESULTS: Study population consisted of 272 patients (mean age 67.3 years) with endoscopic stigmata of hemorrhage. The patients were equally distributed among the endoscopists, whereas only 19% of procedures were done out of working hours. Rockall score and Forrest classification at admission did not differ between time periods and degree of experience.Univariate analysis showed that higher endoscopist's experience was associated with significant reduction in rebleeding rate (14% vs 37%), transfusion requirements (1.8±0.6 vs 3.0±1.7 units) as well as surgery (4% vs 10%), but not associated with the length of hospital stay nor mortality. By contrast, outcomes did not significantly differ between the two time periods of endoscopy.On multivariate analysis, endoscopist's experience was independently associated with rebleeding rate and transfusion requirements. Odds ratios for low experienced endoscopist were 4.47 for

  20. c-KIT positive Gastrointestinal Stromal Tumor presenting with acute bleeding in a patient with neurofibromatosis type 1: a case report

    Aboutaleb, Esam; Kothari, Manish; Damrah, Osama; Canelo, Roben

    2009-01-01

    Background Gastrointestinal stromal tumours are rare (GIST). However, the incidence of GIST among neurofibromatosis type 1 (NF-1) patients is approximately 3.9-25%. GIST can present clinically in different ways such as abdominal pain, gastrointestinal bleeding and obstruction. Case report We present 51 year female patient admitted with Background of neurofibromatosis type 1 admitted with melena. OGD has been done and showed duodenitis with large volume fresh blood in distal duodenum but no ob...

  1. A STUDY ON ENDOSCOPIC EVALUATION OF UPPER GASTROINTESTINAL BLEEDING

    Pranaya Kumar

    2016-03-01

    Full Text Available CONTEXT Upper gastrointestinal bleeding (UGIB is one of the commonest gastrointestinal emergencies encountered by clinicians. Peptic ulcers are the most common cause of UGIB. Endoscopy has become the preferred method for diagnosis in patients with acute UGIB. This study is done in a diagnostic upper gastrointestinal endoscopy (UGIE setup of a tertiary care hospital to ascertain the causes of UGIB prevalent in this part of our country which might differ from other studies. AIM To ascertain prevalent causes of UGIB in patients of this part of India admitted to a Govt. Tertiary Hospital with a provisional diagnosis of UGIB. METHOD One hundred consecutive patients with UGIB were subjected to UGIE to find out the aetiology. The clinical profile and endoscopic findings were analysed and compared with the data on UGIB from other studies. RESULTS The mean age of patients was 47.03 years with male: female ratio of 2.33:1. 58% of patients were first time bleeders. Majority of patients presented with melaena. Visualisation of active bleeding achieved to 85.7% when endoscopy was done within first 24 hrs. The commonest cause of UGIB was duodenal ulcer (DU which accounted for 41% cases. Gastric ulcer was responsible in 13% of cases. Portal hypertension was responsible for bleed in only 13%. Neoplasms accounted for 25% of cases. Other less common causes were erosive gastritis (3%, gastric polyp (3%, Mallory-Weiss tear (1%, and Dieulafoy’s lesion (1%. Among bleeding peptic ulcers, 27.8% of cases were classified as Forrest IIa and 20.4% in Forrest IIb & IIc each. Acid peptic disease was past history elicited in majority (33% followed by NSAID (26% and alcohol (26%. CONCLUSION The present study has diagnosed various causes of upper gastrointestinal bleeding in this part of country. The incidence of gastric carcinoma as a cause of upper gastrointestinal bleeding is significantly high compared to those in other studies. UGI endoscopy should be done in every case

  2. Evaluation and outcomes of patients with obscure gastrointestinal bleeding

    Santhakumar, Cositha; Liu, Ken

    2014-01-01

    Obscure gastrointestinal bleeding (OGIB) is defined as recurrent or persistent bleeding or presence of iron deficiency anaemia after evaluation with a negative bidirectional endoscopy. OGIB accounts for 5% of gastrointestinal bleeding and presents a diagnostic challenge. Current modalities available for the investigation of OGIB include capsule endoscopy, balloon assisted enteroscopy, spiral enteroscopy and computed tomography enterography. These modalities overcome the limitations of previou...

  3. Lower Gastrointestinal Bleeding And Risk of Gastrointestinal Cancer

    Viborg, Søren; Søgaard, Kirstine Kobberøe; Farkas, Dóra Körmendiné; Nørrelund, Helene; Pedersen, Lars; Sørensen, Henrik Toft

    2016-01-01

    OBJECTIVES: Lower gastrointestinal (GI) bleeding is a well-known symptom of colorectal cancer (CRC). Whether incident GI bleeding is also a marker of other GI cancers remains unclear. METHODS: This nationwide cohort study examined the risk of various GI cancer types in patients with lower GI bleeding. We used Danish medical registries to identify all patients with a first-time hospital diagnosis of lower GI bleeding during 1995–2011 and followed them for 10 years to identify subsequent GI cancer diagnoses. We computed absolute risks of cancer, treating death as a competing risk, and calculated standardized incidence ratios (SIRs) by comparing observed cancer cases with expected cancer incidence rates in the general population. RESULTS: Among 58,593 patients with lower GI bleeding, we observed 2,806 GI cancers during complete 10-year follow-up. During the first year of follow-up, the absolute GI cancer risk was 3.6%, and the SIR of any GI cancer was 16.3 (95% confidence interval (CI): 15.6–17.0). Colorectal cancers accounted for the majority of diagnoses, but risks of all GI cancers were increased. During 1–5 years of follow-up, the SIR of any GI cancer declined to 1.36 (95% CI: 1.25–1.49), but risks remained increased for several GI cancers. Beyond 5 years of follow-up, the overall GI cancer risk was close to unity, with reduced risk of rectal cancer and increased risk of liver and pancreatic cancers. CONCLUSIONS: A hospital-based diagnosis of lower GI bleeding is a strong clinical marker of prevalent GI cancer, particularly CRC. It also predicts an increased risk of any GI cancer beyond 1 year of follow-up. PMID:27054580

  4. Obscure gastrointestinal bleeding: preoperative CT-guided percutaneous needle localization of the bleeding small bowel segment.

    Heiss, Peter; Feuerbach, Stefan; Iesalnieks, Igors; Rockmann, Felix; Wrede, Christian E; Zorger, Niels; Schlitt, Hans J; Schölmerich, Jürgen; Hamer, Okka W

    2009-04-01

    A 57-year-old woman presented with obscure gastrointestinal bleeding. Double balloon enteroscopy, angiography, and surgery including intraoperative enteroscopy failed to identify the bleeding site. Multidetector computed tomography (CT) depicted active bleeding of a small bowel segment. The bleeding segment was localized by CT-guided percutaneous needle insertion and subsequently removed surgically. PMID:19328430

  5. Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients

    Krag, Mette; Perner, Anders; Wetterslev, Jørn;

    2015-01-01

    replacement therapy (6.9, 2.7-17.5), co-existing coagulopathy (5.2, 2.3-11.8), acute coagulopathy (4.2, 1.7-10.2), use of acid suppressants (3.6, 1.3-10.2) and higher organ failure score (1.4, 1.2-1.5). In ICU, 73 % (71-76 %) of patients received acid suppressants; most received proton pump inhibitors. In...

  6. Large Duodenal Gastrointestinal Stromal Tumor Presenting with Acute Bleeding Managed by a Whipple Resection. A Review of Surgical Options and the Prognostic Indicators of Outcome

    Norman Oneil Machado

    2011-03-01

    Full Text Available Context Duodenal gastrointestinal stromal tumors (GISTs are uncommon and constitute a relatively small subset of GISTs which presents a unique dilemma having various surgical options. A case of a large ulcerating duodenal GIST arising from the second and third parts of the duodenum and involving the pancreas which was managed by a Whipple resection is presented. The literature is also reviewed to present the current status on surgical options, outcome, prognostic indicators and the role of imatinib mesylate in its management. Case report A 58-year-old patient presented with acute gastrointestinal bleeding which was diagnosed to be due to a duodenal GIST following CT scan and endoscopic biopsy. The mass which measured about 10x9 cm originated from the 2nd part and extended into the 3rd part of the duodenum. He underwent a Whipple resection, and histopathology confirmed a duodenal GIST having a greater than 10 mitotic count per fifty high power field and areas of necrosis. Postoperatively, he received imatinib mesylate 400 mg bid; however, 4 months later, he presented with multiple disseminated peritoneal metastases and succumbed to the disease 2 months later. Conclusion GISTs of the duodenum which are small in size and do not involve the papilla of Vater are better resolved using a limited resection of the duodenum since the outcome in terms of operative risk or disease recurrence is not influenced in these cases. However, large tumors with more extensive involvement would require a pancreaticoduodenectomy to achieve adequate tumor clearance. Even though duodenal GISTs have a relatively better prognosis as compared to GISTs at other sites, their aggressiveness ranges from small indolent tumors to aggressive sarcomas. Following tumor resection, a recurrence rate of about 40% has been reported. A more favorable prognosis in duodenal GISTs is attributed to a lower prevalence of P53 loss, the duodenal location of the tumor, a smaller size of the

  7. Gastrointestinal bleeding in patients with hereditary hemorrhagic telangiectasia

    Kjeldsen, A D; Kjeldsen, J

    2000-01-01

    Gastrointestinal bleeding occurs in a number of patients with hereditary hemorrhagic telangiectasia (HHT) and may lead to a high transfusion need. The aim of this study was to estimate the occurrence and severity of gastrointestinal bleeding in a geographically well defined HHT population....

  8. Acute Lower Gastrointestinal Haemorrhage Secondary to Small Bowel Ascariasis

    Daphne Dewi, Stephen; Sze Li, Siow

    2012-01-01

    Acute lower gastrointestinal haemorrhage secondary to small bowel ascariasis is extremely rare. A high level of suspicion should be maintained when dealing with acute gastrointestinal haemorrhage in migrants and travellers. Small bowel examination is warranted when carefully repeated upper and lower endoscopies have failed to elicit the source of bleeding. Appropriate test selection is determined by the availability of local expertise. We present a case of acute lower gastrointestinal haemorr...

  9. Update on the transfusion in gastrointestinal bleeding (TRIGGER) trial: statistical analysis plan for a cluster-randomised feasibility trial

    Kahan, B. C.; Jairath, V; Murphy, M F; Doré, C. J.

    2013-01-01

    Background Previous research has suggested an association between more liberal red blood cell (RBC) transfusion and greater risk of further bleeding and mortality following acute upper gastrointestinal bleeding (AUGIB). Methods and design The Transfusion in Gastrointestinal Bleeding (TRIGGER) trial is a pragmatic cluster-randomised feasibility trial which aims to evaluate the feasibility of implementing a restrictive vs. liberal RBC transfusion policy for adult patients admitted to hospital w...

  10. New insights to occult gastrointestinal bleeding: From pathophysiology to therapeutics

    Antonio; Damián; Sánchez-Capilla; Paloma; De; La; Torre-Rubio; Eduardo; Redondo-Cerezo

    2014-01-01

    Obscure gastrointestinal bleeding is still a clinical challenge for gastroenterologists. The recent development of novel technologies for the diagnosis and treatment of different bleeding causes has allowed a better management of patients, but it also determines the need of a deeper comprehension of pathophysiology and the analysis of local expertise in order to develop a rational management algorithm. Obscure gastrointestinal bleeding can be divided in occult, when a positive occult blood fecal test is the main manifestation, and overt, when external sings of bleeding are visible. In this paper we are going to focus on overt gastrointestinal bleeding, describing the physiopathology of the most usual causes, analyzing the diagnostic procedures available, from the most classical to the novel ones, and establishing a standard algorithm which can be adapted depending on the local expertise or availability. Finally, we will review the main therapeutic options for this complex and not so uncommon clinical problem.

  11. Systematic review: tranexamic acid for upper gastrointestinal bleeding

    Klingenberg, S.L.; Langholz, S.E.; Gluud, Lise Lotte

    2008-01-01

    BACKGROUND: Tranexamic acid may reduce upper gastrointestinal bleeding and stabilize patients before endoscopic treatments. AIM: To review randomized trials on tranexamic acid for upper gastrointestinal bleeding. METHODS: Manual and electronic searches of The Cochrane Library, MEDLINE, EMBASE and...... were unclearly reported. Data from three of the included trials suggested that tranexamic acid did not significantly increase the risk of thromboembolic disease. CONCLUSIONS: The present review suggests that tranexamic acid may reduce all-cause mortality. However, because of limitations in the internal...

  12. An unusual cause of upper gastrointestinal system bleeding: Duodenal varices

    Yılmaz, Ömer; Ataseven, Hilmi

    2012-01-01

    Abstract Duodenal varices are an uncommon site of hemorrhage in patients with portal hypertension, but their rupture is a serious and often fatal event. We report the case of a 27- year- old man with liver cirrhosis who presented with upper gastrointestinal bleeding. Upper gastrointestinal endoscopy revealed nodular varices in the second portion of the duodenum which were considered to be the source of bleeding. We decided to inject N-butyl-2-cyanoacrylate (Histoacryl), an adhesive agent, and...

  13. Multiple smooth muscle tumours in neurofibromatosis presenting with chronic gastrointestinal bleeding.

    Cox, J. G.; Royston, C M; Sutton, D. R.

    1988-01-01

    Gastrointestinal involvement in neurofibromatosis is well recognised. We present an unusual manifestation of gastro-intestinal neurofibromatosis--chronic gastrointestinal bleeding from extensive smooth muscle tumours.

  14. Congenital portosystemic shunts with and without gastrointestinal bleeding - case series

    Gong, Ying; Chen, Jun; Chen, Qi; Ji, Min; Pa, Mier; Qiao, Zhongwei [Children' s Hospital of Fudan University, Department of Radiology, Shanghai (China); Zhu, Hui [Fudan University Shanghai Cancer Center, Department of Radiology, Shanghai (China); Zheng, Shan [Children' s Hospital of Fudan University, Department of Surgery, Shanghai (China)

    2015-12-15

    The clinical presentation of congenital portosystemic shunt is variable and gastrointestinal bleeding is an uncommon presentation. To describe the imaging features of congenital portosystemic shunt as it presented in 11 children with (n = 6) and without gastrointestinal bleeding (n = 5). We performed a retrospective study on a clinical and imaging dataset of 11 children diagnosed with congenital portosystemic shunt. A total of 11 children with congenital portosystemic shunt were included in this study, 7 with extrahepatic portosystemic shunts and 4 with intrahepatic portosystemic shunts. Six patients with gastrointestinal bleeding had an extrahepatic portosystemic shunt, and the imaging results showed that the shunts originated from the splenomesenteric junction (n = 5) or splenic vein (n = 1) and connected to the internal iliac vein. Among the five cases of congenital portosystemic shunt without gastrointestinal bleeding, one case was an extrahepatic portosystemic shunt and the other four were intrahepatic portosystemic shunts. Most congenital portosystemic shunt patients with gastrointestinal bleeding had a shunt that drained portal blood into the iliac vein via an inferior mesenteric vein. This type of shunt was uncommon, but the concomitant rate of gastrointestinal bleeding with this type of shunt was high. (orig.)

  15. Spironolactone use and the risk of upper gastrointestinal bleeding

    Gulmez, Sinem E; Lassen, Annmarie T; Aalykke, Claus;

    2008-01-01

    WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT * Recent studies have suggested an increased risk of upper gastrointestinal bleeding (UGB) in spironolactone users. * We conducted this population-based case-control study to confirm the association between spironolactone use and acute nonvaricose UGB alone...... risk factors and quantify the absolute risk. METHODS A population based case-control study was conducted in the County of Funen, Denmark. Cases (n = 3652) were all subjects with a first discharge diagnosis of serious UGB during the period 1995 to 2006. Age- and gender-matched controls (10 for each case......) (n = 36 502) were selected by risk set sampling. Data on all subjects' drug exposure and past medical history were retrieved from a prescription database and from the County's patient register. Confounders were controlled by conditional logistic regression. RESULTS The adjusted odds ratio (OR...

  16. Splenic angiosarcoma metastasis to small bowel presented with gastrointestinal bleeding

    Jun-Te Hsu; Chin-Yew Lin; Ting-Jun Wu; Han-Ming Chen; Tsann-Long Hwang; Yi-Yin Jan

    2005-01-01

    Primary splenic angiosarcoma is a very rare,aggressive neoplasm with a high metastatic rate and dismal prognosis. This neoplasm usually presents with abdominal pain, splenomegaly, anemia, and thrombocytopenia. Splenic angiosarcoma with bleeding gastrointestinal metastases is extremely rare. The literature contains only two case reports. This study reported a 44-year-old male patient with splenic angiosarcoma with sustained repeated gastrointestinal bleeding due to small bowel metastases. Salvage surgery was performed by splenectomy and resection of the metastatic small bowel tumors. The post-operative course was uneventful; the patient survived with the disease and had no GI bleeding, 7 mo after surgery.

  17. Prevalence and risk factors of stress-induced gastrointestinal bleeding in critically ill children

    Chookhuan Nithiwathanapong; Sanit Reungrongrat; Nuthapong Ukarapol

    2005-01-01

    AIM: To assess the frequency and the risk factors of stress-induced gastrointestinal (GI) bleeding in children admitted to a pediatric intensive care unit (PICU).METHODS: The medical records of children aged between 1 month and 15 years admitted to the PICU between January 2002 and December 2002 were reviewed.Demographic data, indications for PICU admission, principle diagnosis, and basic laboratory investigations were recorded. Previously described factors for stress ulcer bleeding (mechanical ventilation, sepsis, acute respiratory distress syndrome, renal insufficiency, coagulopathy,thrombocytopenia, and intracranial pathology) were used as independent variables in a multivariate analysis.RESULTS: One hundred and seventy of two hundred and five medical records were eligible for review. The most common indication for PICU admission was respiratory failure (48.8%). Twenty-five children received stress ulcer bleeding prophylaxis with ranitidine. The incidence of stress ulcer bleeding was 43.5%, in which 5.3% were clinically significant bleeding. Only mechanical ventilation and thrombocytopenia were significantly associated with stress ulcer bleeding using the univariate analysis.The odds ratio and 95% confidence intervals were 5.13(1.86-14.12) and 2.26 (1.07-4.74), respectively. However, the logistic regression analysis showed that mechanicai ventilation was the only significant risk factor with the odds ratio of 14.1.CONCLUSION: The incidence of gastrointestinal bleeding was high in critically ill children. Mechanical ventilation was an important risk factor for gastrointestinal bleeding.

  18. PRE-AETHIOLOGICAL TREATMENT IN UPPER GASTRO-INTESTINAL BLEEDING

    G. Dimofte

    2005-01-01

    Full Text Available Upper gastro-intestinal bleeding remains a cornerstone in surgical practice and unfortunately its’ management is profoundly variable according to hospital protocols and local standards of care. Medical interventions are acting at different levels of medical care and a range of specialist are involved in the process, starting from family practitioners to surgeons, as well as highly trained specialist in interventional endoscopy or radiology. This review is trying to establish the landmarks in the early assessment and care of patients with upper gastro-intestinal bleeding, irrespective of the morphological cause of the bleeding. We propose a protocol for the management both of portal and non-portal upper-gastrointestinal bleedings, prior to endoscopic diagnosis. It is fundamental to establish a standard of care which is feasible in Romania and can work both in university and district hospitals. The protocol is marking the essential gestures with their relevance for the bleeding patient but also reminds the significance of clinical evaluation and safety in transportation of the patient to the nearest emergency room. A battery of simple test should be performed in every patient and data interpreted with care, as results vary according to the level of haemodynamic compensation. Standard empiric therapy for upper gastro-intestinal bleeding is not yet been established but a couple of alternatives emerge as possible solutions. We discuss the benefits of a standard therapy based on H2 blockers, proton pump inhibitors, octreoctide and somatostatin regarding both portal and non-portal bleedings.

  19. Recent Update of Embolization of Upper Gastrointestinal Tract Bleeding

    Shin, Ji Hoon [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2012-02-15

    Nonvariceal upper gastrointestinal (UGI) bleeding is a frequent complication with significant morbidity and mortality. Although endoscopic hemostasis remains the initial treatment modality, severe bleeding despite endoscopic management occurs in 5-10% of patients, necessitating surgery or interventional embolotherapy. Endovascular embolotherapy is now considered the first-line therapy for massive UGI bleeding that is refractory to endoscopic management. Interventional radiologists need to be familiar with the choice of embolic materials, technical aspects of embolotherapy, and the factors affecting the favorable or unfavorable outcomes after embolotherapy for UGI bleeding.

  20. A rare cause of anemia due to upper gastrointestinal bleeding: Cameron lesion

    Ismet Özaydın

    2014-01-01

    Full Text Available Asymptomatic large hiatal hernias may lead to iron deficiency anemia due to occult and massive bleeding from linear gastric erosions or ulcers on the mucosal folds at the level of the diaphragm called the Cameron lesions. The diagnosis is usually made during upper gastrointestinal system endoscopies. Current therapy includes the medication with proton pump inhibitors in combination with oral iron supplements and in some cases surgical reconstruction of hiatal hernia with fundoplication. We present a case of a 78-year-old woman who was admitted to the outpatient clinic with the diagnosis of iron deficiency anemia without signs of acute gastrointestinal bleeding. She was treated with medication and her follow-up gastroscopy showed a total cure. She is asymptomatic for two years after treatment with proton pump inhibitors and iron supplements. Cameron lesions should be kept in mind as an unusual cause of iron deficiency anemia due to gastrointestinal bleeding

  1. Localization of bleeding using 4-row detector-CT in patients with clinical signs of acute gastrointestinal hemorrhage; Blutungslokalisation mittels 4-Zeilen-Spiral-CT bei Patienten mit klinischen Zeichen einer akuten gastrointestinalen Haemorrhagie

    Ko, H.S.; Tesdal, K.; Dominguez, E.; Kaehler, G.; Sadick, M.; Dueber, C.; Diehl, S. [Universitaetsklinikum Heidelberg (Germany). Kinderklinik

    2005-12-15

    Purpose: There is no gold-standard regarding the diagnostic work-up and therapy of an acute gastrointestinal (GI) hemorrhage. In most cases endoscopy provides the diagnosis but in a low percentage this modality is not feasible or negative. Purpose of this study was to evaluate the role of multi-phase Multi-Slice-Computertomography (MSCT) as a modality to diagnose and locate the site of acute GI hemorrhage in case of unfeasible or technically difficult endoscopy. Materials and methods: 58 patients, presenting with clinical signs of lower GI hemorrhage, were examined through a 24-month period. Preliminary endoscopy was either negative or unfeasible. Images were obtained with a four-detector row CT with an arterial (4 x 1 mm collimation, 0.8 mm increment, 1.25 mm slice width, 120 kV, 165 mAs) and portal venous series (4 x 2,5 mm collimation, 2 mm increment, 3 mm slice width, 120 kV, 165 mAs). Time interval between endoscopy and CT varied between 30 minutes and 3 hours. The results of the MSCT were correlated with clinical course and surgical or endoscopical treatment. Results: 20 of the 58 patients (34%) undergoing MSCT had a bleeding site identified, thus providing decisive information for the following intervention. In case of a following therapeutic intervention there was 100% correlation regarding the bleeding site. In 38 of the 58 patients (66%), a bleeding site was not identified by MSCT. Twenty of these 38 patients (53%) were stable and required no further treatment. In 18 of these 38 patients further interventional therapy was required due to continuing hemorrhage and in all of those patients the bleeding site was detected by intervention. (orig.)

  2. Radionuclide-monitoring of gastro-intestinal bleeding-activity

    Radionuclide-monitoring was done in 50 patients to assess gastro-intestinal bleeding, activity and location. Monitoring with 99mTc-in vivo-labelled erythrocytes was performed as sequential scintigraphy in increments of 1-2 hours up to 62 hours. 23 patients without active GI-bleeding were correctly identified. 27 patients showed pathologic activities in abdominal bloodpool-scintigraphy. In 25 patients peristaltic movement of these activities were seen - in each case we correctly diagnosed active GI-bleeding. In 2 patients the activity stayed for a longer period in the same location - one patient had a liverhemangioma, the other patient had an aneurysma of the arteria mesenterica superior. The great impact of radionuclide-monitoring on diagnostic and therapeutic management of gastrointestinal bleeding is emphasized. (orig.)

  3. Improving the management of gastrointestinal bleeding in patients with cirrhosis.

    Williams, Michael J; Hayes, Peter

    2016-04-01

    Gastrointestinal bleeding remains a major cause of mortality in patients with cirrhosis. The most common source of bleeding is from gastroesophageal varices but non-variceal bleeding from peptic ulcer disease also carries a significant risk in patients with liver disease. The prognosis is related to the severity of the underlying liver disease, and deaths often occur due to liver failure, infection or renal failure. Optimal management should therefore not only achieve haemostasis but address these complications as well. The management of gastrointestinal bleeding in patients with cirrhosis includes a range of medical, endoscopic and radiological interventions. This article updates the recent developments in this area and highlights topics where further research is still required. PMID:26581713

  4. Endoscopic Removal of an Unusual Foreign Body Causing Gastrointestinal Bleeding

    A. Karaman

    2010-09-01

    Full Text Available Foreign body ingestion is a condition more common in the pediatric population than in adults. In adults, although foreign body ingestion can be well tolerated, approximately 10–20% of patients require endoscopic intervention. Delayed diagnosis and unremoved foreign bodies can cause serious and fatal complications including perforation, fistula and gastrointestinal bleeding. Here we report a patient with bleeding duodenal ulcer thought to be initiated by a large foreign body.

  5. [Jejunal GIST with obscure gastrointestinal bleeding].

    Nelly Manrique, María; Frisancho, Oscar; Rivas Wong, Luz; Palomino, Américo

    2011-01-01

    We report the case of a woman of 84 years with a history of cardiac arrhythmia and hemorrhoids. She had multiple hospitalizations and transfusions for symptomatic iron deficiency anemia, endoscopic studies showed only small diverticula and colon polyps. He was later hospitalized with bloody stools red wines, upper endoscopy and colonoscopy showed gastritis, small colonic ulcers, colonic polyp and multiple diverticula. Readmitted with bleeding of obscure origin, on that occasion showed gastritis, antral erosions, small ulcers, colon polyps and colon ulcers in the process of healing, capsule endoscopy showed angiodysplasia in jejunum, anterograde enteroscopy detected some erythematous lesions in proximal jejunum without evidence of bleeding. Again hospitalized for melena and abdominal. PMID:22086325

  6. A Cause of Mortal Massive Upper Gastrointestinal Bleeding: Aortoesophageal Fistula

    Akin, Mete; Yalcinkaya, Tolga; Alkan, Erhan; Arslan, Gokhan; Tuna, Yasar; Yildirim, Bulent

    2016-01-01

    Introduction: Aortoesophageal fistula is an uncommon but mortal cause of massive upper gastrointestinal bleeding. The most common causes are thoracic aortic aneurisym, foreign body reaction, malignancy and postoperative complication. It can be seen in different pattern on upper gastrointestinal endoscopy. There are surgical, endoscopic and interventional radiological treatment options, however, definitive treatment is surgical intervention. Diagnosis and treatment desicion should be made quickly because of rapid and mortal course. Case report: In this article, a case of aortoesophageal fistula was presented that resulted in mortality as a result of massive bleeding. PMID:26980940

  7. Acute GI bleeding by multiple jejunal gastrointestinal autonomic nerve tumour associated with neurofibromatosis type I Urgencia quirúrgica por sangrado intestinal debido a tumor intestinal de nervios autónomos asociados a neurofibromatosis tipo I

    Keese, M; Riester, T; K. Schwenke; Dinter, D.; Back, W; Palma, P.

    2007-01-01

    We describe a surgical emergency due to GI-bleeding caused by gastrointestinal autonomic nerve tumours (GANT's) in a patient with von Recklinghausen's disease. A 72 year old female patient with von Recklinghausen's disease was admitted with maelena. Endoscopy showed no active bleeding in the stomach and the colon. Therefore an angio-CT-scan was performed which revealed masses of the proximal jejunum as source of bleeding. Laparotomy was indicated and a 20 cm segment of jejunum which carried m...

  8. 克罗恩病并发急性下消化道大出血的护理%Nursing of Crohn's disease complicated with acute lower gastrointestinal bleeding

    苏润婵; 黄美娟; 张萍

    2010-01-01

    Objective To explore the clinical features and nursing strategies of the Crohn's disease(CD) comphcated with acute lower gastrointestinal bleeding. Methods The clinical and nursing data of the CD admitted to our hospital with acute lower gastrointestinal bleeding in patients with 13 cases from 1998 to 2007 were collected and retrospectively analyzed to explore the nursing strategy. Results Four cases of thirteen patients improved after surgery, 9 cases received conservative therapy, 3 cases died. Conclusions Careful medical treatment and nursing during the conservative treatment can effectively control the progression of the disease and reduce mortality.%目的 探讨克罗恩病(Crohn's disease,CD)并发急性下消化道大出血患者的临床特点及护理对策.方法 1998-2007年我院收治的克罗恩病并发急性下消化道大出血患者13例,对其临床及护理资料进行回顾性分析,探讨其护理对策.结果 13例患者中4例接受手术治疗后好转,9例采取保守治疗,其中3例死亡.结论 内科保守治疗过程中精心的治疗与护理,可以有效控制病情发展,降低病死率.

  9. Tranexamic acid for upper gastrointestinal bleeding

    Bennett, Cathy; Klingenberg, Sarah Louise; Langholz, Ebbe;

    2014-01-01

    2011. The number of participants randomly assigned ranged from 47 to 216 (median 204). All trials reported mortality. In total, 42 of 851 participants randomly assigned to tranexamic acid and 71 of 850 in the control group died (RR 0.60, 95% CI 0.42 to 0.87; P value 0.007; I² = 0%). The analysis was...... review will be much more informative in a few years. Further examination of tranexamic acid would require inclusion of high-quality randomised controlled trials. Timing of randomisation is essential to avoid attrition bias and to limit the number of withdrawals. Future trials may use a pragmatic design...... and should include all participants with suspected bleeding or with endoscopically verified bleeding, as well as a tranexamic placebo arm and co-administration of pump inhibitors and endoscopic therapy. Assessment of outcome measures in such studies should be clearly defined. Endoscopic examination...

  10. Angiography and angiotherapy of gastrointestinal tract bleeding

    In selected patients with upper and lower gastrointestinal hemorrhage there is an indication for angiography. Vasoconstrictive drugs or embolization materials can be submitted through the catheter to stop the hermorrhage (angiotherapy). 81 patients were diagnosed by this method. Treatment through the angiographic catheter followed the diagnostic procedure in 41 cases. The hemorrhage was controlled in 36 patients. (orig.)

  11. Treatment of acute variceal bleeding

    Bendtsen, Flemming; Krag, Aleksander Ahm; Møller, Søren

    2008-01-01

    The management of variceal bleeding remains a clinical challenge with a high mortality. Standardisation in supportive and new therapeutic treatments seems to have improved survival within the last 25 years. Although overall survival has improved in recent years, mortality is still closely related...... to failure to control initial bleeding or early re-bleeding occurring in up to 30-40% of patients. Initial procedures are to secure and protect the airway, and administer volume replacement to stabilize the patient. Treatment with vasoactive drugs should be started as soon as possible, since a...... adhesives should be used. In conclusion: Improvements in resuscitation and prevention of complications have together with introduction of vasoactive drugs and refinement of endoscopic therapy majorily changed the prognosis of the patient presenting with variceal bleeding....

  12. Guideline for Capsule Endoscopy: Obscure Gastrointestinal Bleeding

    Shim, Ki-Nam; Moon, Jeong Seop; Chang, Dong Kyung; Do, Jae Hyuk; Kim, Ji Hyun; Min, Byung Hoon; Jeon, Seong Ran; Kim, Jin-Oh; Choi, Myung-Gyu; ,

    2013-01-01

    Capsule endoscopy (CE) is considered as a noninvasive and reliable diagnostic tool of examining the entire small bowel. CE has been performed frequently at many medical centers in South Korea; however, there is no evidence-based CE guideline for adequate diagnostic approaches. To provide accurate information and suggest correct testing approaches for small bowel disease, the guideline on CE was developed by the Korean Gut Image Study Group, a part of the Korean Society of Gastrointestinal End...

  13. Protein C deficiency related obscure gastrointestinal bleeding treated by enteroscopy and anticoagulant therapy

    Hsu, Wei-Fan; Tsang, Yuk-Ming; Teng, Chung-Jen; Chung, Chen-Shuan

    2015-01-01

    Obscure gastrointestinal bleeding is an uncommonly encountered and difficult-to-treat clinical problem in gastroenterology, but advancements in endoscopic and radiologic imaging modalities allow for greater accuracy in diagnosing obscure gastrointestinal bleeding. Ectopic varices account for less than 5% of all variceal bleeding cases, and jejunal variceal bleeding due to extrahepatic portal hypertension is rare. We present a 47-year-old man suffering from obscure gastrointestinal bleeding. C...

  14. Recurrent Renal Cell Carcinoma with Synchronous Tumor Growth in Azygoesophageal Recess and Duodenum: A Rare Cause of Anemia and Upper Gastrointestinal Bleeding

    Vootla, Vamshidhar R.; Kashif, Muhammad; Niazi, Masooma; Nayudu, Suresh K.

    2015-01-01

    Renal cell carcinoma (RCC) has potential to present with distant metastasis several years after complete resection. The common sites of metastases include the lungs, bones, liver, renal fossa, and brain. RCCs metastasize rarely to the duodenum, and duodenal metastasis presenting with acute gastrointestinal bleed is infrequently reported in literature. We present a case of synchronous presentation of duodenal and azygoesophageal metastasis manifesting as acute upper gastrointestinal bleeding, four years after undergoing nephrectomy for RCC. The patient underwent further workup and was treated with radiation. The synchronous presentation is rare and stresses the importance of searching for recurrence of RCC in patients presenting with acute gastrointestinal bleeding. PMID:26640732

  15. The risk factors and outcomes of gastrointestinal bleeding in acute ischaemic stroke%缺血性脑卒中并发消化道出血危险因素及预后分析

    邓晓风

    2012-01-01

    Objective Gastrointestinal(GI) bleeding is one of most serious complications after acute stage of ischemic stroke. This study is to investigate the risk factors as well as the prognosis of those cases with GI bleeding following acute stroke. Methods From Mar 2008 to Aug 2010, we prospectively collected ischemic stroke patients with or without GI bleeding in our intensive care unit grouped as research group and controls. A six month follow-up was conducted. Comparison was done between groups on the aspect of demography, predisposing factors and prognosis. Results Overall 3. 5% of GI bleeding was observed a-mong those ischemic stroke patients. The four major risk factors were coma ( 0R5.0 95% CI 1.4 ~ 17. 5 ) , incontinence ( OR5. 8 95% CI 1. 5 - 22. 2 ) , history of peptic ulcer or GI bleeding ( OR5. 2 95% CI 1. 3 ~ 21.1) and history of stroke ( OR3. 6 95% CI 1. 0 ~ 12. 7)respectively. During the follow-up, higher mortality rate was detected in research group (45. 5% ) especially those with sever GI bleeding (50% ) than that in controls (10% ). Conclusion Although GI bleeding is not a relative common complication after acute ischemic stroke, we should notice that it is associated with increased death risk. Thus we should be focused more attention on those risk factors.%目的 消化道出血是脑卒中后最严重的并发症之一.本研究探讨比较了其危险因素及相关预后.方法 收集2008年3月~2010年8月,我院重症监护室收治的脑梗死并发上消化道出血的患者(研究组)以及未并发上消化道出血的脑梗死患者(对照组),并进行6个月的随访.比较相关人口学数据、危险因素及相关预后.结果 研究发现,脑梗死并发消化道出血发生率为3.5%,其高危因素主要为昏迷(OR5.0 95% CI 1.4 ~ 17.5)、大小便失禁(OR5.8 95% CI1.5 ~22.2)、消化道溃疡或出血病史(OR5.2 95%CI 1.3 ~21.1)以及既往卒中病史(OR3.6 95%CI 1.0 ~ 12.7).在6个月的随访

  16. Detection and localization of lower gastrointestinal bleeding site with scintigraphic techniques

    Successful management of acute gastrointestinal (GI) bleeding frequently depends on accurate localization of the bleeding site. History and clinical findings are often misleading in localizing the site of hemorrhage. The widespread application of flexible endoscopy and selective arteriography now provides accurate diagnoses for the majority of patients with upper GI tract hemorrhage, but lower GI bleeding still is a serious diagnostic problem. Endoscopy and barium studies are of limited value in examining the small bowel and colon in the face of active hemorrhage. Arteriography, although successful in many cases, has limitations. The angiographic demonstration of bleeding is possible only when the injection of contrast material coincides with active bleeding. Since lower GI bleeding is commonly intermittent rather than continuous, a high rate of negative angiographic examinations has been reported. Repeated angiography to pursue recurrent episodes of bleeding is impractical. Because of these shortcomings, in the past decade several noninvasive scintigraphic techniques have been developed to detect and localize sites of GI bleeding. In this chapter the authors discuss details related to the technetium 99m sulfur colloid (Tc-SC) and technetium 99m-labeled red blood cell (Tc-RBC) techniques

  17. Gastrointestinal stromal tumor: acute liquefaction necrosis

    Stromal tumors, together with leiomyomas and schwannomas, constitute the sol-called mesenchymal tumors of the intestinal wall. Stromal tumors are histologically differentiated from other mesenchymal tumors in that they are derived from the interstitial cell of Cajal. These tumors can be encountered at any point throughout the entire digestive tract, by usually develop in stomach or small bowel. the clinical presentation in anemia secondary to gastrointestinal bleeding. Acute abdomen due to perforation or necrosis is rare. We present a case of jejunal stromal tumors with massive liquefaction necrosis, a circumstance that resulted in the peculiar radiological features observed. (Author) 9 refs,

  18. Concurrent amoebic and histoplasma colitis:A rare cause of massive lower gastrointestinal bleeding

    Peng; Soon; Koh; April; Camilla; Roslani; Kumar; Vasudeavan; Vimal; Mohd; Shariman; Ramasamy; Umasangar; Rajkumar; Lewellyn

    2010-01-01

    Infective colitis can be a cause of massive lower gastrointestinal bleeding requiring acute surgical intervention. Causative organisms include entamoeba and histoplasma species. However, concurrent colonic infection with both these organisms is very rare, and the in vivo consequences are not known. A 58-year-old male presented initially to the physicians with pyrexia of unknown origin and bloody diarrhea. Amoebic colitis was diagnosed based on biopsies, and he was treated with metronidazole. Five days later...

  19. Abnormal gastrointestinal accumulation of radiotracer by gastric bleeding during 99mTc-MDP bone scintigraphy

    We present a case in which a patient with acute hemorrhagic gastritis demonstrated abnormal gastrointestinal accumulation of radiotracer during 99mTc-methylene diphosphonate (MDP) skeletal scintigraphy. A hemorrhagic gastritis was subsequently demonstrated by endoscopy. The mechanism for the intestinal localization of 99mTc-MDP in this patients is not clear, but we guess that the extravasated blood containing the radiopharmaceutical cannot recirculate and stays at the bleeding site, so we can see the intestinal activity

  20. Massive extra-enteric gastrointestinal bleeding: angiographic diagnosis.

    Koehler, P R; Nelson, J A; Berenson, M M

    1976-04-01

    Two patients with massive gastrointestinal bleeding are reported. One bled from an aneurysm of a branch of the left hepatic artery, the blood reaching the bowel through communication with the biliary tree. The second had an aneurysm of a branch of the splenic artery which communicated with the pancreatic duct. This type of bleeding is intermittent and, consequently, actual extravasation of contrast media is not always seen. Therefore, if one sees an aneurysm of a visceral artery, even if it does not directly supply the enteric tract, one should consider the possibility that it is the origin of the hemorrhage. Pathogenesis, diagnostic modalities, and therapeutic implications are discussed. PMID:1083037

  1. Infliximab stopped severe gastrointestinal bleeding in Crohn's disease

    Aniwan, Satimai; Eakpongpaisit, Surasak; Imraporn, Boonlert; Amornsawadwatana, Surachai; Rerknimitr, Rungsun

    2012-01-01

    To report the result of rapid ulcer healing by infliximab in Crohn’s patients with severe enterocolic bleeding. During 2005 and 2010, inflammatory bowel disease database of King Chulalongkorn Memorial and Samitivej hospitals were reviewed. There were seven Crohn’s disease (CD) patients (4 women and 3 men; mean age 52 ± 10.4 years; range: 11-86 years). Two of the seven patients developed severe gastrointestinal bleeding (GIB) as a flare up of CD whereas the other five patients presented with G...

  2. Acute Gastric Bleeding Due to Giant Hyperplastic Polyp

    Bulent Aksel

    2013-04-01

    Full Text Available Hyperplastic gastric polyps account for the majority of benign gastric polyps. The vast majority of these lesions are small, asymptomatic and found incidentally on radiologic or endoscopic examination. Giant hyperplastic gastric polyps are uncommon and most of them are asymptomatic. We report a case of a 66-year-old woman who admitted because of acute gastric bleeding. The gastrin levels were within normal ranges. Esophagogastroduodenoscopy showed 12 cm pedunculated and multiple lobulated hyperplastic polyps arising from antrum with signs of diffuse oozing. The patient is treated by subtotal gastrectomy with Roux-Y gastrojejunostomy. Histological examination showed the presence of ulcers and regeneration findings with the contemporary occurrence of hyperplastic polyp. Giant hyperplastic gastric polyp should be kept in mind in the differential diagnosis of acute upper gastrointestinal bleeding.

  3. Endoscopic Evaluation of Upper and Lower Gastro-Intestinal Bleeding

    Emeka Ray-Offor; Elenwo, Solomon N

    2015-01-01

    Introduction: A myriad of pathologies lead to gastro-intestinal bleeding (GIB). The common clinical presentations are hematemesis, melena, and hematochezia. Endoscopy aids localization and treatment of these lesions. Aims: The aim was to study the differential diagnosis of GIB emphasizing the role of endoscopy in diagnosis and treatment of GIB. Patients and Methods: A prospective study of patients with GIB referred to the Endoscopy unit of two health facilities in Port Harcourt Nigeria from F...

  4. Small bowel stromal tumour revealed by a lower gastrointestinal bleeding

    Assamoi B. F. Kassi

    2016-04-01

    Full Text Available Small bowel stromal tumour must be systematically researched in the presence of obscure and persistent low gastrointestinal bleeding despite a normal endoscopic examination (OGDF and colonoscopy. Video capsule endoscopy is the best diagnosis examination; if it is not available a CT enterography could be useful. Surgical treatment is effective on localized and weak malignancy small bowel stromal tumours. [Int J Res Med Sci 2016; 4(4.000: 1248-1250

  5. Small bowel stromal tumour revealed by a lower gastrointestinal bleeding

    Assamoi B. F. Kassi; Lebeau, R; Y. S. Kacou; K. J. N'dah; Traore, M.

    2016-01-01

    Small bowel stromal tumour must be systematically researched in the presence of obscure and persistent low gastrointestinal bleeding despite a normal endoscopic examination (OGDF and colonoscopy). Video capsule endoscopy is the best diagnosis examination; if it is not available a CT enterography could be useful. Surgical treatment is effective on localized and weak malignancy small bowel stromal tumours. [Int J Res Med Sci 2016; 4(4.000): 1248-1250

  6. Trends on gastrointestinal bleeding and mortality: Where are we standing?

    Ahmed Mahmoud EI-Tawil

    2012-01-01

    Bleeding from the gastrointestinal tract and its management are associated with significant morbidity and mortality.The predisposing factors that led to the occurrence of these hemorrhagic instances are largely linked to the life style of the affected persons.Designing a new strategy aimed at educating the publics and improving their awareness of the problem could effectively help in eradicating this problem with no associated risks and in bringing the mortality rates down to almost zero.

  7. No early effect of storage time of transfused red blood cells on fatigue and plasma cytokines in patients with anaemia from non-acute gastrointestinal bleeding

    Mynster, Tommie; Dziegiel, Morten Hanefeld; Kofoed, Kristian

    2007-01-01

    .0 mmol/l, complaints of fatigue and no active bleeding were included. Eleven patients received two red cells units (SAGM) stored less than 1 week (short storage time, S), and 11 patients received two units stored more than 3 weeks (long storage time, L). Fatigue was self-estimated on a visual analogue...

  8. N-butyl cyanoacrylate embolotherapy for acute gastroduodenal ulcer bleeding

    Various embolic agents have been used for embolization of acute gastrointestinal (GI) arterial bleeding. N-butyl cyanoacrylate (NBCA) is not easy to handle, but it is a useful embolic agent. In this retrospective study, we describe our experience with NBCA embolization of acute gastroduodenal ulcer bleeding. NBCA embolization was performed in seven patients with acute upper GI arterial bleeding; they had five gastric ulcers and two duodenal ulcers. NBCA embolization was done in the left gastric artery (n = 3), right gastric artery (n = 2), gastroduodenal artery (n = 1) and pancreaticoduodenal artery (n = 1). Coil was used along with NBCA in a gastric bleeding patient because of difficulty in selecting a feeding artery. NBCA was mixed with Lipiodol at the ratio of 1:1 to 1:2. The blood pressure and heart rate around the time of embolization, the serial hemoglobin and hematocrit levels and the transfusion requirements were reviewed to evaluate hemostasis and rebleeding. Technical success was achieved in all the cases. Two procedure-related complications happened; embolism of the NBCA mixture to the common hepatic artery occurred in a case with embolization of the left gastric artery, and reflux of the NBCA mixture occurred into the adjacent gastric tissue, but these did not cause any clinical problems. Four of seven patients did not present with rebleeding, but two had rebleeding 10 and 16 days, respectively, after embolization and they died of cardiac arrest at 2 months and 37 days, respectively. One other patient died of sepsis and respiratory failure within 24 hours without rebleeding. NBCA embolization with or without other embolic agents could be safe and effective for treating acute gastroduodenal ulcer bleeding

  9. N-butyl cyanoacrylate embolotherapy for acute gastroduodenal ulcer bleeding

    Choi, Young Ho; Kim, Ji Hoon; Koh, Young Hwan; Han, Dae Hee; Cha, Joo Hee; Seong, Chang Kyu; Song, Chi Sung [Seoul National University Boramae Hospital, Seoul (Korea, Republic of)

    2007-01-15

    Various embolic agents have been used for embolization of acute gastrointestinal (GI) arterial bleeding. N-butyl cyanoacrylate (NBCA) is not easy to handle, but it is a useful embolic agent. In this retrospective study, we describe our experience with NBCA embolization of acute gastroduodenal ulcer bleeding. NBCA embolization was performed in seven patients with acute upper GI arterial bleeding; they had five gastric ulcers and two duodenal ulcers. NBCA embolization was done in the left gastric artery (n = 3), right gastric artery (n = 2), gastroduodenal artery (n = 1) and pancreaticoduodenal artery (n = 1). Coil was used along with NBCA in a gastric bleeding patient because of difficulty in selecting a feeding artery. NBCA was mixed with Lipiodol at the ratio of 1:1 to 1:2. The blood pressure and heart rate around the time of embolization, the serial hemoglobin and hematocrit levels and the transfusion requirements were reviewed to evaluate hemostasis and rebleeding. Technical success was achieved in all the cases. Two procedure-related complications happened; embolism of the NBCA mixture to the common hepatic artery occurred in a case with embolization of the left gastric artery, and reflux of the NBCA mixture occurred into the adjacent gastric tissue, but these did not cause any clinical problems. Four of seven patients did not present with rebleeding, but two had rebleeding 10 and 16 days, respectively, after embolization and they died of cardiac arrest at 2 months and 37 days, respectively. One other patient died of sepsis and respiratory failure within 24 hours without rebleeding. NBCA embolization with or without other embolic agents could be safe and effective for treating acute gastroduodenal ulcer bleeding.

  10. Somatostatin analogues for acute bleeding oesophageal varices

    Gøtzsche, Peter C.; Hrobjartsson, A.

    2008-01-01

    BACKGROUND: Somatostatin and its derivatives are sometimes used for emergency treatment of bleeding oesophageal varices in patients with cirrhosis of the liver. OBJECTIVES: To study whether somatostatin or its analogues improve survival or reduce the need for blood transfusions in patients with...... bleeding oesophageal varices. SEARCH STRATEGY: PubMed and The Cochrane Library were searched (November 2007). Reference lists of publications, contacts with authors. SELECTION CRITERIA: All randomised trials comparing somatostatin or analogues with placebo or no treatment in patients suspected of acute or...

  11. Endoscopic evaluation of upper and lower gastro-intestinal bleeding

    Emeka Ray-Offor

    2015-01-01

    Full Text Available Introduction: A myriad of pathologies lead to gastro-intestinal bleeding (GIB. The common clinical presentations are hematemesis, melena, and hematochezia. Endoscopy aids localization and treatment of these lesions. Aims: The aim was to study the differential diagnosis of GIB emphasizing the role of endoscopy in diagnosis and treatment of GIB. Patients and Methods: A prospective study of patients with GIB referred to the Endoscopy unit of two health facilities in Port Harcourt Nigeria from February 2012 to August 2014. The variables studied included: Demographics, clinical presentation, risk score, endoscopic findings, therapeutic procedure, and outcome. Data were collated and analyzed using SPSS version 20 software. Results: A total of 159 upper and lower gastro-intestinal (GI endoscopies were performed during the study period with 59 cases of GI bleeding. There were 50 males and 9 females with an age range of 13-86 years (mean age 52.4 ΁ 20.6 years. The primary presentations were hematochezia, hematemesis, and melena in 44 (75%, 9 (15%, and 6 (10% cases, respectively. Hemorrhoids were the leading cause of lower GIB seen in 15 cases (41%. The majority of pathologies in upper GIB were seen in the stomach (39%: Gastritis and benign gastric ulcer. Injection sclerotherapy was successfully performed in the hemorrhoids and a case of gastric varices. The mortality recorded was 0%. Conclusion: Endoscopy is vital in the diagnosis and treatment of GIB. Gastritis and Haemorrhoid are the most common causes of upper and lower GI bleeding respectively, in our environment

  12. Selective serotonin reuptake inhibitors and gastrointestinal bleeding: a case-control study.

    Alfonso Carvajal

    Full Text Available BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs have been associated with upper gastrointestinal (GI bleeding. Given their worldwide use, even small risks account for a large number of cases. This study has been conducted with carefully collected information to further investigate the relationship between SSRIs and upper GI bleeding. METHODS: We conducted a case-control study in hospitals in Spain and in Italy. Cases were patients aged ≥18 years with a primary diagnosis of acute upper GI bleeding diagnosed by endoscopy; three controls were matched by sex, age, date of admission (within 3 months and hospital among patients who were admitted for elective surgery for non-painful disorders. Exposures to SSRIs, other antidepressants and other drugs were defined as any use of these drugs in the 7 days before the day on which upper gastrointestinal bleeding started (index day. RESULTS: 581 cases of upper GI bleeding and 1358 controls were considered eligible for the study; no differences in age or sex distribution were observed between cases and controls after matching. Overall, 4.0% of the cases and 3.3% of controls used an SSRI antidepressant in the week before the index day. No significant risk of upper GI bleeding was encountered for SSRI antidepressants (adjusted odds ratio, 1.06, 95% CI, 0.57-1.96 or for whichever other grouping of antidepressants. CONCLUSIONS: The results of this case-control study showed no significant increase in upper GI bleeding with SSRIs and provide good evidence that the magnitude of any increase in risk is not greater than 2.

  13. Gastrointestinal bleeding and obstructive jaundice: Think of hepatic artery aneurysm.

    Vultaggio, Fabrice; Morère, Pierre-Henri; Constantin, Christophe; Christodoulou, Michel; Roulin, Didier

    2016-06-27

    Hemobilia is an uncommon and potential life-threatening condition mainly due to hepato-biliary tree traumatic or iatrogenic injuries. Spontaneously ruptured aneurysm of the hepatic artery is seldom described. We report the case of an 89-year-old woman presenting with abdominal pain, jaundice and gastrointestinal bleeding, whose ultrasound and computed tomography revealed a non-traumatic, spontaneous aneurysm of the right hepatic artery. The oeso-gastro-duodenoscopy and colonoscopy did not reveal any bleeding at the ampulla of Vater, nor anywhere else. Selective angiography confirmed the diagnosis of hepatic artery aneurysm and revealed a full hepatic artery originating from the superior mesenteric artery. The patient was successfully treated by selective embolization of microcoils. We discuss the etiologies of hemobilia and its treatment with selective embolization, which remains favored over surgical treatment. Although aneurysm of the hepatic artery is rare, especially without trauma, a high index of suspicion is needed in order to ensure appropriate treatment. PMID:27358680

  14. Three infants with rotavirus gastroenteritis complicated by severe gastrointestinal bleeding.

    Kawamura, Yoshiki; Miura, Hiroki; Mori, Yuji; Sugata, Ken; Nakajima, Yoichi; Yamamoto, Yasuto; Morooka, Masashi; Tsuge, Ikuya; Yoshikawa, Akiko; Taniguchi, Koki; Yoshikawa, Tetsushi

    2016-01-01

    Rotavirus gastroenteritis causes substantial morbidity and mortality worldwide in children. We report three infants with rotavirus gastroenteritis complicated by various severity of gastrointestinal bleeding. Two patients (cases 1 and 2) recovered completely without any specific treatments. One patient (case 3) died despite extensive treatments including a red blood cell transfusion and endoscopic hemostatic therapy. Rotavirus genotypes G1P[8] and G9P[8] were detected in cases 2 and 3, respectively. Rotavirus antigenemia levels were not high at the onset of melena, suggesting that systemic rotaviral infection does not play an important role in causing melena. PMID:26100228

  15. Nonvariceal Upper Gastrointestinal Bleeding: the Usefulness of Rotational Angiography after Endoscopic Marking with a Metallic Clip

    We wanted to assess the usefulness of rotational angiography after endoscopic marking with a metallic clip in upper gastrointestinal bleeding patients with no extravasation of contrast medium on conventional angiography. In 16 patients (mean age, 59.4 years) with acute bleeding ulcers (13 gastric ulcers, 2 duodenal ulcers, 1 malignant ulcer), a metallic clip was placed via gastroscopy and this had been preceded by routine endoscopic treatment. The metallic clip was placed in the fibrous edge of the ulcer adjacent to the bleeding point. All patients had negative results from their angiographic studies. To localize the bleeding focus, rotational angiography and high pressure angiography as close as possible to the clip were used. Of the 16 patients, seven (44%) had positive results after high pressure angiography as close as possible to the clip and they underwent transcatheter arterial embolization (TAE) with microcoils. Nine patients without extravasation of contrast medium underwent TAE with microcoils as close as possible to the clip. The bleeding was stopped initially in all patients after treatment of the feeding artery. Two patients experienced a repeat episode of bleeding two days later. Of the two patients, one had subtle oozing from the ulcer margin and that patient underwent endoscopic treatment. One patient with malignant ulcer died due to disseminated intravascular coagulation one month after embolization. Complete clinical success was achieved in 14 of 16 (88%) patients. Delayed bleeding or major/minor complications were not noted. Rotational angiography after marking with a metallic clip helps to localize accurately the bleeding focus and thus to embolize the vessel correctly.

  16. Nonvariceal Upper Gastrointestinal Bleeding: the Usefulness of Rotational Angiography after Endoscopic Marking with a Metallic Clip

    Song, Ji Soo; Kwak, Hyo Sung; Chung, Gyung Ho [Chonbuk National University Medical School, Chonju (Korea, Republic of)

    2011-08-15

    We wanted to assess the usefulness of rotational angiography after endoscopic marking with a metallic clip in upper gastrointestinal bleeding patients with no extravasation of contrast medium on conventional angiography. In 16 patients (mean age, 59.4 years) with acute bleeding ulcers (13 gastric ulcers, 2 duodenal ulcers, 1 malignant ulcer), a metallic clip was placed via gastroscopy and this had been preceded by routine endoscopic treatment. The metallic clip was placed in the fibrous edge of the ulcer adjacent to the bleeding point. All patients had negative results from their angiographic studies. To localize the bleeding focus, rotational angiography and high pressure angiography as close as possible to the clip were used. Of the 16 patients, seven (44%) had positive results after high pressure angiography as close as possible to the clip and they underwent transcatheter arterial embolization (TAE) with microcoils. Nine patients without extravasation of contrast medium underwent TAE with microcoils as close as possible to the clip. The bleeding was stopped initially in all patients after treatment of the feeding artery. Two patients experienced a repeat episode of bleeding two days later. Of the two patients, one had subtle oozing from the ulcer margin and that patient underwent endoscopic treatment. One patient with malignant ulcer died due to disseminated intravascular coagulation one month after embolization. Complete clinical success was achieved in 14 of 16 (88%) patients. Delayed bleeding or major/minor complications were not noted. Rotational angiography after marking with a metallic clip helps to localize accurately the bleeding focus and thus to embolize the vessel correctly.

  17. Inverted meckel's diverticulum as a cause of obscure lower gastrointestinal bleeding

    Inverted Meckel's diverticulum is an infrequent cause of gastrointestinal blood loss, especially in adults. A high index of suspicion is needed for this rare entity when entertaining the possible differentials of gastrointestinal bleeding.(author)

  18. Critical gastrointestinal bleed due to secondary aortoenteric fistula.

    Malik, Mohammad U; Ucbilek, Enver; Sherwal, Amanpreet S

    2015-01-01

    Secondary aortoenteric fistula (SAEF) is a rare yet lethal cause of gastrointestinal bleeding and occurs as a complication of an abdominal aortic aneurysm repair. Clinical presentation may vary from herald bleeding to overt sepsis and requires high index of suspicion and clinical judgment to establish diagnosis. Initial diagnostic tests may include computerized tomography scan and esophagogastroduodenoscopy. Each test has variable sensitivity and specificity. Maintaining the hemodynamic status, control of bleeding, removal of the infected graft, and infection control may improve clinical outcomes. This review entails the updated literature on diagnosis and management of SAEF. A literature search was conducted for articles published in English, on PubMed and Scopus using the following search terms: secondary, aortoenteric, aorto-enteric, aortoduodenal, aorto-duodenal, aortoesophageal, and aorto-esophageal. A combination of MeSH terms and Boolean operators were used to device search strategy. In addition, a bibliography of clinically relevant articles was searched to find additional articles (Appendix A). The aim of this review is to provide a comprehensive update on the diagnosis, management, and prognosis of SAEF. PMID:26653698

  19. Critical gastrointestinal bleed due to secondary aortoenteric fistula

    Mohammad U. Malik

    2015-12-01

    Full Text Available Secondary aortoenteric fistula (SAEF is a rare yet lethal cause of gastrointestinal bleeding and occurs as a complication of an abdominal aortic aneurysm repair. Clinical presentation may vary from herald bleeding to overt sepsis and requires high index of suspicion and clinical judgment to establish diagnosis. Initial diagnostic tests may include computerized tomography scan and esophagogastroduodenoscopy. Each test has variable sensitivity and specificity. Maintaining the hemodynamic status, control of bleeding, removal of the infected graft, and infection control may improve clinical outcomes. This review entails the updated literature on diagnosis and management of SAEF. A literature search was conducted for articles published in English, on PubMed and Scopus using the following search terms: secondary, aortoenteric, aorto-enteric, aortoduodenal, aorto-duodenal, aortoesophageal, and aorto-esophageal. A combination of MeSH terms and Boolean operators were used to device search strategy. In addition, a bibliography of clinically relevant articles was searched to find additional articles (Appendix A. The aim of this review is to provide a comprehensive update on the diagnosis, management, and prognosis of SAEF.

  20. Infliximab stopped severe gastrointestinal bleeding in Crohn's disease

    Satimai Aniwan; Surasak Eakpongpaisit; Boonlert Imraporn; Surachai Amornsawadwatana; Rungsun Rerknimitr

    2012-01-01

    To report the result of rapid ulcer healing by infliximab in Crohn's patients with severe enterocolic bleeding.During 2005 and 2010,inflammatory bowel disease database of King Chulalongkorn Memorial and Samitivej hospitals were reviewed.There were seven Crohn's disease (CD) patients (4 women and 3 men; mean age 52 ± 10.4 years; range:11-86 years).Two of the seven patients developed severe gastrointestinal bleeding (GIB) as a flare up of CD whereas the other five patients presented with GIB as their first symptom for CD.Their mean hemoglobin level dropped from 12 ± 1.3 g/dL to 8.7 ± 1.3 g/dL in a 3-d period.Median packed red blood cells units needed for resuscitation was 4 units.Because of uncontrolled bleeding,surgical resection was considered.However,due to the poor surgical candidacy of these patients (n =3) and/or possible development of short bowel syndrome (n =6),surgery was not pursued.Likewise angiographic embolization was not considered in any due to the risk of large infarction.All severe GIBs successfully stopped by one or two doses of intravenous infliximab.Our data suggests that infliximab is an alternative therapy for CD with severe GIB when surgery has limitation or patient is a high risk.

  1. The Clinical Outcomes of Transcatheter Microcoil Embolization in Patients with Active Lower Gastrointestinal Bleeding in the Small Bowel

    Kwak, Hyo Sung; Han, Young Min; Lee, Soo Teik [Chonbuk National University, Jeonju (Korea, Republic of)

    2009-08-15

    To assess the clinical outcomes of the transcatheter microcoil embolization in patients with active lower gastrointestinal (LGI) bleeding in the small bowel, as well as to compare the mortality rates between the two groups based on the visualization or non-visualization of the bleeding focus determined by an angiography. We retrospectively evaluated all of the consecutive patients who underwent an angiography for treatment of acute LGI bleeding between January 2003 and October 2007. In total, the study included 36 patients who underwent a colonoscopy and were diagnosed to have an active bleeding in the LGI tracts. Based on the visualization or non-visualization of the bleeding focus, determined by an angiography, the patients were classified into two groups. The clinical outcomes included technical success, clinical success (no rebleeding within 30 days), delayed rebleeding (> 30 days), as well as the major and minor complication rates. Of the 36 patients, 17 had angiography-proven bleeding that was distal to the marginal artery. The remaining 19 patients did not have a bleeding focus based on the angiography results. The technical and clinical success rates of performing transcatheter microcoil embolizations in patients with active bleeding were 100% and 88%, respectively (15 of 17). One patient died from continued LGI bleeding and one patient received surgery to treat the continued bleeding. There was no note made on the delayed bleeding or on the major or minor complications. Of the 19 patients without active bleeding, 16 (84%) did not have recurrent bleeding. One patient died due to continuous bleeding and multi-organ failure. The superselective microcoil embolization can help successfully treat patients with active LGI bleeding in the small bowel, identified by the results of an angiography. The mortality rate is not significantly different between the patients of the visualization and non-visualization groups on angiography.

  2. Endovascular Management of Acute Bleeding Arterioenteric Fistulas

    . Patients with cancer may only need treatment for the acute bleeding episode, and an endovascular approach has the advantage of low morbidity

  3. Helical CT in the diagnosis of acute lower gastrointestinal haemorrhage

    Introduction: A pilot study to evaluate helical computer tomography (CT) as a diagnostic tool for acute lower gastrointestinal tract (GIT) bleeding. CT was compared to conventional angiography (CA) and colonoscopy for the diagnosis and detection of bleeding site in suspected cases of acute lower GIT bleeding. Methods: Seven patients presenting with acute lower GIT bleeding, between June and November 2002, underwent CT examinations. All of these seven patients underwent CA following CT. Emergency colonoscopies were performed on five patients investigated with both CT and CA. Median delay from the most recent episode of hematochezia to CT was two and a half hours, to CA was 3 h, and to colonoscopy was 4 h. None of the patients underwent nuclear medicine (NM) bleeding studies. Results: Haemoglobin drop in all patients was greater than 15 g/L in the first 24 h of presentation. The mean age was 68.86 years (range, 49-83 years). Comparing CT and CA, there were four concordant and three discordant results. Both modalities had concordant findings of two active bleeding sites, one non-bleeding rectal tumour, and one negative case result. In three patients, the source of bleeding was found on CT whereas CA was negative. Emergency colonoscopies performed in all of these three patients confirmed blood in the colon/ileum. Conclusion: Early experience suggests that CT is a safe, convenient and accurate diagnostic tool for acute lower GIT haemorrhage. It raises questions regarding the sensitivity of CA. A new management algorithm for acute lower GIT haemorrhage using CT as the pre-CA screening tool is being proposed based on the preliminary findings. Positive CT will allow directed therapeutic angiography, while negative CT will triage patients into alternative management pathways

  4. Helical CT in the diagnosis of acute lower gastrointestinal haemorrhage

    Sabharwal, Rohan [Department of Radiology, Westmead Hospital, Sydney, NSW (Australia); Vladica, Philip [Department of Radiology, Westmead Hospital, Sydney, NSW (Australia)]. E-mail: rpvl@imag.wsahs.nsw.gov.au; Chou, Roger [Department of Radiology, Westmead Hospital, Sydney, NSW (Australia); Law, W. Phillip [Department of Radiology, Westmead Hospital, Sydney, NSW (Australia)

    2006-05-15

    Introduction: A pilot study to evaluate helical computer tomography (CT) as a diagnostic tool for acute lower gastrointestinal tract (GIT) bleeding. CT was compared to conventional angiography (CA) and colonoscopy for the diagnosis and detection of bleeding site in suspected cases of acute lower GIT bleeding. Methods: Seven patients presenting with acute lower GIT bleeding, between June and November 2002, underwent CT examinations. All of these seven patients underwent CA following CT. Emergency colonoscopies were performed on five patients investigated with both CT and CA. Median delay from the most recent episode of hematochezia to CT was two and a half hours, to CA was 3 h, and to colonoscopy was 4 h. None of the patients underwent nuclear medicine (NM) bleeding studies. Results: Haemoglobin drop in all patients was greater than 15 g/L in the first 24 h of presentation. The mean age was 68.86 years (range, 49-83 years). Comparing CT and CA, there were four concordant and three discordant results. Both modalities had concordant findings of two active bleeding sites, one non-bleeding rectal tumour, and one negative case result. In three patients, the source of bleeding was found on CT whereas CA was negative. Emergency colonoscopies performed in all of these three patients confirmed blood in the colon/ileum. Conclusion: Early experience suggests that CT is a safe, convenient and accurate diagnostic tool for acute lower GIT haemorrhage. It raises questions regarding the sensitivity of CA. A new management algorithm for acute lower GIT haemorrhage using CT as the pre-CA screening tool is being proposed based on the preliminary findings. Positive CT will allow directed therapeutic angiography, while negative CT will triage patients into alternative management pathways.

  5. Comparison of detectable bleeding rates of radiopharmaceuticals for localization of gastrointestinal bleeding in sheep using a closed system

    Owunwanne, A.; Sadek, S.; Yacoub, T.; Awdeh, M.; Abdel-Dayem, H.M. (Kuwait Univ. (Kuwait). Dept. of Nuclear Medicine); Al-Wafai, I.; Vallgren, S. (Kuwait Univ. (Kuwait). Dept. of Surgery)

    1989-06-01

    The closed experimental animal model system was used to compare the detectable gastrointestinal (GI) bleeding rates of {sup 99m}Tc-DTPA, {sup 99m}Tc-RBCs and {sup 99m}Tc tin colloid in sheep. The three radiopharmaceuticals were used to detect the upper GI bleeding sites at rates of 0.57 and 0.25 ml/min. At the lower bleeding rate of 0.1 ml/min, both {sup 99m}Tc-DTPA and {sup 99m}Tc-RBCs were successful in detecting the bleeding site. At the lowest rate of 0.07 ml/min only {sup 99m}Tc-DTPA was successful in detecting the bleeding site. The results indicate that {sup 99m}Tc-DTPA is the most useful {sup 99m}Tc radiopharmaceutical for detecting the upper GI bleeding site at the slowest bleeding rate studied. (orig.).

  6. The effect of transcatheter arterial embolisation for nonvariceal upper gastrointestinal bleeding

    Andersen, Poul Erik; Duvnjak, Stevo

    2010-01-01

    The aim of this investigation was to evaluate the clinical efficacy and safety of transcatheter arterial embolisation with coils for nonvariceal upper gastrointestinal (GI) bleeding after failed endoscopic therapy.......The aim of this investigation was to evaluate the clinical efficacy and safety of transcatheter arterial embolisation with coils for nonvariceal upper gastrointestinal (GI) bleeding after failed endoscopic therapy....

  7. Distribution of bleeding gastrointestinal angioectasias in a Western population

    Elizabeth Bollinger; Daniel Raines; Patrick Saitta

    2012-01-01

    AIM:TO define which segments of the gastrointestinal tract are most likely to yield angioectasias for ablative therapy.METHODS:A retrospective chart review was performed for patients treated in the Louisiana State University Health Sciences Center Gastroenterology clinics between the dates of July 1,2007 and October 1,2010.The selection of cases for review was initiated by use of our electronic medical record to identify all patients with a diagnosis of angioectasia,angiodysplasia,or arteriovenous malformation.Of these cases,chart reviews identified patients who had a complete evaluation of their gastrointestinal tract as defined by at least one upper endoscopy,colonoscopy and small bowel capsule endoscopy within the past three years.Patients without evidence of overt gastrointestinal bleeding or iron deficiency anemia associated with intestinal angioectasias were classified as asymptomatic and excluded from this analysis.Thirty-five patients with confirmed,bleeding intestinal angioectasias who had undergone complete endoscopic evaluation of the gastrointestinal tract were included in the final analysis.RESULTS:A total of 127 cases were reviewed.Sixtysix were excluded during subsequent screening due to lack of complete small bowel evaluation and/or lack of documentation of overt bleeding or iron deficiency anemia.The 61 remaining cases were carefully examined with independent review of endoscopic images as well as complete capsule endoscopy videos.This analysis excluded 26 additional cases due to insufficient records/images for review,incomplete capsule examination,poor capsule visualization or lack of confirmation of typical angioectasias by the principal investigator on independent review.Thirty-five cases met criteria for final analysis.All study patients were age 50 years or older and 13 patients (37.1%) had chronic kidney disease stage 3 or higher.Twenty of 35 patients were taking aspirin (81 mg or 325 mg),clopidogrel,and/or warfarin,with 8/20 on combination

  8. Gastric Glomus Tumor: A Rare Cause of Upper Gastrointestinal Bleeding

    Yoshinori Handa

    2015-01-01

    Full Text Available A 24-year-old woman was referred to our department because of melena. These symptoms combined with severe anemia prompted us to perform an emergency upper endoscopy, which showed bleeding from an ulcerated 30 mm submucosal tumor in the gastric antrum. A computed tomography scan revealed a homogeneously enhanced mass, and endoscopic ultrasonography identified a well-demarcated mass in the third and fourth layers of the gastric wall. Because analysis of the possible medical causes remained inconclusive and the risk of rebleeding, laparoscopy-assisted gastric wedge resection was performed after administration of 10 units of red cell concentrate. Histological and immunohistological analysis revealed the tumor to be a gastric glomus tumor. Gastric submucosal tumors remain challenging to diagnose preoperatively as they show a variety of radiologic and clinicopathologic features and are associated with the risk of bleeding upon biopsy, as is indicated in the guidelines for gastric submucosal tumors. Gastric glomus tumors characteristically present with exsanguinating gastrointestinal hemorrhaging that often requires blood transfusion. Additionally, gastric submucosal tumors typically occur in elderly patients; however, this case involved a young patient who was 24 years old. Here, we describe this case in order to identify features that may aid in early differentiation of gastric submucosal tumors.

  9. Stroke and recurrent haemorrhage associated with antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation

    Staerk, Laila; Lip, Gregory Y H; Olesen, Jonas B;

    2015-01-01

    -2012) included all patients with atrial fibrillation discharged from hospital after gastrointestinal bleeding while receiving antithrombotic treatment. Restarted treatment regimens were single or combined antithrombotic drugs with oral anticoagulation and antiplatelets. Follow-up started 90 days after discharge...... to avoid confounding from use of previously prescribed drugs on discharge. Risks of all cause mortality, thromboembolism, major bleeding, and recurrent gastrointestinal bleeding were estimated with competing risks models and time dependent multiple Cox regression models. STUDY ANSWER AND LIMITATIONS...

  10. 消化道出血概述%Overview of Gastrointestinal Bleeding

    刘文忠

    2015-01-01

    消化道出血是急诊科和消化科常见的临床病况之一。急性大量出血可危及生命,慢性失血可产生贫血症状,部分消化道出血是一些严重疾病,包括胃肠道恶性肿瘤的临床表现。熟悉和掌握消化道出血的临床表现、分类和处理原则,将有助于提高其预防和治疗水平。%Gastrointestinal(GI)bleeding is one of the commonly seen clinical problems in departments of emergency and gastroenterology. Acute massive bleeding may be life-threatening,and chronic blood loss can present symptoms of anemia. GI bleeding is the clinical manifestation of some serious diseases,including GI malignancies. Familiar with and mastering the clinical manifestations,classification and principles of management of GI bleeding will help to improve its prevention and treatment.

  11. [New methods for endoscopic hemostasis: focus on non-variceal gastrointestinal bleeding].

    Albert, J G; Peiffer, K H

    2016-03-01

    Gastrointestinal bleeding is a frequent emergency in daily clinical practice of a gastroenterologist. While incidence and mortality of gastrointestinal bleeding are decreasing in many countries, numbers of endoscopic procedures are increasing. Endoscopic therapy of non-variceal gastrointestinal bleeding is still mainly based on "classical" procedures like injection of vasoactive drugs (i. e. epinephrine) or blood derivates, application of through-the-scope hemoclips (TTSC), Argon plasma coagulation and bipolar coagulation. However, in the last years new endoscopic techniques especially for non-variceal gastrointestinal bleedings have become available and enriched our endoscopic equipment. For example, over-the-scope clips (OTSCs) surpass the size of TTSCs and have been successfully established for treatment of gastrointestinal bleeding and leak closure of fistulas and perforations. In addition, hemostatic powders were shown to achieve primary hemostasis in several cases of gastrointestinal bleeding. Besides a brief overview of "classical" endoscopic procedures for hemostasis of non-variceal gastrointestinal bleeding, this review focuses on new epidemiological data and uprising methods for endoscopic hemostasis. PMID:26894683

  12. Acute GI bleeding by multiple jejunal gastrointestinal autonomic nerve tumour associated with neurofibromatosis type I Urgencia quirúrgica por sangrado intestinal debido a tumor intestinal de nervios autónomos asociados a neurofibromatosis tipo I

    M. Keese

    2007-10-01

    Full Text Available We describe a surgical emergency due to GI-bleeding caused by gastrointestinal autonomic nerve tumours (GANT's in a patient with von Recklinghausen's disease. A 72 year old female patient with von Recklinghausen's disease was admitted with maelena. Endoscopy showed no active bleeding in the stomach and the colon. Therefore an angio-CT-scan was performed which revealed masses of the proximal jejunum as source of bleeding. Laparotomy was indicated and a 20 cm segment of jejunum which carried multiple extraluminal tumours was resected. The source of the bleeding was a 2 cm tumour which had eroded the mucosal surface. Immunohistologically, evidence of neuronal differentiation could be shown in the spindle-formed cells with positive staining for C-Kit (CD 117, CD 34, and a locally positive staining for synaptophysine and S100. This case report illustrates the association between neurofibromatosis and stromal tumours and should alert surgeons and gastroenterologist about gastrointestinal manifestations in patients with von Recklinghausen's disease.Se describe una urgencia quirúrgica por sangrado intestinal debido a tumor gastrointestinal de nervios autónomos (GANT asociado a enfermedad de von Recklinghausen. Una mujer de 72 años con neurofibromatosis fue ingresada con signos de melena. La endoscopia digestiva alta y baja fue negativa. Se indicó TAC con contraste que advirtió tumores yeyunales como causa del sangrado. Se realizó laparotomía y resección de un segmento de 20 cm de yeyuno que incluía varios tumores. La causa del sangrado activo fue lesión en mucosa intestinal por erosión tumoral. El análisis por inmunohistoquímica de la pieza mostró diferenciación neuronal, con células fusiformes con tinción positiva para el C-Kit (CD 117, CD 34. Esta nota clínica pone de manifiesto la asociación entre la neurofibromatosis y los tumores estromales y debe alertar a gastroenterólogos y cirujanos sobre las posibles manifestaciones

  13. Usefulness of angiographic embolization endoscopic metallic clip placement in patient with non-variceal upper gastrointestinal bleeding

    Yoon, Min Jae; Hwang, Cheol Mog; Kim, Ho Jun; Cho, Young Jun; Bae, Seok Hwan [Dept. of Radiology, Konyang University Hospital, Daejeon (Korea, Republic of); Shin, Byung Seok; Ohm, Joon Young [Dept. of Radiology, Chungnam National University College of Medicine, Daejeon (Korea, Republic of); Kang, Chae Hoon [Dept. of Radiology, Inje University College of Medicine, Pusan Paik Hospital, Busan (Korea, Republic of)

    2013-08-15

    The aim of this study is to assess the usefulness of angiographic embolization after endoscopic metallic clip placement around the edge of non-variceal upper gastrointestinal bleeding ulcers. We have chosen 41 patients (mean age, 65.2 years) with acute bleeding ulcers (22 gastric ulcers, 16 duodenal ulcers, 3 malignant ulcers) between January 2010 and December 2012. We inserted metallic clips during the routine endoscopic treatments of the bleeding ulcers. Subsequent transcatheter arterial embolization was performed within 2 hours. We analyzed the angiographic positive rates, angiographic success rates and clinical success rates. Among the 41 patients during the angiography, 19 patients (46%) demonstrated active bleeding points. Both groups underwent embolization using microcoils, N-butyl-cyano-acrylate (NBCA), microcoils with NBCA or gelfoam particle. There are no statistically significant differences between these two groups according to which embolic materials are being used. The bleeding was initially stopped in all patients, except the two who experienced technical failures. Seven patients experienced repeated episodes of bleeding within two weeks. Among them, 4 patients were successful re-embolized. Another 3 patients underwent gastrectomy. Overall, clinical success was achieved in 36 of 41 (87.8%) patients. The endoscopic metallic clip placement was helpful to locate the correct target vessels for the angiographic embolization. In conclusion, this technique reduced re-bleeding rates, especially in patients who do not show active bleeding points.

  14. Abnormal gastrointestinal accumulation of radiotracer by gastric bleeding during {sup 99m}Tc-MDP bone scintigraphy

    Chun, Kyung A.; Lee, Sang Woo; Lee, Jae Tae; Lee, Kyu Bo [College of Medicine, Kyungpook National Univ., Taegu (Korea, Republic of)

    1998-06-01

    We present a case in which a patient with acute hemorrhagic gastritis demonstrated abnormal gastrointestinal accumulation of radiotracer during {sup 99m}Tc-methylene diphosphonate (MDP) skeletal scintigraphy. A hemorrhagic gastritis was subsequently demonstrated by endoscopy. The mechanism for the intestinal localization of {sup 99m}Tc-MDP in this patients is not clear, but we guess that the extravasated blood containing the radiopharmaceutical cannot recirculate and stays at the bleeding site, so we can see the intestinal activity.

  15. The characteristics of adults with upper gastrointestinal bleeding admitted to Tripoli Medical Center: a retrospective case-series analysis

    Elghuel, Abdulbaset

    2011-01-01

    Background: Acute upper gastrointestinal bleeding (UGIB) is a common reason for hospital admissions worldwide. Aetiological causes of UGIB vary according to geographic region and socioeconomic status. However, despite the implementation of early endoscopy as the standard method for the diagnosis and treatment of UGIB, data on the characteristics of patients with UGIB in Libya are still minimal. In this study, we describe patient demographics, aetiological causes for UGIB, and possible risk fa...

  16. Transjugular Endovascular Recanalization of Splenic Vein in Patients with Regional Portal Hypertension Complicated by Gastrointestinal Bleeding

    Luo, Xuefeng; Nie, Ling; Wang, Zhu; Tsauo, Jiaywei; Tang, Chengwei; Li, Xiao, E-mail: simonlixiao@126.com [West China Hospital, Sichuan University, Department of Gastroenterology (China)

    2013-05-02

    PurposeRegional portal hypertension (RPH) is an uncommon clinical syndrome resulting from splenic vein stenosis/occlusion, which may cause gastrointestinal (GI) bleeding from the esophagogastric varices. The present study evaluated the safety and efficacy of transjugular endovascular recanalization of splenic vein in patients with GI bleeding secondary to RPH.MethodsFrom December 2008 to May 2011, 11 patients who were diagnosed with RPH complicated by GI bleeding and had undergone transjugular endovascular recanalization of splenic vein were reviewed retrospectively. Contrast-enhanced computed tomography revealed splenic vein stenosis in six cases and splenic vein occlusion in five. Etiology of RPH was chronic pancreatitis (n = 7), acute pancreatitis with pancreatic pseudocyst (n = 2), pancreatic injury (n = 1), and isolated pancreatic tuberculosis (n = 1).ResultsTechnical success was achieved in 8 of 11 patients via the transjugular approach, including six patients with splenic vein stenosis and two patients with splenic vein occlusion. Two patients underwent splenic vein venoplasty only, whereas four patients underwent bare stents deployment and two covered stents. Splenic vein pressure gradient (SPG) was reduced from 21.5 ± 7.3 to 2.9 ± 1.4 mmHg after the procedure (P < 0.01). For the remaining three patients who had technical failures, splenic artery embolization and subsequent splenectomy was performed. During a median follow-up time of 17.5 (range, 3–34) months, no recurrence of GI bleeding was observed.ConclusionsTransjugular endovascular recanalization of splenic vein is a safe and effective therapeutic option in patients with RPH complicated by GI bleeding and is not associated with an increased risk of procedure-related complications.

  17. Upper gastrointestinal bleeding risk scores: Who, when andwhy?

    2016-01-01

    Upper gastrointestinal bleeding (UGIB) remains a significant cause of hospital admission. In order tostratify patients according to the risk of the complications,such as rebleeding or death, and to predict theneed of clinical intervention, several risk scores havebeen proposed and their use consistently recommendedby international guidelines. The use of risk scoringsystems in early assessment of patients suffering fromUGIB may be useful to distinguish high-risks patients,who may need clinical intervention and hospitalization,from low risk patients with a lower chance of developingcomplications, in which management as outpatientscan be considered. Although several scores havebeen published and validated for predicting differentoutcomes, the most frequently cited ones are the Rockallscore and the Glasgow Blatchford score (GBS). WhileRockall score, which incorporates clinical and endoscopicvariables, has been validated to predict mortality,the GBS, which is based on clinical and laboratorialparameters, has been studied to predict the need ofclinical intervention. Despite the advantages previouslyreported, their use in clinical decisions is still limited. Thisreview describes the different risk scores used in theUGIB setting, highlights the most important research,explains why and when their use may be helpful, reflectson the problems that remain unresolved and guidesfuture research with practical impact.

  18. Massive Upper Gastrointestinal Bleeding Secondary to Duodenal Metastasis of Transitional Cell Carcinoma of the Urinary Bladder

    Carlos H.F. Chan

    2011-04-01

    Full Text Available Acute upper gastrointestinal (UGI bleeding is a common problem in our clinical practice and is often due to peptic ulcer diseases. Occasionally, malignancy may be implicated in these situations. Here we report a rare case of UGI bleeding secondary to metastatic transitional cell carcinoma (TCC of the urinary bladder. A 62-year-old man with a history of stage IIIb TCC of the urinary bladder presented with hematemesis. Endoscopy showed a large tumor in the second stage of the duodenum that occupied 40% of the duodenal circumference, over 7 cm in length. Biopsies revealed a poorly differentiated malignant neoplasm consistent with metastasis from urothelial carcinoma that was identical to the previous surgical specimen of the urinary bladder. He was treated with supportive therapy and intravenous proton pump inhibitor and was discharged home 2 weeks later. Two weeks after discharge, the patient returned to the hospital with a painful swelling of the floor of his mouth. Biopsy again showed the same cancer type. He had unremitting bleeding from his mouth requiring multiple transfusions and a course of palliative radiation therapy. He progressively deteriorated in his cardiopulmonary and neurological functions and expired with cardiopulmonary arrest one month later.

  19. Occult gastrointestinal bleeding due to a Dieulafoy lesion in the terminal ileum

    Wegdam, J.A.; Hofker, H.S.; Dijkstra, G; Stolk, M.F.; Jacobs, M.A.; Suurmeijer, A.J.H.

    2006-01-01

    A 50-year-old man awaiting liver transplantation for primary sclerosing cholangitis developed iron-deficiency anaemia. Repeated occult gastrointestinal bleeding led to an increasing need for blood transfusions. After multiple oesophagogastroduodenoscopies and colonoscopies, videocapsule endoscopy fi

  20. Diagnostic Evaluation and Management of Obscure Gastrointestinal Bleeding: A Changing Paradigm

    Pasha, Shabana F.; Hara, Amy K.; Leighton, Jonathan A.

    2009-01-01

    Obscure gastrointestinal bleeding (OGIB) is defined as bleeding from the gastrointestinal tract that persists or recurs after a negative initial evaluation using bidirectional endoscopy and radiologic imaging with small-bowel radiograph. The main challenges related to evaluation of OGIB include the high miss rate for lesions on initial evaluation with standard endoscopy and the limited capacity of older diagnostic modalities to effectively examine the small bowel. The introduction of capsule ...

  1. Meta-analysis: antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding - an updated Cochrane review

    Chavez-Tapia, N C; Barrientos-Gutierrez, T; Tellez-Avila, F; Soares-Weiser, K; Mendez-Sanchez, N; Gluud, C; Uribe, M

    2011-01-01

    Antibiotic prophylaxis seems to decrease the incidence of bacterial infections in patients with cirrhosis and upper gastrointestinal bleeding and is considered standard of care. However, there is no updated information regarding the effects of this intervention.......Antibiotic prophylaxis seems to decrease the incidence of bacterial infections in patients with cirrhosis and upper gastrointestinal bleeding and is considered standard of care. However, there is no updated information regarding the effects of this intervention....

  2. Diagnostic and Therapeutic Endoscopic Approaches to Upper Gastrointestinal System Bleeding in Children

    Fatih Aygün

    2012-04-01

    Full Text Available In­tro­duc­ti­on: Upper gastrointestinal system bleeding in children is always very important problems requiring further investigation. The aim of the study was to investigate retrospectively the etiologies of upper gastrointestinal bleeding, the therapeutic endoscopic approach to the bleeding, and the efficacy of the endoscopy in the treatment of pediatric age group. Materials and Methods: In this study, 139 (F/M: 63/76 cases diagnosed as upper gastrointestinal bleeding and followed up by the Department of Pediatric Gastroenterology were classified into groups according to the age, etiology, the presence of varicose veins, and history of drug ingestion. In addition bleedings caused by peptic ulcer disease were classified according to Forrest classification. Values of p0.68. Discussion: Endoscopic procedure is very useful in both the determination of etiology of upper gastrointestinal bleeding and the treatment of upper gastrointestinal bleeding in childhood. (Jo­ur­nal of Cur­rent Pe­di­at­rics 2012; 10: 1-7

  3. Chronic portomesenteic venous thrombosis complicated by a high flow arteriovenous malformation presenting with gastrointestinal bleeding.

    Plotnik, Adam N; Hebroni, Frank; McWilliams, Justin

    2016-02-01

    Portomesenteric venous thrombosis is a rare but potentially life-threatening condition. The presenting symptoms of chronic portomesenteric venous thrombosis are often non-specific but may present with variceal bleeding. We present the first reported case of chronic portomesenteric venous thrombosis causing a high flow arteriovenous malformation that resulted in extensive gastrointestinal bleeding. PMID:25871943

  4. A jejunal GIST presenting with obscure gastrointestinal bleeding and small bowel obstruction secondary to intussusception.

    Sadeghi, Peter; Lanzon-Miller, Sandro

    2015-01-01

    A 68-year-old man with episodes of overt obscure gastrointestinal (GI) bleeding was investigated with multiple upper and lower GI endoscopies, CT enterography and capsule endoscopy, but no cause was found. He then presented acutely with small bowel obstruction. A laparotomy revealed complete small bowel obstruction secondary to jejunal intussusception over a 4 cm intraluminal polyp. Following resection and primary anastomosis, histology revealed that the polyp was a GI stromal tumour (GIST). This is an exceptionally uncommon presentation of a rare tumour. It is surprising that this tumour was not detected by CT enterography and not seen on capsule endoscopy. Immunohistochemistry and mutation analysis of the GIST suggested that it had a low risk of metastatic disease, but a high risk of recurrence. Staging CT scans did not reveal evidence of distal spread. The patient is currently receiving 3 years of chemotherapy with imatinib. PMID:26527610

  5. Transcatheter Arterial Embolization of Nonvariceal Upper Gastrointestinal Bleeding with N-Butyl Cyanoacrylate

    To evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with N-Butyl Cyanoacrylate (NBCA) for nonvariceal upper gastrointestinal bleeding. Between March 1999 and December 2002, TAE for nonvariceal upper gastrointestinal bleeding was performed in 93 patients. The endoscopic approach had failed or was discarded as an approach for control of bleeding in all study patients. Among the 93 patients NBCA was used as the primary embolic material for TAE in 32 patients (28 men, four women; mean age, 59.1 years). The indications for choosing NBCA as the embolic material were: inability to advance the microcatheter to the bleeding site and effective wedging of the microcatheter into the bleeding artery. TAE was performed using 1:1 1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure related complications and clinical outcomes were evaluated. The angiographic and clinical success rates were 100% and 91% (29/32), respectively. There were no serious ischemic complications. Recurrent bleeding occurred in three patients (9%) and they were managed with emergency surgery (n = 1) and with a successful second TAE (n = 2). Eighteen patients (56%) had a coagulopathy at the time of TAE and the clinical success rate in this group of patients was 83% (15/18). TAE with NBCA is a highly effective and safe treatment modality for nonvariceal upper gastrointestinal bleeding, especially when it is not possible to advance the microcatheter to the bleeding site and when the patient has a coagulopathy

  6. Transcatheter Arterial Embolization of Nonvariceal Upper Gastrointestinal Bleeding with N-Butyl Cyanoacrylate

    Jae, Hwan Jun; Chung, Jin Wook; Jung, Ah Young; Lee, Whal; Park, Jae Hyung [Seoul National University Hospital, Institute of Radiation Medicine, Seoul (Korea, Republic of)

    2007-02-15

    To evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with N-Butyl Cyanoacrylate (NBCA) for nonvariceal upper gastrointestinal bleeding. Between March 1999 and December 2002, TAE for nonvariceal upper gastrointestinal bleeding was performed in 93 patients. The endoscopic approach had failed or was discarded as an approach for control of bleeding in all study patients. Among the 93 patients NBCA was used as the primary embolic material for TAE in 32 patients (28 men, four women; mean age, 59.1 years). The indications for choosing NBCA as the embolic material were: inability to advance the microcatheter to the bleeding site and effective wedging of the microcatheter into the bleeding artery. TAE was performed using 1:1 1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure related complications and clinical outcomes were evaluated. The angiographic and clinical success rates were 100% and 91% (29/32), respectively. There were no serious ischemic complications. Recurrent bleeding occurred in three patients (9%) and they were managed with emergency surgery (n = 1) and with a successful second TAE (n = 2). Eighteen patients (56%) had a coagulopathy at the time of TAE and the clinical success rate in this group of patients was 83% (15/18). TAE with NBCA is a highly effective and safe treatment modality for nonvariceal upper gastrointestinal bleeding, especially when it is not possible to advance the microcatheter to the bleeding site and when the patient has a coagulopathy.

  7. Sandostatin therapy of acute oesophageal variceal bleeding.

    McKee, R F

    1993-01-01

    This communication deals with the emergency control of variceal bleeding rather than the prevention of rebleeding. The current main options of oesophageal tamponade, emergency sclerotherapy and drug therapy are discussed, with particular reference to the use of somatostatin. Sandostatin (Sandoz, Basel), a synthetic long-acting somatostatin analogue, was found to reduce transhepatic venous gradient by 30% with no effect on systemic haemodynamics in a study of 16 stable cirrhotic patients. In a trial comparing intravenous infusion of Sandostatin (SMS) to oesophageal tamponade (OT) in active variceal bleeding, 18 of 20 bleeds in the SMS group and 19 of 20 bleeds in the OT group were controlled at 4 h. Ten in the SMS group and 14 in the OT group had no further bleeding during the 48-hour study period. Thus SMS may be useful in the temporary control of active variceal bleeding. PMID:8359565

  8. Hepatic Artery-duodenal Fistula with Gastrointestinal Bleeding after Liver Transplantation

    Ruey-Shyang Soong

    2009-10-01

    Full Text Available Gastrointestinal bleeding caused by peptic ulcer or portal hypertension is a serious complicationin liver transplant recipients. However, Gastrointestinal bleeding from hepaticartery origin after liver transplantation is rare. We report duodenal massive bleeding secondaryto erosion of hepatic artery after liver transplantation in two patients. This was diagnosedby angiography and treated subsequently by surgical intervention with hepatic arteryre-anastomosis. We could not salvage one of these patients who died of complications ofgraft failure. Therefore, early diagnosis and aggressive surgical intervention may be requiredin order to salvage both recipient and graft.

  9. Risk assessment after acute upper gastrointestinal haemorrhage.

    Rockall, T A; Logan, R F; Devlin, H. B.; Northfield, T. C.

    1996-01-01

    The aim of this study was to establish the relative importance of risk factors for mortality after acute upper gastrointestinal haemorrhage, and to formulate a simple numerical scoring system that categorizes patients by risk. A prospective, unselected, multicentre, population based study was undertaken using standardised questionnaires in two phases one year apart. A total of 4185 cases of acute upper gastrointestinal haemorrhage over the age of 16 identified over a four month period in 1993...

  10. Upper gastrointestinal bleeding due to gastric stromal tumour: a case report

    Singhal, Tarun; Doddi, Sudeendra; Leake, Tessa; Parsi, Srikanth; Hussain, Abdulzahra; Chandra, Aninda; Smedley, Frank; Ellul, Joe

    2010-01-01

    Introduction Gastro-intestinal stromal tumours are the most common mesenchymal tumours of the gastro-intestinal tract. This case report highlights the necessity of early surgical intervention in such cases to avoid mortality due to rebleeding and to raise the awareness of rare causes of upper gastrointestinal bleed and their management. Case presentation A 61-year-old male presented to the accident and emergency department with a one-day history of haemetemesis with coffee ground vomiting. Af...

  11. Unusual Cause of Massive Upper Gastrointestinal Bleeding: A Pancreatic Arteriovenous Malformation

    Anil Arora

    2013-05-01

    Full Text Available Context Upper gastrointestinal bleeding is one of the most common emergencies in gastroenterology. The common causes of the upper gastrointestinal bleeding include peptic ulcer disease, gastric erosive mucosal disease and portal hypertension. Gastrointestinal arteriovenous malformation is a less common cause of gastrointestinal bleeding and these arteriovenous malformation are most commonly located in the large and small intestine. Pancreatic arteriovenous malformation is a rare condition in which there is tumorlike formation or vascular anomaly built up via an aberrant bypass anastomosis of the arterial and venous systems in the pancreas. Splenic artery is most commonly involved (42%, followed by gastroduodenal artery (22% and small pancreatic arteries (25%. Clinically it may present as gastrointestinal hemorrhage which is occasionally fatal. Other presentations are abdominal pain, pancreatitis, duodenal ulcer, jaundice, and portal hypertension. Case report We present a rare case of pancreatic arteriovenous malformation presenting as massive upper gastrointestinal bleeding. Conclusion Since early surgery is a life saving treatment for such cases, hence, a high index of suspicion should be maintained especially when massive bleeding is detected from the medial wall of second part of duodenum.

  12. /sup 99m/Tc-labeled RBC scan. Diagnostic method for lower gastrointestinal bleeding

    The experience with 62 /sub 99m/Tc-labeled in vivo scans performed for lower gastrointestinal bleeding is discussed. Thirty-seven scans were deemed positive. The tendency of scans to become positive correlated with observations of active bleeding. Five patients had fulminant hemorrhage, necessitating emergency operation. In this group, scanning accurately located the bleeding sources prior to intervention. Seven other patients having later operations bled less rapidly. The bleeding site was localized accurately by scanning in three of these patients. Two studies were falsely positive and two were negative, whereas angiography was positive in two patients studied. Labeled RBC scanning is a useful technique in the early evaluation of patients with lower gastrointestinal bleeding, obviating the need of arteriography in some cases

  13. Active gastrointestinal bleeding:Use of hemostatic forceps beyond endoscopic submucosal dissection

    Dimitri; Coumaros; Niki; Tsesmeli

    2010-01-01

    To the best of our knowledge,this is the f irst report of the application of hemostatic forceps in active gastrointestinal(GI) bleeding that is not related to endoscopic submucosal dissection.An 86-year-old woman with chronic intake of low-dose aspirin had a Dieulafoy's lesion of the third duodenal portion.Bleeding control with epinephrine injection was unsuccessful.A 60-year-old man presented with a bleeding ulcer in the duodenal bulb.Ten days after combined endotherapy,he had recurrent bleeding from two m...

  14. The role of computerized tomography in the evaluation of gastrointestinal bleeding following negative or failed endoscopy: A review of current status

    Stunell H

    2008-01-01

    Full Text Available Gastrointestinal bleeding remains an important cause for emergency hospital admission with a significant related morbidity and mortality. Bleeding may relate to the upper or lower gastrointestinal tracts and clinical history and examination may guide investigations to the more likely source of bleeding. The now widespread availability of endoscopic equipment has made a huge impact on the rapid identification of the bleeding source. However, there remains a large group of patients with negative or failed endoscopy, in whom additional techniques are required to identify the source of bleeding. In the past, catheter angiography and radionuclide red cell labeling techniques were the preferred ′next step′ modalities used to aid in identifying a bleeding source within the gastrointestinal tract. However, these techniques are time-consuming and of limited sensitivity and specificity. In addition, catheter angiography is a relatively invasive procedure. In recent years, computerized tomography (CT has undergone major technological advances in its speed, resolution, multiplanar techniques and angiographic abilities. It has allowed excellent visualization of the both the small and large bowel allowing precise anatomical visualization of many causes of gastrointestinal tract (GIT bleeding. In addition, recent advances in multiphasic imaging now allow direct visualization of bleeding into the bowel. In many centers CT has therefore become the ′next step′ technique in identifying a bleeding source within the GIT following negative or failed endoscopy in the acute setting. In this review article, we review the current literature and discuss the current status of CT as a modality in investigating the patient with GIT bleeding.

  15. Detection of gastrointestinal bleeding with /sup 99m/Tc-sulfur colloid

    We have developed a single scintigraphic technique to detect and localize the site of bleeding in the gastrointestinal tract. This examination requires only intravenous administration of /sup 99m/Tc sulfur colloid and imaging of the abdomen. Very shortly after the introduction of the radiopharmaceutical, a fraction of the injected activity extravasates at the bleeding site and is eliminated from the circulation. This phenomenon is repeated each time the blood recirculates adding another, but smaller fraction to the extravasated activity at the site of hemorrhage. Because of continued clearance of the radiopharmaceutical from the vascular pool by the reticuloendothelial system, a contrast is eventually reached between the site of bleeding and surrounding background. Based on animal experiments bleeding rates as low as .05-0.1 cc/min can be detected with this technique. The sensitivity of the approach in the detection of the site of hemorrhage is significantly higher than arteriography or other techniques which utilize radioactive blood pool indicators. We have mainly used this technique in the evaluation of patients with GI bleeding. In more than 25 patients with negative scintigrams for hemorrhage, arteriography showed no evidence of bleeding. In 38 patients with scintigraphic evidence of bleeding. In 38 patients with scintigraphic evidence of hemorrhage, arteriograms were positive for bleeding in les than 50% of the cases. No false positive results have been noted in the latter group. This technique appears to offer a simple, practical and reliable approach to the evaluation of patients with gastrointestinal bleeding

  16. Guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding.

    Fujishiro, Mitsuhiro; Iguchi, Mikitaka; Kakushima, Naomi; Kato, Motohiko; Sakata, Yasuhisa; Hoteya, Shu; Kataoka, Mikinori; Shimaoka, Shunji; Yahagi, Naohisa; Fujimoto, Kazuma

    2016-05-01

    Japan Gastroenterological Endoscopy Society (JGES) has compiled a set of guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding using evidence-based methods. The major cause of non-variceal upper gastrointestinal bleeding is peptic gastroduodenal ulcer bleeding. As a result, these guidelines mainly focus on peptic gastroduodenal ulcer bleeding, although bleeding from other causes is also overviewed. From the epidemiological aspect, in recent years in Japan, bleeding from drug-related ulcers has become predominant in comparison with bleeding from Helicobacter pylori (HP)-related ulcers, owing to an increase in the aging population and coverage of HP eradication therapy by national health insurance. As for treatment, endoscopic hemostasis, in which there are a variety of methods, is considered to be the first-line treatment for bleeding from almost all causes. It is very important to precisely evaluate the severity of the patient's condition and stabilize the patient's vital signs with intensive care for successful endoscopic hemostasis. Additionally, use of antisecretory agents is recommended to prevent rebleeding after endoscopic hemostasis, especially for gastroduodenal ulcer bleeding. Eighteen statements with evidence and recommendation levels have been made by the JGES committee of these guidelines according to evidence obtained from clinical research studies. However, some of the statements that are supported by a low level of evidence must be confirmed by further clinical research. PMID:26900095

  17. Severe upper gastrointestinal bleeding in extraluminal diverticula in the third part of the duodenum

    Andersen, Johnny Fredsbo; Wilhelmsen, Michael; Lauritsen, Morten Laksafoss

    2014-01-01

    The successful management of upper gastrointestinal (GI) bleeding requires identification of the source of bleeding and when this is achieved the bleeding can often be treated endoscopically. However, the identification of the bleeding can be challenging due to the location of the bleeding or...... technical aspects. Therefore it might be necessary to use other measures than endoscopy such as CT angiography. Duodenal diverticula is a rare cause of upper GI bleeding and can be challenging to diagnose as they often require specialised endoscopy procedures such as endoscopy with a side-viewing scope....... This case describes the first successful management of this rare condition with an upper GI endoscopy with a colonoscope and afterwards intravascular coiling....

  18. Diffuse gastrointestinal bleeding and BK polyomavirus replication in a pediatric allogeneic haematopoietic stem cell transplant patient.

    Koskenvuo, M; Lautenschlager, I; Kardas, P; Auvinen, E; Mannonen, L; Huttunen, P; Taskinen, M; Vettenranta, K; Hirsch, H H

    2015-01-01

    Patients undergoing haematopoietic stem cell transplantation (HSCT) are at high risk of severe gastrointestinal bleeding caused by infections, graft versus host disease, and disturbances in haemostasis. BK polyomavirus (BKPyV) is known to cause hemorrhagic cystitis, but there is also evidence of BKV shedding in stool and its association with gastrointestinal disease. We report putative association of BKPyV replication with high plasma viral loads in a pediatric HSCT patient developing hemorrhagic cystitis and severe gastrointestinal bleeding necessitating intensive care. The observation was based on chart review and analysis of BKPyV DNA loads in plasma and urine as well as retrospective BKPyV-specific IgM and IgG measurements in weekly samples until three months post-transplant. The gastrointestinal bleeding was observed after a >100-fold increase in the plasma BKPyV loads and the start of hemorrhagic cystitis. The BKPyV-specific antibody response indicated past infection prior to transplantation, but increasing IgG titers were seen following BKPyV replication. The gastrointestinal biopsies were taken at a late stage of the episode and were no longer informative of BK polyomavirus involvement. In conclusion, gastrointestinal complications with bleeding are a significant problem after allogeneic HSCT to which viral infections including BKPyV may contribute. PMID:25542476

  19. Localization of gastrointestinal bleeding: superiority of 99mTc sulfur colloid compared with angiography

    Preliminary experience with technetium-99m sulfur colloid scintigraphy in 43 patients with lower gastrointestinal bleeding is described. Within minutes of the intravenous introduction of the radiopharmaceutical, a fraction of the injected activity extravasates at the bleeding site and is eliminated from the circulation. Because of rapid clearance of the radiopharmaceutical from the vascular pool by the reticuloendothelial system, a contrast develops between the site of bleeding and surrounding background. Based on animal experiments, bleeding rates as low as 0.05-0.1 ml/min can be detected with this technique. The sensitivity of this technique in the detection of the site of hemorrhage is significantly higher than arteriography or other techniques that use radioactive blood pool indicators. In this study all patients underwent both scintigraphy and arteriography within several hours. In 20 patients with negative scintigrams, arteriography showed no evidence of bleeding. In the other 23 patients with scintigraphic evidence of hemorrhage, arteriograms were positive for bleeding only in 10. In 19 of the 23 patients, a cause for bleeding was eventually established by other means. This technique appears to offer a simple, practical, and reliable approach to the evaluation of patients with lower gastrointestinal bleeding

  20. Localization of gastrointestinal bleeding: superiority of /sup 99m/Tc sulfur colloid compared with angiography

    Preliminary experience with technetium-99m sulfur colloid scintigraphy in 43 patients with lower gastrointestinal bleeding is described. Within minutes of the intravenous introduction of the radiopharmaceutical, a fraction of the injected activity extravasates at the bleeding site and is eliminated from the circulation. Because of rapid clearance of the radiopharmaceutical from the vascular pool by the rediculoendothelial system, a contrast develops between the site of bleeding and surrounding background. Based on animal experiments, bleeding rates as low as 0.05-0.1 ml/min can be detected with this technique. The sensitivity of this technique in the detection of the site of hemorrhage is significantly higher than arteriography or other techniques that use radioactive blood pool indicators. In this study all patients underwent both scintigraphy and arteriography within several hours. In 20 patients with negative scintigrams, arteriography showed no evidence of bleeding. In the other 23 patients with scintigraphic evidence of hemorrhage, arteriograms were positive for bleeding only in 10. In 19 of the 23 patients, a cause for bleeding was eventually established by other means. This technique appears to offer a simple, practical, and reliable approach to the evaluation of patients with lower gastrointestinal bleeding

  1. The role of capsule endoscopy after negative CT enterography in patients with obscure gastrointestinal bleeding

    The aim of the present study was to evaluate the role of capsule endoscopy in patients with obscure gastrointestinal bleeding (OGIB) after negative computed tomographic (CT) enterography. We retrospectively included 30 patients with OGIB who received capsule endoscopy after negative CT enterography. The median age of the patients was 60 years, and 60% of patients were male. The median follow-up duration was 8 months. Overt bleeding was 60%, and occult bleeding was 40%. Based on capsule endoscopy results, a definitive diagnosis was made for 17 patients (57%): ulcer in nine patients (30%), active bleeding with no identifiable cause in five (17%), angiodysplasia in two (7%) and Dieulafoy's lesion in one (3%). Two patients with jejunal ulcers were diagnosed with Crohn's disease. Seven patients (41%) with positive capsule endoscopy received double balloon enteroscopy and two patients (12%) received steroid treatment for Crohn's disease. Patients with overt bleeding, a previous history of bleeding, or who received large amounts of blood transfusions were more likely to show positive capsule endoscopy. Capsule endoscopy showed high diagnostic yields in patients with OGIB after negative CT enterography and may help to provide further therapeutic plans for patients with OGIB and negative CT enterography. circle CT enterography has been widely used in evaluating obscure gastrointestinal bleeding (OGIB). circle Capsule endoscopy showed high diagnostic yield for OGIB after negative CT enterography. circle Negative CT enterography does not exclude important causes of small bowel bleeding. circle Most lesions missed at CT-enterography are flat and can be detected by capsule endoscopy. (orig.)

  2. Cyanoacrylate spray as treatment in difficult-to-manage gastrointestinal bleeding

    Toapanta-Yanchapaxi, Liz; Chavez-Tapia, Norberto; Téllez-Ávila, Félix

    2014-01-01

    Gastrointestinal bleeding can be a life-treating event that is managed with standard endoscopic therapy in the majority of cases. However, up to 5%-10% of patients may have persistent bleeding that does not respond to conventional measures. Several endoscopic treatment techniques have been proposed as strategies to control such cases, such as epinephrine injection, hemoclips or argon plasma coagulation, but there are certain clinical scenarios where it is difficult to achieve hemostasis even ...

  3. Antidepressant-warfarin interaction and associated gastrointestinal bleeding risk in a case-control study.

    Hedi Schelleman

    Full Text Available BACKGROUND: Bleeding is the most common and worrisome adverse effect of warfarin therapy. One of the factors that might increase bleeding risk is initiation of interacting drugs that potentiate warfarin. We sought to evaluate whether initiation of an antidepressant increases the risk of hospitalization for gastrointestinal bleeding in warfarin users. METHODOLOGY/PRINCIPAL FINDINGS: Medicaid claims data (1999-2005 were used to perform an observational case-control study nested within person-time exposed to warfarin in those ≥18 years. In total, 430,455 warfarin users contributed 407,370 person-years of warfarin use. The incidence rate of hospitalization for GI bleeding among warfarin users was 4.48 per 100 person-years (95% CI, 4.42-4.55. Each gastrointestinal bleeding cases was matched to 50 controls based on index date and state. Warfarin users had an increased odds ratio of gastrointestinal bleeding upon initiation of citalopram (OR = 1.73 [95% CI, 1.25-2.38], fluoxetine (OR = 1.63 [95% CI, 1.11-2.38], paroxetine (OR = 1.64 [95% CI, 1.27-2.12], amitriptyline (OR = 1.47 [95% CI, 1.02-2.11]. Also mirtazapine, which is not believed to interact with warfarin, increased the risk of GI bleeding (OR = 1.75 [95% CI, 1.30-2.35]. CONCLUSIONS/SIGNIFICANCE: Warfarin users who initiated citalopram, fluoxetine, paroxetine, amitriptyline, or mirtazapine had an increased risk of hospitalization for gastrointestinal bleeding. However, the elevated risk with mirtazapine suggests that a drug-drug interaction may not have been responsible for all of the observed increased risk.

  4. Direct Versus Video Laryngoscopy for Intubating Adult Patients with Gastrointestinal Bleeding

    Jestin N. Carlson; Jason Crofts; Walls, Ron M.; Brown III, Calvin A.

    2015-01-01

    Introduction: Video laryngoscopy (VL) has been advocated for several aspects of emergency airway management; however, there are still concerns over its use in select patient populations such as those with large volume hematemesis secondary to gastrointestinal (GI) bleeds. Given the relatively infrequent nature of this disease process, we sought to compare intubation outcomes between VL and traditional direct laryngoscopy (DL) in patients intubated with GI bleeding, using the third iteration o...

  5. A prospective study of aspirin use and the risk of gastrointestinal bleeding in men.

    Edward S Huang

    Full Text Available Data regarding the influence of dose and duration of aspirin use on risk of gastrointestinal bleeding are conflicting.We conducted a prospective cohort study of 32,989 men enrolled in the Health Professionals Follow-up Study (HPFS in 1994 who provided biennial aspirin data. We estimated relative risk of major gastrointestinal bleeding requiring hospitalization or a blood transfusion.During 14 years of follow-up, 707 men reported an episode of major gastrointestinal bleeding over 377,231 person-years. After adjusting for risk factors, regular aspirin use (≥2 times/week had a multivariate relative risk (RR of gastrointestinal bleeding of 1.32 (95% confidence interval [CI], 1.12-1.55 compared to non-regular use. The association was particularly evident for upper gastrointestinal bleeding (multivariate RR, 1.49; 95% CI, 1.16-1.92. Compared to men who denied any aspirin use, multivariate RRs of upper gastrointestinal bleeding were 1.05 (95% CI 0.71-1.52 for men who used 0.5-1.5 standard tablets/week, 1.31 (95% CI 0.88-1.95 for 2-5 aspirin/week, 1.63 (95% CI, 1.15-2.32 for 6-14 aspirin/week and 2.40 (95% CI, 1.10-5.22 for >14 aspirin/week (P(trend<0.001. The relative risk also appeared to be dose-dependent among short-term users <5 years; P(trend<.001 and long-term users (≥5 years; P(trend = 0.015. In contrast, after controlling for dose, increasing duration of use did not appear to be associated with risk (P(trend = 0.749.Regular aspirin use increases the risk of gastrointestinal bleeding, especially from the upper tract. However, risk of bleeding appears to be more strongly related to dose than to duration of use. Risk of bleeding should be minimized by using the lowest effective dose among short-term and long-term aspirin users.

  6. Clinical application of Hawkeye VG SPECT/CT imaging in the bleeding position of lower gastrointestinal

    Objective: To evaluate the clinical application of Hawkeye VG SPECT/CT imaging on diagnosing and locating lower gastrointestinal bleeding using in vivo labeling 99Tcm-RBC. Methods: Fifty-six patients (42 males, 14 females, age ranging from 10 to 76 years) who had definite lower gastrointestinal bleeding were studied retrospectively. All patients had intravenous injection with 370 MBq 99Tcm-RBC and then underwent planar, SPECT, and CT imaging respectively in the abdomen before exploratory laparotomy. Images from SPECT and CT were fused thereafter to locate the active bleeder, if any. χ2 test was performed to show the differences of diagnostic sensitivity and accuracy between planar and SPECT/CT imaging. Results: In 56 patients with lower gastrointestinal bleeding, 50 patients showed abnormally concentrated radionuclide activity with planar images and 52 patients showed the similar imaging pattern with SPECT/CT. Among these patients, concordant bleeding with operation findings was found in 31 patients with planar images and 48 patients with SPECT/CT images. The sensitivity and accuracy were 89.3% (50/56) and 73.8% (31/42) in planar images, and 92.9% (52/56) and 92.3% (48/52) in SPECT/CT images (χ2=0.11, P>0.05; χ2=4.63, P<0.05). Conclusion: Hawkeye VG SPECT/CT imaging shows an effective, simple and accurate method and could be used for diagnosing and locating lower gastrointestinal bleeding. (authors)

  7. Three-year Study of Effective Factors in Gastrointestinal Bleeding in Hospitalized Burn Patients in Ahvaz Taleghani Hospital

    Pipelzadeh MH

    2011-01-01

    Full Text Available Background and Objective: Gastrointestinal bleeding can arise following various stressing conditions such as burns. Gastrointestinal bleeding has serious effect on the treatment process of burn patients. The aim of the present study was to investigate the incidence of gastrointestinal bleeding and to identify factors contributing to its occurrence in burn patientsSubjects and Methods: In this descriptive and retrospective research study, the population of the study included all patients admitted in the Ahvaz Taleghani burn center from the year 2008 to 2010 and 3901 medical records were reviewed. Data were collected by a checklist and analyzed using descriptive and analytical statistical methods. Results: From a total of 3901 patients admitted during the three years period of study, 45 patients had gastrointestinal bleeding (1.15%. The average of burned surface area in these patients was 61%. Seventy seven percent of gastrointestinal bleeding had occurred in patients with burn over 50 percent, and there was direct correlation between the incidence of gastrointestinal bleeding and the extent of burn. The age group of 15-30 years comprised 40.1% of our cases. The mortality among patients suffered from gastrointestinal bleeding was 71%. A significant relationship was found between burn in face and incidence of gastrointestinal bleeding (P<0.001. However, the risk of gastrointestinal bleeding among different sexes was not statistically significant.Conclusion: The results of this study show that the importance of timely diagnosis and treatment of gastrointestinal bleeding in burn patients. Therefore, doing preventive procedures such as medication and psychiatric interventions to reduce stress can decrease the incidence of gastrointestinal bleeding in burn patients.Sci Med J 2011; 9(6:535-542

  8. Arteriovenous malformation of the mandible presented as massive upper gastrointestinal bleeding: report of one case.

    Su, Kuan-Wen; Peng, Yen-Shih; Wu, Yu-Nian; Tsai, Ya-Huei; Lee, Hung-Chang

    2006-01-01

    Arteriovenous malformation is an uncommon cause of upper gastrointestinal bleeding in children. It should be taken into consideration when a child has upper gastrointestinal bleeding because without proper management, it might be fatal. We report a 10-year-old boy whose initial presentation was massive hematemesis and impending shock. After angiography, arteriovenous malformation (AVM) of the mandible was found and treated with embolization. This 10-year-old boy also had chicken pox during admission. Case reports regarding AVM of dental arches in literature are reviewed and the proposed managements are summarized. Embolization combined with surgical excision might be the optimal way to manage AVM of dental arches. PMID:17180789

  9. Prognostic factors for recurrence of gastrointestinal bleeding due to Dieulafoy's lesion

    Yuliana Jamanca-Poma; Antonio Velasco-Guardado; Concepción Pi(n)ero-Pérez; Renzo Calderón-Begazo; Josue Uma(n)a-Mejía; Fernando Geijo-Martínez; Antonio Rodríguez-Pérez

    2012-01-01

    AIM:To analyze the effectiveness of the endoscopic therapy and to identify prognostic factors for recurrent bleeding.METHODS:Retrospective study of patients with gastrointestinal bleeding secondary to Dieulafoy's lesion (DL) from 2005 to 2011.We analyzed the demographic characteristics of the patients,risk factors for gastrointestinal bleeding,endoscopic findings,characteristics of the endoscopic treatment,and the recurrence of bleeding.We included cases in which endoscopy described a lesion compatible with Dieulafoy.We excluded patients who had potentially bleeding lesions such as angiodysplasia in other areas or had undergone other gastrointestinal endoscopic procedures.RESULTS:Twenty-nine patients with DL were identified.Most of them were men with an average age of 71.5 years.Fifty-five percent of the patients received antiaggregatory or anticoagulant therapy.The most common location for DL was the stomach (51.7%).The main type of bleeding was oozing in 65.5% of cases.In 27.6% of cases,there was arterial (spurting) bleeding,and 6.9% of the patients presented with an adherent clot.A single endoscopic treatment was applied to nine patients (31%); eight of them with adrenaline and one with argon,while 69% of the patients received combined treatment.Six patients (20.7%)presented with recurrent bleeding at a median of 4 d after endoscopy (interquartile range =97.75).Within these six patients,the new endoscopic treatment obtained a therapeutic success of 100%.The presence of arterial bleeding at endoscopy was associated with a higher recurrence rate for bleeding (50% vs 33.3% for other type of bleeding) [P =0.024,odds ratio (OR) =8.5,95% CI =1.13-63.87].The use of combined endoscopic treatment prevented the recurrence of bleeding (10% vs 44.4% of single treatment) (P =0.034,OR =0.14,95% CI =0.19-0.99).CONCLUSION:Endoscopic treatment of DL is safe and effective.Adrenaline monotherapy and arterial (spurting) bleeding are associated with a

  10. Primary evaluation of 99mTc-RBC imaging for the diagnosis of lower gastrointestinal bleeding

    99mTc-RBC gastrointestinal (GI) scintigraphy was performed in 10 patients with lower GI bleeding which was confirmed by operation later. The results suggested that 99mTc-RBC imaging was an effective method for the diagnosis of intestinal hemorrhage, especially the small intestine. However, there was some difficulty in accurately localizing the bleeding site due to the movement of the blood containing labelled RBC from original bleeding site to lower portion during intestinal peristalsis and also displacement of the moving colon. Therefore it is necessary to completely explore the intestine carefully and awareness of the possibility of biliary hemorrhage

  11. Crohn's disease and massive lower gastrointestinal bleeding: angiographic appearance and two case reports

    Massive lower gastrointestinal bleeding is described in two patients with Crohn's disease. In case 1, extravasation of contrast material from the ileal branch of the ileocolic artery was seen during selective angiography. In case 2, results of an in vitro labeled 99Tc pyrophosphate red blood cell scan localized bleeding to the ileum. In both cases, medical management was unsuccessful, and surgical resection of the affected bowel was required to stop the bleeding. Angiographic appearance of Crohn's disease is discussed, and a review of the literature of this unusual feature of Crohn's disease is presented. 16 references

  12. Technetium sulfur colloid scintigraphy in the detection of lower gastrointestinal tract bleeding

    /sup 99m/Tc sulfur colloid scintigraphy is a technique which can be used to localize sites of lower gastrointestinal hemorrhage. Two reports of patients illustrate its use clinically. This procedure is non-invasive, relatively inexpensive, easily performed and has a high degree of sensitivity. The technique may, in some instances, replace angiography or endoscopy as the initial procedure used to diagnose the site of lower gastrointestinal bleeding or, more likely, serve as a complementary diagnostic modality

  13. Use of the Enteroscope for Colo-Ileoscopy: Low Yield in Unexplained Lower Gastrointestinal Bleeding

    Belaiche, Jacques; Van Kemseke, Catherine; Louis, Edouard

    1999-01-01

    BACKGROUND AND STUDY AIMS: The small intestine is a potential origin of bleeding in patients with unexplained gastrointestinal tract hemorrhage or iron-deficiency anemia. Most reports on the investigation of these patients describe the use of upper tract enteroscopy. The diagnostic yield of combined upper and lower enteroscopy has not been widely assessed and remains to be clarified. The aim of this study was to assess the benefit of lower gastrointestinal tract enteroscopy in occult digestiv...

  14. Use of technetium-labeled autologous red blood cells in detection of gastrointestinal bleeding

    Twenty patients with occult gastrointestinal bleeding underwent diagnostic evaluation with autologous TcRBC imaging, which identified a locus of bleeding in 19. Bleeding was demonstrated in the esophagogastroduodenal area in four patients, the cecum in four patients, the ascending colon or hepatic flexure in nine patients and the descending colon in two patients. In the six patients who underwent surgical intervention, the source of bleeding had been correctly located by imaging. The advantages of imaging over those of conventional arteriography included its minimally invasive nature and its ability to detect areas of intermittent minimal bleeding for a period of 30 hours. The major disadvantages of the technique were that localization of the site of bleeding was not as precise as that obtained with arteriography, imaging could not be used as a treatment modality and the nature of the lesion could not be defined. However, we believe that, as an adjunct to conventional angiography and other techniques, autologous TcRBC imaging will improve the localization of obscure foci of gastrointestinal bleeding. Studies are underway to determine the proper place of TcRBC imaging in the gastroenterologic armamentarium. Its noninvasive nature and sensitivity to intermittent hemorrhage suggest that it may become the initial investigative modality of choice in many instances

  15. Evaluation of patients with upper gastrointestinal bleeding in chronic renal failure

    Mehmet Sinan Dal

    2011-06-01

    Full Text Available Incidence of gastrointestinal complications especially gastric bleeding increased in patients with chronic renal failure (CRF. The aim of this study was to comparatively investigate upper gastrointestinal bleeding (UGB in patients with non-hemodialysis CRF and the patients without CRF.Materials and Methods: Seventy-six patients (55 men and 21 women with and without CRF and UGB was included. The first group who had CRF consisted of 23 patients and the control group 53. All patients were evaluated in the view point of age, gender, smoking status, other illnesses, medicine usage, laboratory parameters, endoscopic evidence and endoscopic intervention (scleroteraphy.Results: Calcium levels of patients with a history of previous UGB was significantly lower compared with those bleeding for the first time (p<0.05. The mean parathormon level was higher in patients with CRF (171.24 ± 141.96 pg/ml (p<0.05. Serum albumin level was negatively correlated with urea and creatinine (p<0.001, and positively correlated with hemoglobin and hematocrit levels (p=0.003 and p=0.005. The patients undergoing sclerotherapy more frequently needed transfusions (p<0.05. The hospitalization time found to be shortening with increasing hemoglobin, hematocrit, calcium and albumin levels; and lengthens with increased urea and creatinine.Conclusion: The history of previous gastrointestinal bleeding and detection of pathological findings in endoscopy were more frequent in patients with CRF. Gastrointestinal bleeding risk did not reduce using by gastric protection against acetylsalicylic acid and other non-steroidal antiinflammatory drugs. Also, low albumin levels and secondary hiperparathyroidism in these patients may be risky for gastrointestinal bleeding. J Clin Exp Invest 2011;2(2:207-13

  16. Predictors of In-hospital Mortality Among Patients Presenting with Variceal Gastrointestinal Bleeding

    Amith S Kumar

    2015-01-01

    Full Text Available Background/Aim: The recent years have witnessed an increase in number of people harboring chronic liver diseases. Gastroesophageal variceal bleeding occurs in 30% of patients with cirrhosis, and accounts for 80%-90% of bleeding episodes. We aimed to assess the in-hospital mortality rate among subjects presenting with variceal gastrointestinal bleeding and (2 to investigate the predictors of mortality rate among subjects presenting with variceal gastrointestinal bleeding. Patients and Methods: This retrospective study was conducted from treatment records of 317 subjects who presented with variceal upper gastrointestinal bleeding to Government Medical College, Patiala, between June 1, 2010, and May 30, 2014. The data thus obtained was compiled using a preset proforma, and the details analyzed using SPSSv20. Results: Cirrhosis accounted for 308 (97.16% subjects with bleeding varices, with extrahepatic portal vein obstruction 9 (2.84% completing the tally. Sixty-three (19.87% subjects succumbed to death during hospital stay. Linear logistic regression revealed independent predictors for in-hospital mortality, including higher age (P = 0.000, Child-Pugh Class (P = 0.002, altered sensorium (P = 0.037, rebleeding within 24 h of admission (P = 0.000, low hemoglobin level (P = 0.023, and serum bilirubin (P = 0.002. Conclusion: Higher age, low hemoglobin, higher Child-Pugh Class, rebleeding within 24 h of admission, higher serum bilirubin, and lower systolic blood pressure are the independent predictors of in-hospital mortality among subjects presenting with variceal gastrointestinal bleeding.

  17. CT enteroclysis in the diagnosis of obscure gastrointestinal bleeding: initial results

    Jain, T.P. [Department ofRadiodiagnosis, All India Institute of Medical Sciences, New Delhi (India); Gulati, M.S. [Department of Imaging, Queen Elizabeth Hospital NHS Trust, London (United Kingdom); Makharia, G.K. [Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi (India)]. E-mail: govindmakharia@aiims.ac.in; Bandhu, S. [Department ofRadiodiagnosis, All India Institute of Medical Sciences, New Delhi (India); Garg, P.K. [Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi (India)

    2007-07-15

    Aim: To evaluate the usefulness of computed tomography (CT) enteroclysis in patients with obscure gastrointestinal (GI) bleeding. Materials and methods: In a prospective study, CT enteroclysis was performed in 21 patients (median age 50 years; range 13-71 years) with obscure GI bleeding in which the source of the bleeding could not be detected despite the patient having undergone both upper GI endoscopic and colonoscopic examinations. The entire abdomen and pelvis was examined in the arterial and venous phases using multisection CT after distending the small intestine with 2 l of 0.5% methylcellulose as a neutral enteral contrast medium and the administration of 150 ml intravenous contrast medium. Results: Adequate distension of the small intestine was achieved in 20 of the 21 (95.2%) patients. Potential causes of GI bleeding were identified in 10 of the 21 (47.6%) patients using CT enteroclysis. The cause of the bleeding could be detected nine of 14 (64.3%) patients with overt, obscure GI bleeding. However, for patients with occult, obscure GI bleeding, the cause of the bleeding was identified in only one of the seven (14.3%) patients. The lesions identified by CT enteroclysis included small bowel tumours (n = 2), small bowel intussusceptions (n = 2), intestinal tuberculosis (n = 2), and vascular lesions (n = 3). All vascular lesions were seen equally well in both the arterial and venous phases. Conclusions: The success rate in detection of the cause of bleeding using CT enteroclysis was 47.6% in patients with obscure GI bleeding. The diagnostic yield was higher in patients with overt, obscure GI bleeding than in those with occult obscure GI bleeding.

  18. Multidetector computed tomography mesentericography for the diagnosis of obscure gastrointestinal bleeding

    Heiss, P.; Hamer, O.W.; Mueller-Wille, R.; Rennert, J.; Feuerbach, S.; Zorger, N. [Regensburg Univ. (Germany). Inst. fuer Roentgendiagnostik; Wrede, C.E. [Helios-Klinikum Berlin-Buch (Germany). Interdisziplinaeres Notfallzentrum mit Rettungsstelle; Siebig, S.; Schoelmerich, J. [Regensburg Univ. (Germany). Medizinische Klinik und Poliklinik I

    2011-01-15

    Purpose: To evaluate the diagnostic yield of 16-row multidetector computed tomography (CT) mesentericography in patients with obscure gastrointestinal bleeding. Materials and Methods: The radiological information system database was used to retrospectively identify all patients in whom CT mesentericography (CTM) was performed for the diagnosis of obscure gastrointestinal bleeding between July 2002 and September 2006. A subsequent prospective study was conducted between October 2006 and September 2009 to evaluate CTM in patients with major obscure gastrointestinal bleeding. The retrospectively identified patients (six patients) as well as the prospectively evaluated patients (seven patients) constitute the study population. Following mesenteric DSA the catheter was left in the superior mesenteric artery, the patient was transferred to the CT suite and CTM was carried out by scanning the abdomen after contrast material injection via the catheter. Active bleeding was suspected if a focal area of high attenuation consistent with contrast material extravasation was found within the bowel lumen. Results: CTM detected the site of active bleeding in three of 13 patients (23 %). In the subpopulation of patients who were prospectively evaluated, CT mesentericography identified the site of active bleeding in one of seven patients (14 %). Depiction of active bleeding by CTM prompted surgical intervention in each case and surgery confirmed the findings of CT mesentericography. Conclusion: Due to the relatively low rate of positive findings and inherent drawbacks, we feel that CTM cannot be recommended in general. However, in selected patients who are continuously bleeding at a low rate and in whom iv-CT was negative, CT mesentericography might be helpful. (orig.)

  19. Multidetector computed tomography mesentericography for the diagnosis of obscure gastrointestinal bleeding

    Purpose: To evaluate the diagnostic yield of 16-row multidetector computed tomography (CT) mesentericography in patients with obscure gastrointestinal bleeding. Materials and Methods: The radiological information system database was used to retrospectively identify all patients in whom CT mesentericography (CTM) was performed for the diagnosis of obscure gastrointestinal bleeding between July 2002 and September 2006. A subsequent prospective study was conducted between October 2006 and September 2009 to evaluate CTM in patients with major obscure gastrointestinal bleeding. The retrospectively identified patients (six patients) as well as the prospectively evaluated patients (seven patients) constitute the study population. Following mesenteric DSA the catheter was left in the superior mesenteric artery, the patient was transferred to the CT suite and CTM was carried out by scanning the abdomen after contrast material injection via the catheter. Active bleeding was suspected if a focal area of high attenuation consistent with contrast material extravasation was found within the bowel lumen. Results: CTM detected the site of active bleeding in three of 13 patients (23 %). In the subpopulation of patients who were prospectively evaluated, CT mesentericography identified the site of active bleeding in one of seven patients (14 %). Depiction of active bleeding by CTM prompted surgical intervention in each case and surgery confirmed the findings of CT mesentericography. Conclusion: Due to the relatively low rate of positive findings and inherent drawbacks, we feel that CTM cannot be recommended in general. However, in selected patients who are continuously bleeding at a low rate and in whom iv-CT was negative, CT mesentericography might be helpful. (orig.)

  20. Lower gastrointestinal bleeding secondary to a rectal leiomyoma

    Giovanni D De Palma; Maria Rega; Stefania Masone; Saverio Siciliano; Marcello Persico; Francesca Salvatori; Francesco Maione; Dario Esposito; Antonio Bellino; Giovanni Persico

    2009-01-01

    The occurrence of leiomyoma of the rectum is uncommon. Most of these lesions are clinically silent and are found incidentally during laparotomy or endoscopic procedures for unrelated conditions. Symptomatic leiomyomas of the rectum are encountered less frequently, with only sporadic reports in the literature. We describe a case of a leiomyoma of the rectum presenting as recurrent lower gastrointestinal hemorrhage and secondary anemia.

  1. Treatment of massive gastrointestinal bleeding occurred during autologous stem cell transplantation with recombinant activated factor VII and octreotide

    Erman Atas

    2015-01-01

    Full Text Available After hematopoietic stem cell transplantation (HSCT, patients may suffer from bleeding. One of the bleeding type is gastrointestinal (GI which has serious morbidity and mortality in children with limited treatment options. Herein, we presented a child with upper GI bleeding post autologous HSCT controlled successfully by using recombinant activated factor VII (rFVIIa and octreotide infusion.

  2. Interaction between Gemcitabine and Warfarin Causing Gastrointestinal Bleeding in a Patient with Pancreatic Cancer

    Saif, M. Wasif

    2005-01-01

    Gemcitabine (Gemzar) is the only chemotherapeutic agent approved by the U.S. Food and Drug Administration (FDA) for the treatment of advanced pancreatic cancer. Thromboembolism requiring anticoagulation is a common paraneoplastic complication in these patients. We report a case of patient with pancreatic cancer, complicated by gastrointestinal bleeding following therapy with concomitant gemcitabine-warfarin (Coumadin).

  3. Helicobacter pylori and risk of upper gastrointestinal bleeding among users of selective serotonin reuptake inhibitors

    Dall, Michael; Schaffalitzky de Muckadell, Ove B; Møller Hansen, Jane;

    2011-01-01

    A number of studies have reported a possible association between use of selective serotonin reuptake inhibitors (SSRIs) and serious upper gastrointestinal bleeding (UGB). We conducted this case-control study to assess if Helicobacter pylori (H. pylori) potentiates the risk of serious UGB in SSRI ...

  4. Recurrent lower gastrointestinal bleeding from idiopathic ileocolonic varices: a case report

    Krishna Ravula

    2010-08-01

    Full Text Available Abstract Introduction Varices of the colon are a rare cause of lower gastrointestinal bleeding, usually associated with portal hypertension due to liver cirrhosis or other causes of portal venous obstruction. Idiopathic colonic varices are extremely rare. Recognition of this condition is important as idiopathic colonic varices may be a cause of recurrent lower gastrointestinal bleeding. Case presentation We report the case of a 21-year-old Asian man from north India who presented with recurrent episodes of lower gastrointestinal bleeding. Colonoscopy revealed varices involving the terminal ileum and colon to the sigmoid. Thorough evaluation was undertaken to rule out any underlying portal hypertension. Our patient underwent subtotal colectomy including resection of involved terminal ileum and an ileorectal anastomosis. Conclusion Colonic varices are an uncommon cause of lower gastrointestinal bleeding. Idiopathic colonic varices are diagnosed after excluding underlying liver disease and portal hypertension. Recognition of this condition is important as prognosis is good in the absence of liver disease and is curable by resection of the involved bowel.

  5. An Association Between Selective Serotonin Reuptake Inhibitor Use and Serious Upper Gastrointestinal Bleeding

    Dall, Michael; Schaffalitzky de Muckadell, Ove B; Lassen, Annmarie Touborg;

    2009-01-01

    -based case-control study was conducted in the county of Funen, Denmark. The 3652 cases all had a first discharge diagnosis of serious upper gastrointestinal bleeding (UGB) from 1995 to 2006. All cases were manually validated. Controls (n = 36,502), matched for age and sex, were selected by risk-set sampling...

  6. Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding?

    Pedro Monsanto

    2012-04-01

    Full Text Available Background: in 21st century, endoscopic study of the small intestine has undergone a revolution with capsule endoscopy and balloon-assisted enteroscopy. The difficulties and morbidity associated with intraoperative enteroscopy, the gold-standard in the 20th century, made this technique to be relegated to a second level. Aims: evaluate the actual role and assess the diagnostic and therapeutic value of intraoperative enteroscopy in patients with obscure gastrointestinal bleeding. Patients and methods: we conducted a retrospective study of 19 patients (11 males; mean age: 66.5 ± 15.3 years submitted to 21 IOE procedures for obscure GI bleeding. Capsule endoscopy and double balloon enteroscopy had been performed in 10 and 5 patients, respectively. Results: with intraoperative enteroscopy a small bowel bleeding lesion was identified in 79% of patients and a gastrointestinal bleed-ing lesion in 94%. Small bowel findings included: angiodysplasia (n = 6, ulcers (n = 4, small bowel Dieulafoy's lesion (n = 2, bleed-ing from anastomotic vessels (n = 1, multiple cavernous hemangiomas (n = 1 and bleeding ectopic jejunal varices (n = 1. Agreement between capsule endoscopy and intraoperative enteroscopy was 70%. Endoscopic and/or surgical treatment was used in 77.8% of the patients with a positive finding on intraoperative enteroscopy, with a rebleeding rate of 21.4% in a mean 21-month follow-up period. Procedure-related mortality and postoperative complications have been 5 and 21%, respectively. Conclusions: intraoperative enteroscopy remains a valuable tool in selected patients with obscure GI bleeding, achieving a high diagnostic yield and allowing an endoscopic and/or surgical treatment in most of them. However, as an invasive procedure with relevant mortality and morbidity, a precise indication for its use is indispensable.

  7. Gastrointestinal bleeding in a patient with a continuous-flow biventricular assist device

    Mirasol, Raymond V; Tholany, Jason J; Reddy, Hasini; Fyfe-Kirschner, Billie S; Cheng, Christina L; Moubarak, Issam F; Nosher, John L

    2016-01-01

    The association between continuous-flow left ventricular assist devices (CF-LVADs) and gastrointestinal (GI) bleeding from angiodysplasia is well recognized. However, the association between continuous-flow biventricular assist devices (CF-BIVADs) and bleeding angiodysplasia is less understood. We report a case of GI bleeding from a patient with a CF-BIVAD. The location of GI bleeding was identified by nuclear red blood cell bleeding scan. The vascular malformation leading to the bleed was identified and localized on angiography and then by pathology. The intensity of bleeding, reflected by number of units of packed red blood cells needed for normalization of hemoglobin, as well as the time to onset of bleeding after transplantation, are similar to that seen in the literature for CF-LVADs and pulsatile BIVADs. While angiography only detected a dilated late draining vein, pathology demonstrated the presence of both arterial and venous dilation in the submucosa, vascular abnormalities characteristic of a late arteriovenous malformation. PMID:27158430

  8. Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding

    Supot Pongprasobchai; Sireethorn Nimitvilai; Jaroon Chasawat; Sathaporn Manatsathit

    2009-01-01

    AIM: To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding (UGIB) Etiology Score for predicting the types of UGIB and validate the score.METHODS: Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected.Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defined from the receiver operating curve and prospectively validated in another set of patients with UGIB.RESULTS: Among 261 patients with UGIB, 47 (18%) had variceal and 214 (82%) had non-variceal bleeding.Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding;previous diagnosis of cirrhosis or signs of chronic liver disease (OR 22.4, 95% CI 8.3-60.4, P < 0.001), red vomitus (OR4.6, 95% CI 1.8-11.9, P = 0.02), and red nasogastric (NG) aspirate (OR 3.3, 95% CI 1.3-8.3, P = 0.011).The UGIB Etiology Score was calculated from (3.1 x previous diagnosis of cirrhosis or signs of chronic liver disease) + (1.5 × red vornitus) + (1.2 × red NG aspirate), when 1 and 0 are used for the presence and absence of each factor, respectively. Using a cutoff ≥ 3.1, the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) in predicting variceal bleeding were 85%, 81%,82%, 50%, and 96%, respectively. The score was prospectively validated in another set of 195 UGIB cases (46 variceal and 149 non-variceal bleeding). The PPV and NPV of a score ≥3.1 for variceal bleeding were 79% and 97%, respectively.CONCLUSION: The UGIB Etiology Score, composed of 3 parameters, using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.

  9. Iatrogenic Complications in Five Patients with Upper Gastrointestinal Bleeding due to Ambient Air: Case Series and Literature Review

    Christine N. Manser

    2012-04-01

    Full Text Available Despite the increasing use of carbon dioxide for endoscopies during the last years, ambient air is still used. The amount of air depends on several factors such as examination time, presumable diameter of the endoscope channel and of course active use of air by the operator. Although endoscopic complications due to ambient air in the gastrointestinal (GI tract are a rare observation and mostly described in the colon, we report five cases in the upper GI tract due to insufflating large amounts of air through the endoscopes. All 5 patients needed an emergency upper endoscopy for acute presumed upper GI bleeding. In two cases both esophageal variceal bleeding and ulcer bleeding were detected; the fifth case presented with a bleeding due to gastric cancer. Due to insufflation of inadequate amounts of air through the endoscope channel, all patients deteriorated in circulation and ventilation. Two rumenocenteses and consecutively three laparotomies had to be performed in three patients. In the other two, gastroscopies had to be stopped for an emergency computed tomography. All critical incidents were believed to be a consequence of a long-lasting examination with use of too much air. Therefore in emergency situations, endoscopies should be performed with either submersion, low air flow pumps or even better by the use of carbon dioxide.

  10. Esophageal Involvement of Pemphigus Vulgaris Associated with Upper Gastrointestinal Bleeding

    Chang, Sooyun; Park, Soo Jung; Kim, Sun Wook; Jin, Moo-Nyun; Lee, Jung-Hee; Kim, Hyun Ju; Hong, Sung Pil; Kim, Tae Il

    2014-01-01

    Esophageal involvement of pemphigus vulgaris is rare, and when present, the most common presenting symptoms reported in the medical literature are odynophagia and dysphagia. Here, we present two cases of pemphigus vulgaris presenting with upper gastrointestinal hemorrhage because of esophageal involvement of the disease. In case 1, a 41-year-old female patient with a prior diagnosis of pemphigus vulgaris presented with hematemesis. Esophagogastroduodenoscopy showed diffuse mucosal exfoliation...

  11. Superselective arterial embolisation with a liquid polyvinyl alcohol copolymer in patients with acute gastrointestinal haemorrhage

    Lenhart, Markus; Schneider, Hans [Sozialstiftung Bamberg, Department of Diagnostic and Interventional Radiology, Bamberg (Germany); Paetzel, Christian [Klinikum Weiden, Department of Radiology, Weiden (Germany); Sackmann, Michael [Sozialstiftung Bamberg, Department of Gastroenterology, Bamberg (Germany); Jung, Ernst Michael; Schreyer, Andreas G.; Feuerbach, Stefan; Zorger, Niels [University of Regensburg, Department of Radiology, Regensburg (Germany)

    2010-08-15

    To evaluate the results of emergency embolisation in acute arterial bleeding of the gastrointestinal tract with a liquid polyvinyl alcohol copolymer from two centres. We retrospectively analysed 16 cases (15 patients) of acute arterial bleeding of the gastrointestinal tract where emergency embolotherapy was performed by using the copolymer when acute haemorrhage was not treatable with endoscopic techniques alone. Cause of haemorrhage and technical and clinical success were documented. Arterial embolotherapy was successful in all 16 cases. The technical success rate was 100%. The cause of bleeding was pancreatitis in four, graft-versus-host disease (GVHD) of the colon in three, malignancy in three, angiodysplasia in two, ulcer in two and panarteritis no dosa and trauma in one each. There were no procedure-related complications. No bowel necrosis occurred because of embolisation. In 13 cases, the patients were discharged in good condition (81%); the three patients with GVHD died because of the underlying disease. The copolymer seems to have great potential in embolotherapy of acute arterial gastrointestinal bleeding. In our series none of the patients had rebleeding at the site of embolisation and no clinically obvious bowel necrosis occurred. (orig.)

  12. The role of capsule endoscopy after negative CT enterography in patients with obscure gastrointestinal bleeding

    Heo, Hyun Mi; Park, Chan Hyuk; Lee, Jin Ha; Kim, Bo Kyung; Cheon, Jae Hee; Kim, Tae Il; Kim, Won Ho; Hong, Sung Pil [Yonsei University College of Medicine, Department of Internal Medicine and Institute of Gastroenterology, Seoul (Korea, Republic of); Lim, Joon Seok [Yonsei University College of Medicine, Department of Diagnostic Radiology, Seoul (Korea, Republic of)

    2012-06-15

    The aim of the present study was to evaluate the role of capsule endoscopy in patients with obscure gastrointestinal bleeding (OGIB) after negative computed tomographic (CT) enterography. We retrospectively included 30 patients with OGIB who received capsule endoscopy after negative CT enterography. The median age of the patients was 60 years, and 60% of patients were male. The median follow-up duration was 8 months. Overt bleeding was 60%, and occult bleeding was 40%. Based on capsule endoscopy results, a definitive diagnosis was made for 17 patients (57%): ulcer in nine patients (30%), active bleeding with no identifiable cause in five (17%), angiodysplasia in two (7%) and Dieulafoy's lesion in one (3%). Two patients with jejunal ulcers were diagnosed with Crohn's disease. Seven patients (41%) with positive capsule endoscopy received double balloon enteroscopy and two patients (12%) received steroid treatment for Crohn's disease. Patients with overt bleeding, a previous history of bleeding, or who received large amounts of blood transfusions were more likely to show positive capsule endoscopy. Capsule endoscopy showed high diagnostic yields in patients with OGIB after negative CT enterography and may help to provide further therapeutic plans for patients with OGIB and negative CT enterography. circle CT enterography has been widely used in evaluating obscure gastrointestinal bleeding (OGIB). circle Capsule endoscopy showed high diagnostic yield for OGIB after negative CT enterography. circle Negative CT enterography does not exclude important causes of small bowel bleeding. circle Most lesions missed at CT-enterography are flat and can be detected by capsule endoscopy. (orig.)

  13. Severe Gastrointestinal Bleeding in a Patient With Subvalvular Aortic Stenosis Treated With Thalidomide and Octreotide: Bridging to Transcoronary Ablation of Septal Hypertrophy

    Hvid-Jensen, Helene S.; Poulsen, Steen H.; Agnholt, Jorgen S.

    2015-01-01

    Gastrointestinal bleeding (GB) due to angiodysplasias can cause severe, recurrent bleeding, especially in elderly patients. Angiodysplastic bleedings in the gastrointestinal tract have been associated with aortic stenosis and, more recently, hypertrophic obstructive cardiomyopathy, caused by an acquired coagulopathy known as Heyde’s syndrome. Multiple factors are involved in the pathogenesis of angiodysplastic bleeding including genetic factors and increased levels of vascular intestinal grow...

  14. Diagnostic performance of CT angiography in patients visiting emergency department with overt gastrointestinal bleeding

    Kim, Ji Hang; Kim, Young Hoon; Lee, Kyoung Ho; Lee, Yoon Jin; Park, Ji Hoon [Dept. of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam (Korea, Republic of)

    2015-06-15

    To investigate the diagnostic performance of computed tomography angiography (CTA) in identifying the cause of bleeding and to determine the clinical features associated with a positive test result of CTA in patients visiting emergency department with overt gastrointestinal (GI) bleeding. We included 111 consecutive patients (61 men and 50 women; mean age: 63.4 years; range: 28-89 years) who visited emergency department with overt GI bleeding. They underwent CTA as a first-line diagnostic modality from July through December 2010. Two radiologists retrospectively reviewed the CTA images and determined the presence of any definite or potential bleeding focus by consensus. An independent assessor determined the cause of bleeding based on other diagnostic studies and/or clinical follow-up. The diagnostic performance of CTA and clinical characteristics associated with positive CTA results were analyzed. To identify a definite or potential bleeding focus, the diagnostic yield of CTA was 61.3% (68 of 111). The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value were 84.8% (67 of 79), 96.9% (31 of 32), 98.5% (67 of 68), and 72.1% (31 of 43), respectively. Positive CTA results were associated with the presence of massive bleeding (p = 0.001, odds ratio: 11.506). Computed tomography angiography as a first-line diagnostic modality in patients presenting with overt GI bleeding showed a fairly high accuracy. It could identify definite or potential bleeding focus with a moderate diagnostic yield and a high PPV. CTA is particularly useful in patients with massive bleeding.

  15. Diagnostic performance of CT angiography in patients visiting emergency department with overt gastrointestinal bleeding

    To investigate the diagnostic performance of computed tomography angiography (CTA) in identifying the cause of bleeding and to determine the clinical features associated with a positive test result of CTA in patients visiting emergency department with overt gastrointestinal (GI) bleeding. We included 111 consecutive patients (61 men and 50 women; mean age: 63.4 years; range: 28-89 years) who visited emergency department with overt GI bleeding. They underwent CTA as a first-line diagnostic modality from July through December 2010. Two radiologists retrospectively reviewed the CTA images and determined the presence of any definite or potential bleeding focus by consensus. An independent assessor determined the cause of bleeding based on other diagnostic studies and/or clinical follow-up. The diagnostic performance of CTA and clinical characteristics associated with positive CTA results were analyzed. To identify a definite or potential bleeding focus, the diagnostic yield of CTA was 61.3% (68 of 111). The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value were 84.8% (67 of 79), 96.9% (31 of 32), 98.5% (67 of 68), and 72.1% (31 of 43), respectively. Positive CTA results were associated with the presence of massive bleeding (p = 0.001, odds ratio: 11.506). Computed tomography angiography as a first-line diagnostic modality in patients presenting with overt GI bleeding showed a fairly high accuracy. It could identify definite or potential bleeding focus with a moderate diagnostic yield and a high PPV. CTA is particularly useful in patients with massive bleeding.

  16. Use of Provocative Angiography to Localize Site in Recurrent Gastrointestinal Bleeding

    Background. While the source of most cases of lower gastrointestinal bleeding may be diagnosed with modern radiological and endoscopic techniques, approximately 5% of patients remain who have negative endoscopic and radiological investigations.Clinical Problem. These patients require repeated hospital admissions and blood transfusions, and may proceed to exploratory laparotomy and intraoperative endoscopy. The personal and financial costs are significant. Method of Diagnosis and Decision Making. The technique of adding pharmacologic agents (anticoagulants, vasodilators, fibrinolytics) during standard angiographic protocols to induce a prohemorrhagic state is termed provocative angiography. It is best employed when significant bleeding would otherwise necessitate emergency surgery. Treatment. This practice frequently identifies a bleeding source (reported success rates range from 29 to 80%), which may then be treated at the same session. We report the case of a patient with chronic lower gastrointestinal hemorrhage with consistently negative endoscopic and radiological workup, who had an occult source of bleeding identified only after a provocative angiographic protocol was instituted, and who underwent succeeding therapeutic coil embolization of the bleeding vessel

  17. Outcome of patients who have undergone total enteroscopy for obscure gastrointestinal bleeding

    Takayoshi Shishido; Shiro Oka; Shinji Tanaka; Hiroki Imagawa; Yoshito Takemura; Shigeto Yoshida; Kazuaki Chayama

    2012-01-01

    AIM:To assess the diagnostic success and outcome among patients with obscure gastrointestinal bleeding who underwent total enteroscopy with double-balloon endoscopy.METHODS:Total enteroscopy was attempted in 156 patients between August 2003 and June 2008 at Hiroshima University Hospital and achieved in 75 (48.1%).It is assessed whether sources of bleeding were identified,treatment methods,complications,and 1-year outcomes (including re-bleeding) after treatment,and we compared re-bleeding rates among patients.RESULTS:The source of small bowel bleeding was identified in 36 (48.0%) of the 75 total enteroscopy patients; the source was outside the small bowel in 11 patients (14.7%) and not identified in 28 patients (37.3%).Sixty-one of the 75 patients were followed up for more than 1 year (27.2 ± 13.3 mo).Four (6.6%)of these patients showed signs of re-bleeding during the first year,but bleeding did not recur after treatment.Although statistical significance was not reached,a marked difference was found in the re-bleeding rate between patients in whom total enteroscopy findings were positive (8.6%,3/35) and negative (3.8%,1/26)(3/35 vs 1/26,P =0.63).CONCLUSION:A good outcome can be expected for patients who undergo total enteroscopy and receive proper treatment for the source of bleeding in the small bowel.

  18. Angiodysplasia in gaint diverticulum of transverse duodenum causing massive gastrointestinal bleeding: a case report

    Choi, Pil Yeob; Lee, Sang Wook; Kwon, Jae Soo; Sung, Young Soon; Rho, Myoung Ho; Hwon, Oh Joon [Sungkyunkwan Univ. College of Medicine, Seoul (Korea, Republic of)

    1998-12-01

    The incidence of duodenal diverticulum found incidentally during upper gastrointestinal roentgenographic examination varies between 2% and 5%. The majority of cases occur along the medial aspect of the second portion of the duodenum, within 2.5 cm of the ampulla of Vater. The majority of duodenal diverticual are asymptomatic, but in some cases, complications such as diverticulitis, hemorrhage, perforation, and fistula formation occur in the third and fourth portions of the duodenum. We describe a case of giant diverticulum of the transverse duodenum, revealed by UGI and angiography, massive gastrointestinal bleeding in a 80-year-old patient.=20.

  19. RECOMMENDATION FOR MANAGING PATIENTS WITH NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING

    G. Dimofte

    2006-01-01

    Full Text Available Upper gastrointestinal bleeding remains an important problem for all emergency hospitals. Any attempt to standardise the care for these patients is dependent on the expertise of the medical and surgical team but also on the availability of emergency endoscopy and the quality of endoscopic haemostatic therapy. The present paper does not intended to present a state of the art in the matter of upper gastrointestinal haemorrhage, but to offer a working protocol that can be implemented in an emergency hospital, as long as on call emergency diagnostic endoscopy is available. Decision making is based on accurate evaluation of the bleeding lesion and its risk of rebleeding. The protocol designates responsabilities for each department and establishes criteria for ICU admission and protocols for intensive monitorisation of patients on surgical wards. Far from being definitive we consider this paper a draft open for discussions and for further improvement.

  20. Haemosuccus pancreaticus due to true splenic artery aneurysm: a rare cause of massive upper gastrointestinal bleeding

    MK Roy

    2010-07-01

    Full Text Available “Haemosuccus pancreaticus” is an unusual cause of severe upper gastrointestinal bleeding and results from rupture of splenic artery aneurysm into the pancreatic duct. More commonly, it is a pseudoaneurysm of the splenic artery which develops as sequelae of pancreatitis. However, true aneurysm of the splenic artery without pancreatitis has rarely been incriminated as the etiologic factor of this condition. Owing to the paucity of cases and limited knowledge about the disease, diagnosis as well as treatment become challenging. Here we describe a 60-year-old male presenting with severe recurrent upper gastrointestinal bleeding and abdominal pain, which, after considerable delay, was diagnosed to be due to splenic artery aneurysm. Following an unsuccessful endovascular embolisation, the patient was cured by distal pancreatectomy and ligation of aneurysm.

  1. A rare cause of anemia due to upper gastrointestinal bleeding: Cameron lesion

    Ismet Özaydın; Sami Doğan; Arif Aslaner; Mehmet Yaşar; Metin Aydın

    2014-01-01

    Asymptomatic large hiatal hernias may lead to iron deficiency anemia due to occult and massive bleeding from linear gastric erosions or ulcers on the mucosal folds at the level of the diaphragm called the Cameron lesions. The diagnosis is usually made during upper gastrointestinal system endoscopies. Current therapy includes the medication with proton pump inhibitors in combination with oral iron supplements and in some cases surgical reconstruction of hiatal hernia with fundoplication. We pr...

  2. Epidemiology and Endoscopic Findings of the Patients Suffering from Upper Gastrointestinal System Bleeding

    Mehmet Suat Yalçın; Banu Kara; Nevin A Öztürk; Şehmus Ölmez; Burçak E. Taşdoğan; Adnan Taş

    2016-01-01

    Objective: In the present study, we aim to investigate general and endoscopic findings of the patients who were hospitalized in our clinic because of upper gastrointestinal system bleeding (UGSB). Methods: The files of 403 patients who applied to our clinic between January 2014 and December 2014 with UGSB diagnosis were scanned retrospectively. The de­mographic, laboratorial and endoscopic findings of the patients were examined. Results: The average age of 403 patients were 61.12±17.1 (...

  3. Selection of variables using 'independence Bayes' in computer-aided diagnosis of upper gastrointestinal bleeding

    Ohmann, C; Künneke, M.; Zaczyk, R.; Thon, K.; Lorenz, Wilfried

    1986-01-01

    In this paper two problems of computer-aided diagnosis with 'independence Bayes' were investigated: selection of variables and monotonicity in performance as the number of measurements is increased. Using prospective data from patients with upper gastrointestinal bleeding, the stepwise forward selection approach maximizing the apparent diagnostic accuracy was analysed with respect to different kinds of bias in estimation of the true diagnostic accuracy and to the stability of the number and t...

  4. Continuing challenges in the diagnosis and management of obscure gastrointestinal bleeding

    Veronica; Baptista; Neil; Marya; Anupam; Singh; Abbas; Rupawala; Bilal; Gondal; David; Cave

    2014-01-01

    The diagnosis and management of obscure gastrointestinal bleeding(OGIB) have changed dramatically since the introduction of video capsule endoscopy(VCE) followed by deep enteroscopy and other imaging technologies in the last decade. Significant advances have been made, yet there remains room for improvement in our diagnostic yield and treatment capabilities for recurrent OGIB. In this review, we will summarize the latest technologies for the diagnosis of OGIB, limitations of VCE, technological enhancement in VCE, and different management options for OGIB.

  5. Continuing challenges in the diagnosis and management of obscure gastrointestinal bleeding.

    Baptista, Veronica; Marya, Neil; Singh, Anupam; Rupawala, Abbas; Gondal, Bilal; Cave, David

    2014-11-15

    The diagnosis and management of obscure gastrointestinal bleeding (OGIB) have changed dramatically since the introduction of video capsule endoscopy (VCE) followed by deep enteroscopy and other imaging technologies in the last decade. Significant advances have been made, yet there remains room for improvement in our diagnostic yield and treatment capabilities for recurrent OGIB. In this review, we will summarize the latest technologies for the diagnosis of OGIB, limitations of VCE, technological enhancement in VCE, and different management options for OGIB. PMID:25400996

  6. A case of massive lower gastrointestinal bleeding from a rectal Dieulafoy lesion

    Yuan-Kai Lee

    2015-09-01

    Full Text Available A Dieulafoy lesion is an uncommon and sometimes life-threatening cause of gastrointestinal hemorrhage. Typically, it presents as a tiny mucosal defect with an exposed protruding artery with normal surrounding mucosa. An 84-year-old woman developed sudden massive hematochezia and had an unstable hemodynamic status. The source of bleeding was found to be an exposed vessel in the rectum without surrounding ulceration. The patient was treated successfully with an epinephrine injection given endoscopically, followed by hemostatic clipping.

  7. Transfusion treatment impact in the improvement of haematological parameters in patients with gastrointestinal bleeding

    Iliriane Bunjaku; Mimoza Zhubi; Bukurije Zhubi; Emrush Kryeziu; Sadik Zeka

    2012-01-01

    Introduction: Transfusion treatment (TT) is necessary in patients with gastrointestinal bleeding (GIB) for lost blood substitution. This study was aimed at assessing the changes in haematological parameters  (hemoglobin, hematocrit, red blood cell count, white cell count, platelet count and prothrombin time) before and after TT in anaemic patients with GIB in order to analyse the effect of this treatment.Methods: There have been included 293 patients with GIB (the average age was 57.3, ranged...

  8. Jejunal angiodysplasia causing recurrent gastrointestinal bleeding presenting as severe anaemia and melena.

    Tiwary, Satyendra K; Hakim, Md Zeeshan; Kumar, Puneet; Khanna, Ajay Kumar

    2015-01-01

    Angiodysplasia of the gastrointestinal (GI) tract consists of ectasia of the submucosal vessels of the bowel. The evaluation of such patients needs proctoscopy, colonoscopy, small bowel enema, enteroscopy, capsule enteroscopy and angiography. Capsule enteroscopy has come up as an alternative to GI enteroscopy and colonoscopy in patients with occult GI bleeding; up to 52% cases of small bowel angiodysplasia in patients with occult GI bleed with negative upper GI and colonoscopy have been reported. The use of capsule enteroscopy potentially limits the hazard of radiation exposure from angiography and is less invasive than double balloon endoscopy. The treatment options for angiodysplasias include intra-arterial vasopressin injection, selective gel foam embolisation, endoscopic electrocoagulation and injection of sclerosants, with each of these being technically demanding, and requiring centres with good access to enteroscopy technology and trained gastroenterologists. Operative intervention has been indicated for refractory bleeding or lesions in sites not accessible to endoscopic interventions. PMID:26567241

  9. Obscure gastrointestinal bleeding: difficulties in comparing CT enterography and video capsule endoscopy

    A paper reports the results of a retrospective study that was designed to evaluate the potential role of video capsule endoscopy (VCE) in elucidating the cause of bleeding in patients with obscure gastrointestinal bleeding (OGIB) for whom CT enterography was negative. The authors highlight the limitations of dual-phase CT enterography for the detection of flat lesions of the small bowel such as ulcers, angiodysplasias or arteriovenous malformations, and confirm the superiority of VCE for the detection of this category of lesions. This commentary discusses some of the issues raised. Key Points circle Video capsule endoscopy surpasses CT enterography in detecting flat small bowel lesions. circle Retrospective VCE and CT enterography findings in obscure bleeding need further evaluation. circle A fair and unbiased comparison of the two investigations is still needed. (orig.)

  10. Obscure gastrointestinal bleeding: difficulties in comparing CT enterography and video capsule endoscopy

    Soyer, Philippe [Hopital Lariboisiere-APHP 2, Department of Imaging and Nuclear Medicine, Paris (France); UMR INSERM 965-Paris 7 ' ' Angiogenese et recherche translationnelle' ' , Paris (France); Universite Diderot-Paris 7, Paris (France)

    2012-06-15

    A paper reports the results of a retrospective study that was designed to evaluate the potential role of video capsule endoscopy (VCE) in elucidating the cause of bleeding in patients with obscure gastrointestinal bleeding (OGIB) for whom CT enterography was negative. The authors highlight the limitations of dual-phase CT enterography for the detection of flat lesions of the small bowel such as ulcers, angiodysplasias or arteriovenous malformations, and confirm the superiority of VCE for the detection of this category of lesions. This commentary discusses some of the issues raised. Key Points circle Video capsule endoscopy surpasses CT enterography in detecting flat small bowel lesions. circle Retrospective VCE and CT enterography findings in obscure bleeding need further evaluation. circle A fair and unbiased comparison of the two investigations is still needed. (orig.)

  11. Lower gastrointestinal bleeding due to hepatic artery pseudoaneurysm following laparoscopic cholecystectomy

    Ajay D Mate

    2013-01-01

    Full Text Available Pseudoaneurysm of hepatic artery is a rare but known complication of laparoscopic cholecystectomy (LC. Such pseudoaneurysms may bleed in biliary tree, upper gastrointestinal (GI tract or peritoneal cavity leading to life-threatening internal haemorrhage. It is very rare for them to present as lower GI bleeding. We report an unusual case of Right hepatic artery pseudoaneurysm developed following LC, which ruptured into hepatic flexure of colon resulting in catastrophic lower GI bleeding. This was associated with partial celiac artery occlusion due to thrombosis. Due to failure of therapeutic embolisation, the patient was subjected to exploratory laparotomy to control haemorrhage. Postoperatively, patient recovered well and was discharged on postoperative day 10. A strong index of suspicion is necessary for early diagnosis of such condition and to limit resultant morbidity. Angioembolisation is the first-line treatment and surgery is indicated in selected cases.

  12. Acute gingival bleeding as a complication of dengue hemorrhagic fever

    Saif Khan; Gupta, N. D.; Sandhya Maheshwari

    2013-01-01

    Dengue fever is mosquito borne disease caused by dengue virus (DENV) of Flaviviridae family. The clinical manifestations range from fever to severe hemorrhage, shock and death. Here, we report a case of 20-year-old male patient undergoing orthodontic treatment presenting with acute gingival bleeding with a history of fever, weakness, backache, retro orbital pain and ecchymosis over his right arm. The hematological investigations revealed anemia, thrombocytopenia and positive dengue non-struct...

  13. Gastrointestinal Bleeding and Diffuse Skin Thickening as Kaposi Sarcoma Clinical Presentation

    Sara Querido

    2015-01-01

    Full Text Available A 56-year-old African patient received a kidney from a deceased donor with 4 HLA mismatches in April 2013. He received immunosuppression with basiliximab, tacrolimus, mycophenolate mofetil, and prednisone. Immediate diuresis and a good allograft function were soon observed. Six months later, the serum creatinine level increased to 2.6 mg/dL. A renal allograft biopsy revealed interstitial fibrosis and tubular atrophy grade II. Toxicity of calcineurin inhibitor was assumed and, after a switch for everolimus, renal function improved. However, since March 2014, renal function progressively deteriorated. A second allograft biopsy showed no new lesions. Two months later, the patient was admitted due to anuria, haematochezia with anaemia, requiring 5 units of packed red blood cells, and diffuse skin thickening. Colonoscopy showed haemorrhagic patches in the colon and the rectum; histology diagnosis was Kaposi sarcoma (KS. A skin biopsy revealed cutaneous involvement of KS. Rapid clinical deterioration culminated in death in June 2014. This case is unusual as less than 20 cases of KS with gross gastrointestinal bleeding have been reported and only 6 cases had the referred bleeding originating in the lower gastrointestinal tract. So, KS should be considered in differential diagnosis of gastrointestinal bleeding in some kidney transplant patients.

  14. Video capsule endoscopy in left ventricular assist device recipients with obscure gastrointestinal bleeding

    Amornsawadwattana, Surachai; Nassif, Michael; Raymer, David; LaRue, Shane; Chen, Chien-Huan

    2016-01-01

    AIM: To assess whether video capsule endoscopy (VCE) affects the outcomes of left ventricular assist devices (LVADs) recipients with gastrointestinal bleeding. METHODS: This is a retrospective study of LVAD recipients with obscure gastrointestinal bleeding (OGIB) who underwent VCE at a tertiary medical center between 2005 and 2013. All patients were admitted and monitored with telemetry and all VCE and subsequent endoscopic procedures were performed as inpatients. A VCE study was considered positive only when P2 lesions were found and was regarded as negative if P1 or P0 were identified. All patients were followed until heart transplant, death, or the end of the study. RESULTS: Between 2005 and 2013, 30 patients with LVAD underwent VCE. Completion rate of VCE was 93.3% and there was no capsule retention. No interference of VCE recording or the function of LVAD was found. VCE was positive in 40% of patients (n = 12). The most common finding was active small intestinal bleeding (50%) and small intestinal angiodysplasia (33.3%). There was no difference in the rate of recurrent bleeding between patients with positive and negative VCE study (50.0% vs 55.6%, P = 1.00) during an average of 11.6 ± 9.6 mo follow up. Among patients with positive VCE, the recurrent bleeding rate did not differ whether subsequent endoscopy was performed (50% vs 50%, P = 1.00). CONCLUSION: VCE can be safely performed in LVAD recipients with a diagnostic yield of 40%. VCE does not affect recurrent bleeding in LVAD patients regardless of findings.

  15. Incidence of Serious Upper Gastrointestinal Bleeding in Patients Taking Non-steroidal Anti-infl ammatory Drugs in Japan

    Fukuda,Yasuyo; Yokota,Hitomi; Kuzume,Toshiaki; Kuwaki, Kenji; Okada,Hiroyuki; Mizuno,Motowo; Inaba, Tomoki; ISHIKAWA, SHIGENAO; Takeda,Kou; Nagano, Hiroshi; Wato,Masaki; Kawai,Kozo

    2008-01-01

    Upper gastrointestinal bleeding is a major adverse event of non-steroidal anti-inflammatory drugs (NSAIDs), and co-administration of proton pump inhibitors and H2 receptor antagonists has been established as a means of preventing such an eff ect. However, the incidence of bleeding associated with NSAID-induced ulcers under conditions where such strong anti-acid agents are used for prevention has yet to be clarified. We aimed to determine the annual incidence of serious upper gastrointestinal ...

  16. Embolization of the Vasa Recta in Acute Lower Gastrointestinal Hemorrhage: A Report of Five Cases

    Purpose: To present our preliminary experience in embolization of the vasa recta in acute gastrointestinal hemorrhage. Methods: In four of five patients with acute gastrointestinal hemorrhage superselective embolization of the vasa recta was performed. In one patient in whom superselective catheterization of the bleeding vas rectum was technically impossible, the origin of this vessel was embolized at the level of the terminal arcade. The following embolization materials were used: microcoils and polyvinyl alcohol particles (355-500 μm), n= 2; microcoils only, n= 2; Gelfoam particles, n1. Results: Bleeding was found in two patients in the small bowel (jejunum and ileum) and in three patients in the colon. Immediate hemostasis was achieved in all patients. No signs of ischemia or infarction were observed after intervention. Conclusions: Superselective embolization of the vasa recta proved efficient and safe in our small patient group. Advantages of this technique are reduction of the embolized area to a minimum and direct control of hemostasis

  17. Re-prescribing of causative drugs in persons discharged after serious drug-induced upper gastrointestinal bleeding

    Dall, M; Christensen, René dePont; Schaffalitzky de Muckadell, O B;

    2012-01-01

    Several drug classes are known to be associated with serious upper gastrointestinal bleeding (UGIB), among others NSAID, low-dose acetylsalicylic acid (ASA), vitamin K antagonists (VKA), clopidogrel and selective serotonin reuptake inhibitors (SSRIs). There are few data on how and to what extent...... these drugs are reintroduced in patients who have been discharged after a bleeding episode related to any of them....

  18. Single center experience of capsule endoscopy in patients with obscure gastrointestinal bleeding

    Mahesh Kumar Goenka; Shounak Majumder; Sanjeev Kumar; Pradeepta Kumar Sethy; Usha Goenka

    2011-01-01

    AIM: To identify optimum timing to maximize diagnostic yield by capsule endoscopy (CE) in patients with obscure gastrointestinal bleeding (OGIB).METHODS: We identified patients who underwent CE at our institution from August 2003 to December 2009.Patient medical records were reviewed to determine type of OGIB (occult, overt), CE results and complications,and timing of CE with respect to onset of bleeding.RESULTS: Out of 385 patients investigated for OGIB,284 (74%) had some lesion detected by CE. In 222 patients (58%), definite lesions were detected that could unequivocally explain OGIB. Small bowel ulcer/erosions secondary to Crohn's disease, tuberculosis or non-steroidal anti-inflammatory agent use were the commonest lesions detected. Patients with overt GI bleeding for <48 h before CE had the highest diagnostic yield (87%).This was significantly greater (P < 0.05) compared to that in patients with overt bleeding prior to 48 h (68%),as well as those with occult OGIB (59%).CONCLUSION: We established the importance of early CE in management of OGIB. CE within 48 h of overt bleeding has the greatest potential for lesion detection.

  19. Gallbladder ulcer erosion into the cystic artery: a rare cause ofupper gastro-intestinal bleeding Case report

    Person Benjamin; Shmulevsky Pavel; Farraj Mouad; Ben-Ishay Offir; Kluger Yoram

    2010-01-01

    Abstract Intra luminal gallbladder bleeding is a rare cause of hemobilia that results in upper gastro-intestinal bleeding. In this case report we present a patient who presented with melena and eventually was diagnosed as bleeding from an ulcer in the gallbladder which was induced by gallstones and eroded into the cystic artery. Surgery revealed perforation of gallbladder which was the result of a pressure sore induced by a second gallstone.

  20. Octreotide for the Management of Gastrointestinal Bleeding in a Patient with a HeartWare Left Ventricular Assist Device

    Geetanjali Dang

    2014-01-01

    Full Text Available HeartWare is a third generation left ventricular assist device (LVAD, widely used for the management of advanced heart failure patients. These devices are frequently associated with a significant risk of gastrointestinal (GI bleeding. The data for the management of patients with LVAD presenting with GI bleeding is limited. We describe a 56-year-old lady, recipient of a HeartWare device, who experienced recurrent GI bleeding and was successfully managed with subcutaneous (SC formulations of octreotide.

  1. Thrombin in combination with intensive nursing in treating upper gastrointestinal bleeding in children.

    Yang, F; Xiang, M L; Liu, Y M

    2016-01-01

    Pediatric upper gastrointestinal bleeding, a commonly seen pediatric emergency, needs timely symptomatic treatment to avoid a worse outcome. To discuss the clinical effect of thrombin treatment in combination with intensive nursing on pediatric upper gastrointestinal bleeding, this study analyzed 128 children who were treated in the second ward of the Children’s Internal Medical Department in the First Affiliated Hospital of Zhengzhou University between February 2012 and December 2014. The patients were divided into two groups, an experimental group and a control group. Besides thrombin, the experimental group was given intensive nursing, consisting of regular nursing and targeted nursing, while the control group was given regular nursing only. Clinical indexes of the two groups, such as effective rate, nursing satisfaction and side effect rate, were compared. Relevant clinical indexes such as duration of hospital stay, time to stopping of bleeding and Self-Rating Anxiety Scale (SAS) score, as well as overall satisfaction level of the observation group were all better than those of the control group and differences between the two groups had statistical significance (P less than 0.05). Furthermore, difference of overall effective rate between the experimental group (90.63%) and the control group (68.75%) was significant. Difference of incidence of side effects between the two groups was statistically significant. Thus thrombin treatment in combination with intensive nursing proved to have a remarkable clinical effect and high safety level in treating pediatric upper gastrointestinal bleeding and, moreover, it shortens treatment time and enhances the patients’ quality of life. PMID:27358137

  2. The vital threat of an upper gastrointestinal bleeding: Risk factor analysis of 121 consecutive patients

    Peter Schemmer; Frank Decker; Genevieve Dei-Anane; Volkmar Henschel; Klaus Buhl; Christian Herfarth; Stefan Riedl

    2006-01-01

    AIM: To analyze the importance in predicting patients risk of mortality due to upper gastrointestinal (UGI)bleeding under today's therapeutic regimen.METHODS: From 1998 to 2001, 121 patients with the diagnosis of UGI bleeding were treated in our hospital.Based on the patients' data, a retrospective multivariate data analysis with initially more than 270 single factors was performed. Subsequently, the following potential risk factors underwent a logistic regression analysis:age, gender, initial hemoglobin, coumarines, liver cirrhosis, prothrombin time (PT), gastric ulcer (small curvature), duodenal ulcer (bulbus back wall), Forrest classification, vascular stump, variceal bleeding, MalloryWeiss syndrome, RBC substitution, recurrent bleeding,conservative and surgical therapy.RESULTS: Seventy male (58%) and 51 female (42%)patients with a median age of 70 (range: 21-96) years were treated. Their in-hospital mortality was 14%. While 12% (11/91) of the patients died after conservative therapy, 20% (6/30) died after undergoing surgical therapy. UGI bleeding occurred due to duodenal ulcer (n = 36; 30%), gastric ulcer (n = 35; 29%), esophageal varicosis (n = 12; 10%), Mallory-Weiss syndrome (n = 8; 7%), erosive lesions of the mucosa (n = 20;17%), cancer (n = 5; 4%), coagulopathy (n = 4; 3%),lymphoma (n = 2; 2%), benign tumor (n = 2; 2%)and unknown reason (n = 1; 1%). A logistic regression analysis of all aforementioned factors revealed that liver cirrhosis and duodenal ulcer (bulbus back wall)were associated risk factors for a fatal course after UGI bleeding. Prior to endoscopy, only liver cirrhosis was an assessable risk factor. Thereafter, liver cirrhosis,the location of a bleeding ulcer (bulbus back wall) and patients' gender (male) were of prognostic importance for the clinical outcome (mortality) of patients with a bleeding ulcer.CONCLUSION: Most prognostic parameters used in clinical routine today are not reliable enough in predicting a patient's vital threat posed by

  3. Gastric Ulcer - A Cause of Portal Cavernoma and Upper Gastrointestinal Bleeding: Case Report

    Laurențiu V Sima

    2014-10-01

    Full Text Available Gastric ulcers, with a long duration of the disease, can lead to an inflammatory process in the upper abdomen (supramesocolic floor, with repercussions on the surrounding structures. Such ulcers can penetrate the gastric wall, toward the pancreas and hepatic hilum, the inflammatory process can lead to splenic vein trombosis and teh appearance of a portal cavernoma. A complication of the portal cavernoma and the portal hypertension is the formation of esophageal varices. This paper reports the case of a 58 years old patient with multiple episodes of upper gastrointestinal bleeding, determined by both, esophageal varices and existing gastric ulcers. This patient was initially diagnosed with portal cavernoma and the esophageal varices were considered the cause of gastrointestinal bleeding. A spleno-renal shunt was proposed, but intraoperative it was found that this was not necessary because the portal vein was thrombosed and the bleeding was probably caused by the gastric lesions. We performed a distal spleno-pancreatectomy associated with a cuneiform resection of the gastric lession, as well as the resection of the hepatic tumor. The patient had a favorable postoperative outcome.

  4. Multi-detector CT angiography for lower gastrointestinal bleeding: can it select patients for endovascular intervention?

    Full text: This is a retrospective review of the results at our institution of using multi-detector CT angiography (CTA) to localise lower gastrointestinal (GI) bleeding. We hypothesised that in our patient population: (i) CTA was unlikely to demonstrate bleeding in patients who were haemodynamically stable; (ii) in haemodynamically unstable patients in whom CTA was undertaken, the results could be used to select patients who would benefit from catheter angiography; and (iii) in haemodynamically unstable patients in whom CTA was undertaken, a subgroup of patients could be identified who would benefit from primary surgical treatment, avoiding invasive angiography completely. A retrospective review was conducted of the clinical records of all patients undergoing CTA for lower GI haemorrhage at our institution between 1 January 2005 and 30 June 2007. Out of the 20 patients examined, 10 had positive CTAs demonstrating the bleeding site. Nine were haemodynamically unstable at the time of the study. Four patients with positive CT angiograms were able to be treated directly with surgery and avoided invasive angiography. Ten patients had negative CTAs. Four of these were haemodynamically unstable, six haemodynamically stable. Only one required intervention to secure haemostasis, the rest stopped spontaneously. No haemodynamically stable patient who had a negative CTA required intervention. CTA is a useful non-invasive technique for localising the site of lower GI bleeding. In our patient population, in the absence of haemodynamic instability, the diagnostic yield of CTA was low and bleeding was likely to stop spontaneously. In haemodynamically unstable patients, a positive CTA allowed patients to be triaged to surgery or angiography, whereas there was a strong association between a negative CTA and spontaneous cessation of bleeding.

  5. Dieulafoy's lesion-like bleeding: an underrecognized cause of upper gastrointestinal hemorrhage in patients with advanced liver disease.

    Akhras, Jamil; Patel, Pragnesh; Tobi, Martin

    2007-03-01

    Dieulafoy's lesion is a gastrointestinal submucosal artery that ruptures into the lumen causing massive hemorrhage. Until recently, failure to diagnose and treat patients endoscopically may have necessitated blind gastrectomy. Because arteriolar spider nevi abound in patients with liver disease and bleeding from such lesions has been described in the upper gastrointestinal tract, we reviewed our experience to determine whether a diagnosis of advanced liver disease could facilitate recognition and treatment of this type of arterial bleeding. Endoscopy records from 1991 to 1996 for all cases of upper gastrointestinal bleeding at our institution were reviewed. Dieulafoy's lesion-like bleeding was defined as arterial-type bleeding with no evidence of mucosal ulceration or erosions. Advanced liver disease was defined as signs of portal hypertension and/or cirrhosis or infiltrative liver disease. Dieulafoy's lesion-like bleeding was the cause in 6 of 4569 cases (0.13%). Five patients with Dieulafoy's lesion-like gastrointestinal hemorrhage had advanced liver disease compared with 954 of 4569 of all patients endoscoped for gastrointestinal hemorrhage for the period evaluated (OR = 19.04; 95% CI 2.1-900.8; p < 0.002 by Fisher's exact test). Dieulafoy's lesion-like bleeding was treated successfully with epinephrine injection and endoscopic cauterization in 5 of 6 patients with 1 patient requiring surgery. No other clinical associations were evident. Dieulafoy's lesion-like bleeding occurs more commonly in patients with advanced liver disease and should be included as a potential cause for bleeding in advanced liver disease and aggressively sought. PMID:17237996

  6. An obscure cause of gastrointestinal bleeding: Renal cell carcinoma metastasis to the small bowel

    Robyn L. Gorski

    2015-01-01

    Full Text Available Renal cell carcinoma metastasis to the small intestine is a rare condition. It usually results in gastrointestinal bleeding and it could happen many years after the diagnosis with renal cell cancer. Treatment includes surgery as well as targeted agents such as tyrosine kinases. We report here the case of an 82-year-old man with a past medical history of high-grade renal cell carcinoma and right nephrectomy 6 years earlier, who presented with recurrent episodes of syncope and black stools. He underwent esophagogastroduodenoscopy (EGD and colonoscopy without evident source of bleeding. Video capsule endoscopy (VCE showed three bleeding lesions in the jejunum and ileum. Push enteroscopy revealed a proximal jejunum bleeding mass that was suspicious for malignancy. Histopathology demonstrated poorly differentiated carcinoma. Given the patient’s history of high-grade renal cell carcinoma, and similarity of histologic changes to the old renal cell cancer specimen, metastatic renal cell carcinoma was felt to be the responsible etiology.

  7. Massive lower gastrointestinal bleeding after low anterior resection for middle rectal cancer -case report

    Mircea Beuran; Ionut Negoi; Sorin Paun; Valentina Negoita; Bogdan Stoica; Ioan Tanase; Mihaela Vartic; Ruxandra Irina Negoi; Sorin Hostiuc

    2015-01-01

    Objective:To emphasize the value of emergency diagnostic angiography and angioembolization in massive postoperative bleeding. Methods:A case report was presented and electronic search of U.S. National Library of Medicine National Institutes of Health PubMed/MEDLINE, EMBASE, Google Scholar, ISI Web of Knowledge, to identify original articles and reviews about the subject. Results: A 55 year-old male patient was addmited for rectal bleeding. ECOG index=2, digital rectal examination revealed the inferior pole of a middle rectal tumor. Colonoscopy exam validated the presence of a middle rectal tumor, 8 cm from the anal verge. CT scan showed rectal wall thickening up to 3 cm, that extends 9 cm proximally, whit infiltration of the perirectal fatty tissue and multiple enlarged lymph nodes up to 12 mm in dimension. There was a laparoscopic converted to open approach, with low anterior resection of the rectum and total mesorectal excision, an end to end stapled colorectal anastomosis and protective loop ileostomy. In the 5th postoperative day a massive lower gastrointestinal bleeding occured, with hypovolemic shock and a decrease in hemoglobin. Emergency angiography was performed. This revealed active bleeding from an internal iliac branch that was successfully angioembolized. Conclusions: Angiography with angioembolization is an effective tool in emergency setting, avoiding the morbidity and associated mortality of a surgical reinervention. In early postoperative hemorrhages, only a rapid clinical recognition, a personalized diagnostic workup and an agressive intervention may offer the patient the best chances for cure.

  8. Georges Brohee Prize. Oestrogen-progesterone, a new therapy of bleeding gastrointestinal vascular malformations.

    Van Cutsem, E

    1993-01-01

    Gastrointestinal vascular malformations can cause haemorrhage requiring multiple transfusions. Surgical or endoscopic therapy are ineffective when the vascular malformations are spread diffusely over the gastrointestinal tract, when lesions escape identification or are not accessible for treatment. Several reports suggest that oestrogen-progesterone therapy is effective in the treatment of epistaxis in hereditary haemorrhagic telangiectasia. The aim of our studies is to test the hypothesis that oestrogen-progesterone is an effective treatment for bleeding gastrointestinal vascular malformations in patients with a very high transfusion need and in whom surgical or endoscopic treatment failed or could not be performed. The mean transfusion requirement prior to entering the studies amounted to 35.4 units packed per patient. In an uncontrolled trial oestrogen-progesterone therapy diminished significantly transfusion requirements from 3.4 units packed cells per patient per month to 0.1 units packed cells (p = 0.02). Haemorrhage ceased totally in 3 of 7 patients. A double-blind randomized placebo-controlled, cross-over trial shows that therapy with 0.050 mg ethinyloestradiol and 1 mg norethisterone is very effective in reducing transfusion requirements: 2.8 versus 11.2 units packed cells over a 6 month treatment period (p = 0.002). Only 3 of 13 patients treated with ethinyloestradiol and norethisterone required transfusions for persistent bleeding, while 12 of 13 patients in the placebo group had transfusion requirements (p = 0.001). After stopping hormonal therapy, no transfusions were needed for a mean of 10 months. This indicates a long-lasting effect of ethinyloestradiol and norethisterone on bleeding and transfusion requirements.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8342398

  9. Frequecy of different causes of upper gastrointestinal bleeding using endoscopic procedure at a tertiary care hospital

    To assess the outcome of early endoscopy in terms of frequency of different causes of upper Gastrointestinal bleeding at a tertiary care hospital.Study Design: Cross sectional descriptive study. Place and Duration of Study: Outpatients / indoor patients, Department of Medicine Military Hospital Rawalpindi from 1st Jan 2010 to 30th June 2010. Patients and Methods: Study was carried out in department of medicine Military Hospital Rawalpindi. Two hundred and forty four after cosen. Patients of upper gastrointestinal bleeding fulfilling the inclusion criteria were included in the study. Haemodynamically stable patients were kept empty stomach for at least 6 -8 hours before procedure. A detailed history and thorough physical examination was carried out. Protocols for endoscopic examination were followed. Mandatory baseline investigations were obtained. Endoscopic findings were documented on a proforma. pvalue of less than 0.05 was considered statistically significant. Results: There were 174 males (71.3%) and 70 females (28.7%). The age of the patients ranged from 15 years to 75 years, mean age was 52.23 years (SD = 14.78). The most common cause of upper GI bleed was varices in 176 (72.1%) patients; followed by gastric ulcer in 24 (9.8%) patients. Other causes in order of decreasing frequency included gastritis 16(6.55%), duodenal ulcer 14(5.73%), esophagitis 6(2.45%), Mallory Weiss tear 2(0.81%) and miscellaneous 6(2.45%). Conclusion: Esophageal varices is the most common cause of upper GI bleed in our set up reflecting high prevalence of liver cirrhosis secondary to chronic HBV and HCV infection. (author)

  10. Retrograde jejunoduodenogastric intussusception due to a replacement percutaneous gastrostomy tube presenting as upper gastrointestinal bleeding

    2007-01-01

    Percutaneous endoscopic gastrostomy (PEG) tube complications can be serious or life threatening.Retrograde intussusception is a very rare complication of PEG tubes with only 9 cases reported in the literature.We describe a case of retrograde intussusception,associated with the use of a Foley catheter as a replacement gastrostomy tube, presenting with upper gastrointestinal bleeding. To our knowledge, this is the first reported case of PEG-related retrograde intussusception successfully managed in a non-surgical manner. Retrograde intussusception likely occurred due to migration of the replacement tube with resultant securing and invagination of the proximal jejunum when the gastrostomy tube was anchored to the abdominal wall.

  11. An obscure cause of gastrointestinal bleeding: Renal cell carcinoma metastasis to the small bowel

    Robyn L. Gorski; Salah Abdel Jalil; Manver Razick; Ala' Abdel Jalil

    2015-01-01

    Renal cell carcinoma metastasis to the small intestine is a rare condition. It usually results in gastrointestinal bleeding and it could happen many years after the diagnosis with renal cell cancer. Treatment includes surgery as well as targeted agents such as tyrosine kinases. We report here the case of an 82-year-old man with a past medical history of high-grade renal cell carcinoma and right nephrectomy 6 years earlier, who presented with recurrent episodes of syncope and black stools. He ...

  12. A massive bleeding from a gastrointestinal stromal tumor of a Meckel’s diverticulum

    Chabowski Mariusz

    2016-01-01

    Full Text Available Introduction. Meckel’s diverticulum is the most common congenital anomaly of the gastro intestinal tract, present in about 2% of population. Case Outline. The article presents the case of a 44-year-old otherwise healthy man with anemia, who was diagnosed lower gastrointestinal bleeding. An abdominal CT scan revealed a clearly demarcated solid tumor in hypogastric region, measuring 65 Ч 45 mm. A laparotomy through lower midline incision was performed. A surgical resection of a lesion of a Meckel’s diverticulum was carried out and a final diagnosis of gastrointestinal stromal tumor was made. The patient made an uneventful recovery. Conclusion. The preoperative diagnosis of a complicated Meckel’s diverticulum may be challenging. CT is usually an adequate method to diagnose tumors arising from Meckel’s diverticulum.

  13. Upper Gastrointestinal Bleeding from Gastric Amyloidosis in a Patient with Smoldering Multiple Myeloma

    Mihajlo Gjeorgjievski

    2015-01-01

    Full Text Available Amyloidosis is a common complication of patients with monoclonal gammopathy of undetermined significance (MGUS, smoldering multiple myeloma (SMM, and multiple myeloma (MM. This proteinaceous material can be deposited intercellularly in any organ system, including the gastrointestinal (GI tract. In the GI tract, amyloidosis affects the duodenum most commonly, followed by the stomach and colorectum. Gastric amyloidosis causes symptoms of nausea, vomiting, early satiety, abdominal pain, and GI bleeding. A case of upper GI bleeding from gastric amyloidosis is presented in a patient with SMM. Esophagogastroduodenoscopy (EGD revealed a gastric mass. Endoscopic biopsies revealed amyloid deposition in the lamina propria, consistent with gastric amyloidosis. Liquid chromatography tandem mass spectrometry performed on peptides extracted from Congo red-positive microdissected areas of paraffin-embedded stomach specimens revealed a peptide profile consistent with AL- (lambda- type amyloidosis. Based on this and multiple other case reports, we recommend that patients with GI bleeding and MGUS, SMM, or MM undergo EGD and pathologic examination of endoscopic biopsies of identified lesions using Congo red stains for amyloidosis for early diagnosis and treatment.

  14. Etiology of lower gastrointestinal bleeding in paediatric patients, a colonoscopic surgery

    Objective: To determine the frequency of various etiologies of painless lower gastrointestinal bleeding (LGIB) in pediatric patients using colonoscopy. Study Design: Cross sectional descriptive study. Place and Duration of Study: This study was carried out at the department of Pediatrics, Military Hospital, Rawalpindi, from June 2010 to February 2012. Patients and Methods: A total of 80 patients (2-18 years of age) presenting with painless lower gastrointestinal bleeding were subjected to fiber-optic colonoscopy and findings were recorded. Data was analyzed with the help of SPSS version 10. Descriptive statistics were used to determine the mean +- SD of numerical data, e.g., for age. Categorical data like gender and colonoscopic findings were analyzed by their frequencies and percentages. Results: The study included 80 children out of which 53 were boys and 27 girls (male: female ratio was 1.96: 1). The majority of children, n=54 (67.5%) were between two and six years of age. The most common colonoscopic findings were polyps. In 47 (58.75%) patients, polyps were found in the colon and were resected. In 9 (11.25%) patients, gross appearance of colon was normal. Evidence of colitis was found in 17 (21.25%) patients. Patients with hemangiomas were 2 (2.5%). A total of 5(6.25%) patients had non specific ulcerative lesions. Conclusion: Polyps of the colorectal area are the most common cause of rectal bleeding in children in our set up. Thorough physical examination which includes a digital rectal examination and colonoscopy leads to rapid and accurate diagnosis and appropriate therapeutic measures. (author)

  15. Investigation on the clinical practice of transcatheter embolization for acute gastrointestinal hemorrhage

    Objective: To study the tactics, methods and relevant factors of transcatheter embolization for acute gastrointestinal hemorrhage. Methods: Fifteen patients with acute gastrointestinal hemorrhage were embolized by one of the methods of Polyvinyl Alcohol (PVA), gelfoam or metal coils. Four of the fifteen patients were upper gastrointestinal hemorrhage, the other cases were lower gastrointestinal hemorrhage which were embolized using coaxial microcatheter. Results: Fourteen of the fifteen patients were treated successfully by these methods. There were total 17 times of embolization for 16 parts, the success rate reached 94. 1%. The other one revealed an infarction of intestine after the embolization and was cured by resection. One of the fifteen patients appeared a recurrent hemorrhage 3 months later, and confirmed to be a hemangiolymphangioma. Two patients with malignant tumor were operated upon selectively. The other patient of intestinal hemorrhage was embolized successfully by using a metal coil after shock. Leiomyoma complicated with large area of bleeding was finally proven by operation. Conclusions: Transcatheter embolization for acute massive gastrointestinal hemorrhage is safe and efficient under different choice of methods. The key of success is the right selection of embolized target artery and dosage of emboli

  16. Comparison of AIMS65 Score and Other Scoring Systems for Predicting Clinical Outcomes in Koreans with Nonvariceal Upper Gastrointestinal Bleeding

    Park, Sung Min; Yeum, Seok Cheon; Kim, Byung-Wook; Kim, Joon Sung; Kim, Ji Hee; Sim, Eun Hui; Ji, Jeong-Seon; Choi, Hwang

    2016-01-01

    Background/Aims The AIMS65 score has not been sufficiently validated in Korea. The objective of this study was to compare the AIMS65 and other scoring systems for the prediction of various clinical outcomes in Korean patients with acute nonvariceal upper gastrointestinal bleeding (NVUGIB). Methods The AIMS65 score, clinical and full Rockall scores (cRS and fRS) and Glasgow-Blatchford (GBS) score were calculated in patients with NVUGIB in a single center retrospectively. The performance of these scores for predicting mortality, rebleeding, transfusion requirement, and endoscopic intervention was assessed by calculating the area under the receiver-operating characteristic curve. Results Of the 523 patients, 3.4% died within 30 days, 2.5% experienced rebleeding, 40.0% required endoscopic intervention, and 75.7% needed transfusion. The AIMS65 score was useful for predicting the 30-day mortality, the need for endoscopic intervention and for transfusion. The fRS was superior to the AIMS65, GBS, and cRS for predicting endoscopic intervention and the GBS was superior to the AIMS65, fRS, and cRS for predicting the transfusion requirement. Conclusions The AIMS65 score was useful for predicting the 30-day mortality, transfusion requirement, and endoscopic intervention in Korean patients with acute NVUGIB. However, it was inferior to the GBS and fRS for predicting the transfusion requirement and endoscopic intervention, respectively. PMID:27377742

  17. Endoscopic resection of an ampullary carcinoid presenting with upper gastrointestinal bleeding: A case report and review of the literature

    Nooman Gilani; Francisco C Ramirez

    2007-01-01

    Ampullary carcinoid is a rare tumor that can present with gastrointestinal bleeding, obstructive jaundice or pancreatitis. Some of these tumors are associated with Von Recklinghausen disease. The usual surgical options are a biliary-enteric anastomosis, Whipple procedure or rarely a local resection. The mean survival dges not appear to be much different after a pancreaticoduodenectomy versus local surgical excision.We report a very rare case of a non-metastatic ampullary carcinoid causing upper gastrointestinal bleeding, which was managed by endoscopic ampullectomy.

  18. Traumatic pseudoaneurysm of the superior rectal artery with recurrent lower gastrointestinal and pelvic extraperitoneal bleeding: Importance of pretreatment recognition

    Kim, Kyung Joon; Seo, Jung Wook; Kim, You Sung [Dept. of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang (Korea, Republic of)

    2015-01-15

    Traumatic pseudoaneurysm of the superior rectal artery is a rare cause of massive lower gastrointestinal bleeding. We reported a case of a 43-year-old male patient with pseudoaneurysm following a penetrating perineal wound. The patient had repeat massive lower gastrointestinal and pelvic extraperitoneal bleeding and was diagnosed as traumatic pseudoaneurysm of the superior rectal artery. To our knowledge, there are three case reports of traumatic pseudoaneurysm of the superior rectal artery treated by embolization. However, spontaneous regression occurred in the study subject after surgical hematoma removal, without any further pseudoaneurysm resection.

  19. Defining upper gastrointestinal bleeding from linked primary and secondary care data and the effect on occurrence and 28 day mortality

    Crooks Colin

    2012-11-01

    Full Text Available Abstract Background Primary care records from the UK have frequently been used to identify episodes of upper gastrointestinal bleeding in studies of drug toxicity because of their comprehensive population coverage and longitudinal recording of prescriptions and diagnoses. Recent linkage within England of primary and secondary care data has augmented this data but the timing and coding of concurrent events, and how the definition of events in linked data effects occurrence and 28 day mortality is not known. Methods We used the recently linked English Hospital Episodes Statistics and General Practice Research Database, 1997–2010, to define events by; a specific upper gastrointestinal bleed code in either dataset, a specific bleed code in both datasets, or a less specific but plausible code from the linked dataset. Results This approach resulted in 81% of secondary care defined bleeds having a corresponding plausible code within 2 months in primary care. However only 62% of primary care defined bleeds had a corresponding plausible HES admission within 2 months. The more restrictive and specific case definitions excluded severe events and almost halved the 28 day case fatality when compared to broader and more sensitive definitions. Conclusions Restrictive definitions of gastrointestinal bleeding in linked datasets fail to capture the full heterogeneity in coding possible following complex clinical events. Conversely too broad a definition in primary care introduces events not severe enough to warrant hospital admission. Ignoring these issues may unwittingly introduce selection bias into a study’s results.

  20. Acute gingival bleeding as a complication of dengue hemorrhagic fever

    Saif Khan

    2013-01-01

    Full Text Available Dengue fever is mosquito borne disease caused by dengue virus (DENV of Flaviviridae family. The clinical manifestations range from fever to severe hemorrhage, shock and death. Here, we report a case of 20-year-old male patient undergoing orthodontic treatment presenting with acute gingival bleeding with a history of fever, weakness, backache, retro orbital pain and ecchymosis over his right arm. The hematological investigations revealed anemia, thrombocytopenia and positive dengue non-structural protein-1 antigen and also positive immunoglobulin M and immunoglobulin G antibodies for DENV. Patient was diagnosed as a case of dengue hemorrhagic fever and was immediately referred for appropriate management. This case report emphasizes the importance of taking correct and thorough medical history.

  1. Acute gingival bleeding as a complication of dengue hemorrhagic fever.

    Khan, Saif; Gupta, N D; Maheshwari, Sandhya

    2013-07-01

    Dengue fever is mosquito borne disease caused by dengue virus (DENV) of Flaviviridae family. The clinical manifestations range from fever to severe hemorrhage, shock and death. Here, we report a case of 20-year-old male patient undergoing orthodontic treatment presenting with acute gingival bleeding with a history of fever, weakness, backache, retro orbital pain and ecchymosis over his right arm. The hematological investigations revealed anemia, thrombocytopenia and positive dengue non-structural protein-1 antigen and also positive immunoglobulin M and immunoglobulin G antibodies for DENV. Patient was diagnosed as a case of dengue hemorrhagic fever and was immediately referred for appropriate management. This case report emphasizes the importance of taking correct and thorough medical history. PMID:24174736

  2. Is Occult Obscure Gastrointestinal Bleeding a Definite Indication for Capsule Endoscopy? A Retrospective Analysis of Diagnostic Yield in Patients with Occult versus Overt Bleeding

    Ikue Watari; Shiro Oka; Shinji Tanaka; Makoto Nakano; Taiki Aoyama; Shigeto Yoshida; Kazuaki Chayama

    2013-01-01

    Background/Aim. Usefulness of capsule endoscopy (CE) for diagnosing small-bowel lesions in patients with obscure gastrointestinal bleeding (OGIB) has been reported. Most reports have addressed the clinical features of overt OGIB, with few addressing occult OGIB. We aimed to clarify whether occult OGIB is a definite indication for CE. Methods. We retrospectively compared the cases of 102 patients with occult OGIB and 325 patients with overt OGIB, all having undergone CE. The diagnostic yield o...

  3. A 22-year-old woman with recurrent gastrointestinal bleeding since childhood

    Chris Fraser

    2006-09-01

    Full Text Available CASE PRESENTATIONA 22-year-old woman was referred to our unit for capsule endoscopy because of recurrent iron deficiency anaemia and gastrointestinal bleeding since childhood. Cutaneous vascular lesions had been surgically removed when she was a child.During the preceding year she required blood transfusions every month and had a total of 9 iron infusions. Gastroscopy and colono-scopy at another hospital had shown small vascular lesions in the stomach, duodenum and colon. Clinical examination revealed pallor. Blood investigations showed a haemoglobin level of 9.6 g/dl and a MCV of 67 fl.The capsule endoscopy (PillCam, Given Imaging was performed. Fifteen lesions similar to those shown in figures 1 and 2 were noted through-out small bowel. She underwent a laparotomy with intra-operative entero-scopy; the lesions were removed and the histology is shown in Figure 3.

  4. Gastrointestinal bleedings during therapy with new oral anticoagulants are rarely reported

    Bay-Nielsen, Morten; Kampmann, Jens Peter; Bisgaard, Thue

    2014-01-01

    INTRODUCTION: Post-marketing surveillance of drugs relies on spontaneous reporting of adverse drug events to the Danish Health and Medicines Authority. A number of new oral anticoagulants (NOAC) have recently been marketed in Denmark. The purpose of this study was to evaluate the reporting of......, Surgical Section, Hvidovre Hospital, during a one-year-period. Patients in treatment with NOAC and admitted for gastrointestinal bleeding were identified. Relevant patients were cross-checked for a reported adverse drug event in the Danish Health and Medi-cines Authority's database on adverse medical...... underreported which questions the current effectiveness of post-marketing surveillance of adverse drug effects. FUNDING: not relevant. TRIAL REGISTRATION: The study was registered with clin-icaltrials.gov (NCT02107651)....

  5. Transfusion treatment impact in the improvement of haematological parameters in patients with gastrointestinal bleeding

    Iliriane Bunjaku

    2012-04-01

    Full Text Available Introduction: Transfusion treatment (TT is necessary in patients with gastrointestinal bleeding (GIB for lost blood substitution. This study was aimed at assessing the changes in haematological parameters  (hemoglobin, hematocrit, red blood cell count, white cell count, platelet count and prothrombin time before and after TT in anaemic patients with GIB in order to analyse the effect of this treatment.Methods: There have been included 293 patients with GIB (the average age was 57.3, ranged from 18-89 years who were treated with TT at the Internal Clinic at the University Clinical Center Prishtina during oneyear period. Data for applied blood product and results of the coagulation screen (PT were collected from the Kosovo’s Blood Transfusion Center (KBTC.Results: TT has been carried out in 404 episodes, with 714 units of concentrated red blood cells (78.6%, 189 units of fresh frozen plasma (20.8% and concentrated platelets (0.6%, with an average dose 3.1 fortransfunded patients. Average values of Hb before and after TT were 71.8 g/L and 81.4 g/L, respectively; while the average values of hematocrite before and after TT were 22.9% and 25.6%, respectively. The averageerythrocytes count before TT was 2.6 respectively after treatment 2.8(pConclusions: Having in mind difficult clinical and unsustainable situation in patients with gastrointestinal bleeding, the Transfusion Treatment resulted in the considerable improvement of the specific blood indicators.

  6. Transfusion treatment impact in the improvement of haematological parameters in patients with gastrointestinal bleeding

    Iliriane Bunjaku

    2012-04-01

    Full Text Available Introduction: Transfusion treatment (TT is necessary in patients with gastrointestinal bleeding (GIB for lost blood substitution. This study was aimed at assessing the changes in haematological parameters  (hemoglobin, hematocrit, red blood cell count, white cell count, platelet count and prothrombin time before and after TT in anaemic patients with GIB in order to analyse the effect of this treatment.Methods: There have been included 293 patients with GIB (the average age was 57.3, ranged from 18-89 years who were treated with TT at the Internal Clinic at the University Clinical Center Prishtina during oneyear period. Data for applied blood product and results of the coagulation screen (PT were collected from the Kosovo’s Blood Transfusion Center (KBTC.Results: TT has been carried out in 404 episodes, with 714 units of concentrated red blood cells (78.6%, 189 units of fresh frozen plasma (20.8% and concentrated platelets (0.6%, with an average dose 3.1 fortransfunded patients. Average values of Hb before and after TT were 71.8 g/L and 81.4 g/L, respectively; while the average values of hematocrite before and after TT were 22.9% and 25.6%, respectively. The averageerythrocytes count before TT was 2.6 respectively after treatment 2.8(p<0.0001. The PT was carried out in the 43% of patients with GIB before treatment with FFP, but after that only in 2% of cases.Conclusions: Having in mind difficult clinical and unsustainable situation in patients with gastrointestinal bleeding, the Transfusion Treatment resulted in the considerable improvement of the specific blood indicators.

  7. Is tranexamic acid effective for acute upper gastrointestinal bleeding?

    Sebastián Flores

    2015-12-01

    Full Text Available La hemorragia digestiva alta corresponde a una emergencia médico-quirúrgica debido a la alta morbilidad y mortalidad que conlleva. El ácido tranexámico, un antifibrinolítico, podría ayudar a lograr un control precoz del sangrado, sin embargo existe controversia sobre su real utilidad. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos cinco revisiones sistemáticas que en conjunto incluyen ocho estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que el ácido tranexámico probablemente disminuye el resangrado y la mortalidad, y no aumenta los efectos adversos tromboembólicos en pacientes con hemorragia digestiva alta.

  8. Is tranexamic acid effective for acute upper gastrointestinal bleeding?

    Sebastián Flores; Carolina Avilés; Gabriel Rada

    2015-01-01

    La hemorragia digestiva alta corresponde a una emergencia médico-quirúrgica debido a la alta morbilidad y mortalidad que conlleva. El ácido tranexámico, un antifibrinolítico, podría ayudar a lograr un control precoz del sangrado, sin embargo existe controversia sobre su real utilidad. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos cinco revisiones sistemáticas que en conjunto incluyen ocho estudios aleatorizados. Realizam...

  9. Whole blood viscosity issues VI: Association with blood salicylate level and gastrointestinal bleeding

    Ezekiel Uba Nwose

    2010-01-01

    Full Text Available Background : This series on whole blood viscosity issues has been trying to elucidate the sensitivity, specificity and usefulness of the laboratory parameter in clinical practice. The postulation has been that since antiplatelet is used in the management of stasis, of which blood viscosity is an index, the latter would be useful laboratory indication and/or contraindication. Aim : The aim of this study was to observe whether blood level of acetylsalicylic acid differs with the level of whole blood viscosity. Patients and Methods : Out of the ten years database, 538 cases that were concomitantly tested for haematocrit, total proteins and blood level of salicylate were selected for this study. A separate nine cases of positive faecal occult blood tests were audited for blood viscosity and reviewed. Results : A statistically significant difference is observed with lower blood viscosity being associated with higher salicylate level in comparison of the former between the highest vs. lowest quartiles (p < 0.002. This observation demonstrates the effect of aspirin in lowering blood stasis. Reviewing the positive faecal occult blood cases indicate that gastrointestinal bleeding is characterized by relative hypoviscosity and that hyperviscosity is not present during bleeding complications. Conclusion : The findings affirm that whole blood viscosity is a valid clinical laboratory parameter for evidence-based contraindication, indication and monitoring of antiplatelet medication. It calls for better appreciation and clinical utility of whole blood viscosity, which (in the absence of viscometer can now be extrapolated from haematocrit and total proteins.

  10. Upper gastrointestinal bleeding treatment by methods of interventional radiology; Leczenie krwotokow z gornego odcinka przewodu pokarmowego metodami radiologii zabiegowej

    Jargiello, T.; Szajner, M.; Janczarek, M.; Szczerbo-Trojanowska, M. [Akademia Medyczna, Lublin (Poland)

    1994-12-31

    The results of arterial vasopressin infusion and transcatheter embolization in 26 patients with upper gastrointestinal bleeding were presented and evaluated. In all 26 patients vasopressin infusion was performed. The procedure was successful in 21 patients. In 5 who did not respond to the therapy hemorrhage was successfully controlled by transcatheter embolization. No complications were observed. (author). 14 refs, 2 figs.

  11. Simple risk factors to predict urgent endoscopy in nonvariceal upper gastrointestinal bleeding pre-endoscopically.

    Wang, Jianzong; Hu, Duanming; Tang, Wen; Hu, Chuanyin; Lu, Qin; Li, Juan; Zhu, Jianhong; Xu, Liming; Sui, Zhenyu; Qian, Mingjie; Wang, Shaofeng; Yin, Guojian

    2016-06-01

    The goal of this study is to evaluate how to predict high-risk nonvariceal upper gastrointestinal bleeding (NVUGIB) pre-endoscopically. A total of 569 NVUGIB patients between Match 2011 and January 2015 were retrospectively studied. The clinical characteristics and laboratory data were statistically analyzed. The severity of NVUGIB was based on high-risk NVUGIB (Forrest I-IIb), and low-risk NVUGIB (Forrest IIc and III). By logistic regression and receiver-operating characteristic curve, simple risk score systems were derived which predicted patients' risks of potentially needing endoscopic intervention to control bleeding. Risk score systems combined of patients' serum hemoglobin (Hb) ≤75 g/L, red hematemesis, red stool, shock, and blood urine nitrogen ≥8.5 mmol/L within 24 hours after admission were derived. As for each one of these clinical signs, the relatively high specificity was 97.9% for shock, 96.4% for red stool, 85.5% for red hematemesis, 76.7% for Hb ≤75 g/L, and the sensitivity was 50.8% for red hematemesis, 47.5% for Hb ≤75 g/L, 14.2% for red stool, and 10.9% for shock. When these 5 clinical signs were presented as a risk score system, the highest area of receiver-operating characteristic curve was 0.746, with sensitivity 0.675 and specificity 0.733, which discriminated well with high-risk NVUGIB. These simple risk factors identified patients with high-risk NVUGIB of needing treatment to manage their bleeding pre-endoscopically. Further validation in the clinic was required. PMID:27367977

  12. Direct Versus Video Laryngoscopy for Intubating Adult Patients with Gastrointestinal Bleeding

    Jestin N. Carlson

    2015-12-01

    Full Text Available Introduction: Video laryngoscopy (VL has been advocated for several aspects of emergency airway management; however, there are still concerns over its use in select patient populations such as those with large volume hematemesis secondary to gastrointestinal (GI bleeds. Given the relatively infrequent nature of this disease process, we sought to compare intubation outcomes between VL and traditional direct laryngoscopy (DL in patients intubated with GI bleeding, using the third iteration of the National Emergency Airway Registry (NEARIII. Methods: We performed a retrospective analysis of a prospectively collected national database (NEARIII of intubations performed in United States emergency departments (EDs from July 1, 2002, through December 31, 2012. All cases where the indication for intubation was “GI bleed” were analyzed. We included patient, provider and intubation characteristics. We compared data between intubation attempts initiated as DL and VL using parametric and non-parametric tests when appropriate. Results: We identified 325 intubations, 295 DL and 30 VL. DL and VL cases were similar in terms of age, sex, weight, difficult airway predictors, operator specialty (emergency medicine, anesthesia or other and level of operator training (post-graduate year 1, 2, etc. Proportion of successful first attempts (DL 261/295 (88.5% vs. VL 28/30 (93.3% p=0.58 and Cormack-Lehane grade views (p=0.89 were similar between devices. The need for device change was similar between DL [2/295 (0.7% and VL 1/30 (3.3%; p=0.15]. Conclusion: In this national registry of intubations performed in the ED for patients with GI bleeds, both DL and VL had similar rates of success, glottic views and need to change devices.

  13. High-altitude gastrointestinal bleeding: An observation in Qinghai-Tibetan railroad construction workers on Mountain Tanggula

    Tian-Yi Wu; Shou-Quan Ding; Jin-Liang Liu; Jian-Hou Jia; Rui-Chen Dai; Dong-Chun Zhu; Bao-Zhu Liang; De-Tang Qi; Yong-Fu Sun

    2007-01-01

    AIM: To investigate the gastrointestinal bleeding (GIB) in people from lowland to high altitude and in workers on Mountain Tanggula and its causes as well as treatment and prophylaxis.METHODS: From 2001 to October 2003, we studied GIB in 13 502 workers constructing the railroad on Mountain Tanggula which is 4905 m above the sea level. The incidence of GIB in workers at different altitudes was recorded. Endoscopy was performed when the workersevacuated to Golmud (2808 m) and Xining (2261 m).The available data on altitude GIB were analyzed.RESULTS: The overall incidence of GIB was 0.49% in 13502 workers. The incidence increased with increasing altitude. The onset of symptoms in most patients was within three weeks after arrival at high altitude. Bleeding manifested as hematemesis, melaena or hematochezia,and might be occult. Endoscopic examination showed that the causes of altitude GIB included hemorrhage gastritis, gastric ulcer, duodenal ulcer, and gastric erosion. Experimental studies suggested that acute gastric mucosal lesion (AGML) could be induced by hypoxic and cold stress, which might be the pathogenesis of altitude GIB. Those who consumed large amount of alcohol, aspirin or dexamethasone were at a higher risk of developing GIB. Persons who previously suffered from peptic ulcer or high-altitude polycythemia were also at risk of developing GIB. Early diagnosis, evacuation, and treatment led to early recovery.CONCLUSION: GIB is a potentially life threatening disease, if it is not treated promptly and effectively. Early diagnosis, treatment and evacuation lead to an early recovery. Death due to altitude GIB can be avoided if early symptoms and signs are recognized.

  14. Hemosuccus pancreaticus caused by rupture of a splenic artery pseudoaneurysm complicating chronic alcoholic pancreatitis: an uncommon cause of gastrointestinal bleeding.

    Hiltrop, Nick; Vanhauwaert, Anke; Palmers, Pieter-Jan Liesbeth Herman; Cool, Mike; Deboever, Guido; Lambrecht, Guy

    2015-12-01

    We present a case of a 52-year old female patient with intermittent gastrointestinal bleeding and iron deficiency anaemia. Repeated endoscopic investigation revealed no diagnosis, but contrast-enhanced computed tomography showed a splenic artery pseudo-aneurysm secondary to chronic alcoholic pancreatitis. A distal pancreatectomy and splenectomy was performed. Hemosuccus pancreaticus is an uncommon cause of gastrointestinal bleeding, most frequently associated with chronic pancreatitis. Erosion of a peripancreatic artery by a pseudocyst can cause a pseudoaneurysm and rupture occurs in up to 10% of the cases. Bleeding from a pseudocyst wall or rupture of an atherosclerotic or traumatic aneurysm is rare. Angiography, contrast-enhanced computed tomography and endoscopic findings can be diagnostic in the majority of cases. Angiographic embolization or surgery are both therapeutic options depending on underlying nonvascular pancreas related indications requiring surgery. We discuss diagnostic pitfalls and current therapeutic strategies in the management of this disease. PMID:26712055

  15. Limited value of technetium 99m-labeled red cell scintigraphy in localization of lower gastrointestinal bleeding

    The aim of this study was to assess the accuracy of technetium 99m-labeled red cell scintigraphy in localizing the site of lower gastrointestinal bleeding. The outcome of 203 patients undergoing technetium 99m-labeled red cell scintigraphy was reviewed, and the scan result was compared with the true site of bleeding. The true site of bleeding was determined by other methods including angiography and surgical pathology. Fifty-two scans (26%) were positive and indicated a specific site of bleeding. A definitive bleeding site was identified in 22 patients by other means and correlated with the technetium scan in only 9 cases. The nuclear scan was incorrect in the remaining 13 cases, implying a localization error of 25% (13 of 52). A subgroup of 19 patients with a positive scan underwent a surgical procedure directed by the nuclear scan. Eight of these 12 patients had incorrect surgical procedures based upon findings of more definitive tests, indicating a surgical error of 42% (8 of 19). We conclude that the technetium 99m-labeled red cell scan's ability to accurately localize the site of lower gastrointestinal bleeding is limited. Furthermore, performing a surgical procedure that relies exclusively on localization by red cell scintigraphy will produce an undesirable result in at least 42% of patients

  16. Limited value of technetium 99m-labeled red cell scintigraphy in localization of lower gastrointestinal bleeding

    Hunter, J.M.; Pezim, M.E. (Univ. of British Columbia, Vancouver (Canada))

    1990-05-01

    The aim of this study was to assess the accuracy of technetium 99m-labeled red cell scintigraphy in localizing the site of lower gastrointestinal bleeding. The outcome of 203 patients undergoing technetium 99m-labeled red cell scintigraphy was reviewed, and the scan result was compared with the true site of bleeding. The true site of bleeding was determined by other methods including angiography and surgical pathology. Fifty-two scans (26%) were positive and indicated a specific site of bleeding. A definitive bleeding site was identified in 22 patients by other means and correlated with the technetium scan in only 9 cases. The nuclear scan was incorrect in the remaining 13 cases, implying a localization error of 25% (13 of 52). A subgroup of 19 patients with a positive scan underwent a surgical procedure directed by the nuclear scan. Eight of these 12 patients had incorrect surgical procedures based upon findings of more definitive tests, indicating a surgical error of 42% (8 of 19). We conclude that the technetium 99m-labeled red cell scan's ability to accurately localize the site of lower gastrointestinal bleeding is limited. Furthermore, performing a surgical procedure that relies exclusively on localization by red cell scintigraphy will produce an undesirable result in at least 42% of patients.

  17. SPECT/CT with a hybrid imaging system in the study of lower gastrointestinal bleeding with technetium-99m red blood cells

    Aim. Lower gastrointestinal (G I) hemorrhage is a complex clinical problem that requires disciplined evaluation for successful management. This study was conducted to evaluate the applicability of single photon emission computed tomography/computed tomography (SPECT/CT) in patients with acute lower gastrointestinal bleeding undergoing scintigraphy with 99m Tc-labelled red blood cells (RBC), and to assess the additional clinical value of fused images when compared to the standard radionuclide scan. Methods. Twenty-seven patients presenting with acute lower G I tract hemorrhage were studied with conventional dynamic and planar 99m Tc-RBC imaging. In 19 patients with positive findings on scans taken within 6 hours, a SPECT/CT study was immediately performed using a hybrid system composed of a dual-head, variable angle gamma camera and an X-ray tube. The number of patients in whom SPECT/CT changed the scintigraphic interpretation with regard to the presence or site of G I blood loss as confirmed by other diagnostic or therapeutical procedures was recorded. Results. Image fusion was easy and successful in all patients showing perfect correspondence between SPECT and CT data and allowing precise anatomical localization of the sites of 99m Tc-RBC extravasation. SPECT/CT had significant impact on the scintigraphic results in 7/19 patients (36.8%): in 6 patients it precisely localized the bleeding foci whose location could not be identified in standard scans and in one it excluded the presence of an active G I hemorrhage. Conclusion. SPECT/CT with a hybrid system is feasible and useful for facilitating imaging interpretation and improving the accuracy of 99m Tc-RBC scintigraphy in patients with acute lower G I bleeding.

  18. Upper gastrointestinal bleeding in a Brazilian hospital: a retrospective study of endoscopic records Sangramento digestivo alto em um hospital brasileiro: estudo retrospectivo de registros endoscópicos

    Zaltman, Cyrla; de Souza, Heitor Siffert Pereira; Castro, Maria Elizabeth C; Maria de Fátima S. SOBRAL; DIAS Paula Cristina P.; Vilson LEMOS Jr.

    2002-01-01

    Background - Upper gastrointestinal bleeding is a frequent and potentially severe complication of most digestive diseases of the upper gastrointestinal tract. Upper endoscopy has a crucial role in the diagnosis and treatment of upper gastrointestinal bleeding, however epidemiological studies are still limited in our country. Aims - To assess the clinical characteristics, endoscopic accuracy, treatment efficiency and clinical outcome of patients admitted to the endoscopic unit with upper gastr...

  19. Importance of Heparin Provocation and SPECT/CT in Detecting Obscure Gastrointestinal Bleeding on 99mTc-RBC Scintigraphy

    Haghighatafshar, Mahdi; Gheisari, Farshid; Ghaedian, Tahereh

    2015-01-01

    Abstract We presented a pediatric case with a history of intermittent melena for 3 years because of angiodyplasia of small intestine. The results of frequent upper gastrointestinal endoscopies and colonoscopies as well as both 99mTc-red blood cell (RBC) and Meckel's scintigraphies for several times were negative in detection of bleeding site. However, 99mTc-RBC scintigraphy with single-photon emission computed tomography (SPECT)/computed tomography (CT) after heparin augmentation detected a site of bleeding in the distal ileum which later was confirmed during surgery with final diagnosis of angiodysplasia. It could be stated that heparin provocation of bleeding before 99mTc-RBC scintigraphy accompanied by fused SPECT/CT images should be kept in mind for management of intestinal bleeding especially in difficult cases. PMID:26313771

  20. Thalidomide in refractory bleeding due to gastrointestinal angiodysplasias Talidomida en la hemorragia recidivante por angiodisplasias gastrointestinales

    Antonio Garrido

    2012-02-01

    Full Text Available Objectives: to assess the efficacy of thalidomide in the treatment of relapsed or refractory bleeding secondary to gastrointestinal angiodysplasia. Material and methods: we carried out a prospective study of 12 patients with bleeding due to gastrointestinal angiodysplasia refractory to conventional therapy who were treated with thalidomide. For each patient, we considered: age, sex, underlying disease, previous therapies, dose and duration of thalidomide treatment, evolution of haemoglobin levels and adverse effects of treatment. The data obtained were analysed using descriptive statistics with SPSS v. 16. Results: seven men and 5 women with a mean age of 77 years were included in the present study. Five had some underlying pathology and all of them had received prior endoscopic/octreotide treatment. The dose of thalidomide administered was 200 mg/24 h and the duration of the treatment four months, with the exception of two patients in whom treatment was discontinued because of adverse side effects. Mean haemoglobin concentration before onset of treatment was 6.5 g/dL, at two months it was 11.3 g/dL and at the end of treatment 12.1 g/dL. Conclusions: thalidomide is an effective treatment in gastrointestinal bleeding due to angiodysplasia, but it was withdrawn due to side effects in 16% of the patients included in our study.Objetivos: valorar la eficacia de talidomida en la hemorragia recidivante y refractaria por angiodisplasias gastrointestinales. Material y métodos: se realizó un estudio prospectivo de 12 pacientes con hemorragia por angiodisplasias refractarios a la terapia convencional, que recibieron tratamiento con talidomida. Se determinó en cada caso: edad, sexo, patología de base, tratamientos previos, dosis y duración del tratamiento con talidomida, evolución de los valores de hemoglobina y efectos secundarios del tratamiento. Los datos fueron procesados mediante estadística descriptiva con SPSS versión 16. Resultados: se

  1. Incidence of serious upper gastrointestinal bleeding in patients taking non-steroidal anti-inflammatory drugs in Japan.

    Ishikawa, Shigenao; Inaba, Tomoki; Mizuno, Motowo; Okada, Hiroyuki; Kuwaki, Kenji; Kuzume, Toshiaki; Yokota, Hitomi; Fukuda, Yasuyo; Takeda, Kou; Nagano, Hiroshi; Wato, Masaki; Kawai, Kozo

    2008-02-01

    Upper gastrointestinal bleeding is a major adverse event of non-steroidal anti-inflammatory drugs (NSAIDs), and co-administration of proton pump inhibitors and H2 receptor antagonists has been established as a means of preventing such an effect. However, the incidence of bleeding associated with NSAID-induced ulcers under conditions where such strong anti-acid agents are used for prevention has yet to be clarified. We aimed to determine the annual incidence of serious upper gastrointestinal ulcer bleeding among Japanese patients in whom NSAIDs were used in our hospital. Before commencing the study, we recommended to all the physicians in our hospital the best method for caring for NSAID users, focusing on the concomitant use of proton pump inhibitors or H2 receptor antagonists. We conducted a cohort study involving 17,270 patients for whom NSAIDs had been newly prescribed. Bleeding from gastric ulcers was observed in 8 of the 17,270 patients using NSAIDs (0.05%). The pooled incidence rate for bleeding was calculated as 2.65 (95% confidence interval, 2.56-2.74) and 1.29 (1.27-1.31) per 1,000 patient years for low-dose aspirin and non-aspirin NSAID users, respectively. None of the bleeding ulcer patients required blood transfusion or were in serious condition. In conclusion, gastric ulcer bleeding occurred in low-dose aspirin or non-aspirin NSAID users, but its incidence was low and outcomes were not serious when adequate preventive measures were taken. PMID:18323869

  2. Wireless capsule endoscopy in the investigation of patients with chronic renal failure and obscure gastrointestinal bleeding (preliminary data)

    Stephanos Karagiannis; Spyros Goulas; Georgios Kosmadakis; Petros Galanis; Dimitrios Arvanitis; John Boletis; Evangelos Georgiou; Christos Mavrogiannis

    2006-01-01

    AIM: To investigate the role of wireless capsule endoscopy (WCE) in detection of small bowel (SB) pathology in patients with chronic renal failure (CRF) and obscure bleeding.METHODS: Consecutive CRF patients with obscure bleeding were prospectively studied. Patients with normal renal function and obscure bleeding, investigated during the same period with WCE, were used for the interpretation of results.RESULTS: Seventeen CRF patients (11 overt, 6 occult bleeding) and 51 patients (33 overt, 18 occult bleeding) with normal renal function were enrolled in this study.Positive SB findings were detected in 70.6% of CRF patients and in 41.2% of non-CRF patients (P < 0.05). SB angiodysplasia was identified in 47% of CRF patients and in 17.6% of non-CRF patients. Univariate logistic regression revealed CRF as a significant predictive factor for angiodysplasia (P < 0.05). Therapeutic measures were undertaken in 66% of the patients with the positive findings.CONCLUSION: According to our preliminary results, SB angiodysplasia was found in an increased prevalence among CRF patients with obscure bleeding. WCE is useful in diagnosis of gastrointestinal pathologies and in planning appropriate therapeutic intervention and, therefore, should be included in the work-up of this group of patients.

  3. Clinical impact of multidetector computed tomography before double-balloon enteroscopy for obscure gastrointestinal bleeding

    Hsu-Heng Yen; Yang-Yuan Chen; Chia-Wei Yang; Chi-Kuang Liu; Maw-Soan Soon

    2012-01-01

    AIM:To evaluate the clinical impact of multidetector computed tomography (MDCT) before double-balloon endoscopy (DBE) for patients with obscure gastrointestinal bleeding (OGIB).METHODS:A retrospective analysis of prospectively collected cases with DBE and MDCT for overt OGIB was conducted from April 2004 to April 2010 at Changhua Christian Hospital.We evaluated the clinical impact of MDCT on the subsequent DBE examinations and the diagnostic yields of both MDCT and DBE respectively.RESULTS:From April 2004 to April 2010,a total of 75 patients underwent DBE for overt OGIB.Thirty one cases received MDCT followed by DBE for OGIB.The overall diagnostic yields of DBE and MDCT was 93.5% and 45.2%.The MDCT had a high diagnostic yield of tumor vs non-tumor etiology of OGIB (85.7% vs 33.3%,P =0.014).Additionally,the choice of initial route of DBE was correct in those with a positive MDCT vs negative MDCT (100% vs 52.9%,P =0.003).CONCLUSION:This study suggests MDCT as a triage tool may identify patients who will benefit from DBE and aid the endoscopist in choosing the most efficient route.

  4. Blue rubber bleb nevus syndrome: a rare presentation of late-onset anemia and lower gastrointestinal bleeding without cutaneous manifestations

    Goud, Aditya; Abdelqader, Abdelhai; Walters, Jamie; Selinger, Stephen

    2016-01-01

    Blue rubber bleb nevus syndrome (BRBNS) is a congenital disorder with characteristic venous anomalies that can present with varying degree of blood loss. The most clinically significant symptoms in adults include gastrointestinal (GI) bleeding and iron deficiency anemia. Severe complications can include intestinal torsion, intussusception, and even perforation, with each leading to significant morbidity and mortality. This report serves to give a brief understanding of this rare disease along...

  5. Blue rubber bleb nevus syndrome: a rare presentation of late-onset anemia and lower gastrointestinal bleeding without cutaneous manifestations

    Goud, Aditya; Abdelqader, Abdelhai; Walters, Jamie; Selinger, Stephen

    2016-01-01

    Blue rubber bleb nevus syndrome (BRBNS) is a congenital disorder with characteristic venous anomalies that can present with varying degree of blood loss. The most clinically significant symptoms in adults include gastrointestinal (GI) bleeding and iron deficiency anemia. Severe complications can include intestinal torsion, intussusception, and even perforation, with each leading to significant morbidity and mortality. This report serves to give a brief understanding of this rare disease along with current diagnostic and therapeutic options. PMID:26908380

  6. Blue rubber bleb nevus syndrome: a rare presentation of late-onset anemia and lower gastrointestinal bleeding without cutaneous manifestations

    Aditya Goud

    2016-02-01

    Full Text Available Blue rubber bleb nevus syndrome (BRBNS is a congenital disorder with characteristic venous anomalies that can present with varying degree of blood loss. The most clinically significant symptoms in adults include gastrointestinal (GI bleeding and iron deficiency anemia. Severe complications can include intestinal torsion, intussusception, and even perforation, with each leading to significant morbidity and mortality. This report serves to give a brief understanding of this rare disease along with current diagnostic and therapeutic options.

  7. Complimentary Imaging Modalities for Investigating Obscure Gastrointestinal Bleeding: Capsule Endoscopy, Double-Balloon Enteroscopy, and Computed Tomographic Enterography

    Ye Chu; Sheng Wu; Yuting Qian; Qi Wang; Juanjuan Li; Yanping Tang; Tingting Bai; Lifu Wang

    2016-01-01

    Objectives. The complimentary value of computed tomographic enterography (CTE) and double-balloon enteroscopy (DBE) combined with capsule endoscopy (CE) was evaluated in the diagnosis of obscure gastrointestinal bleeding (OGIB). Methods. Patients who received CE examinations at Ruijin Hospital between July 2007 and July 2014 with the indication of OGIB were identified, and those who also underwent DBE and/or CTE were included. Their clinical information was retrieved, and results from each te...

  8. Impact of proton pump inhibitor treatment on gastrointestinal bleeding associated with non-steroidal anti-inflammatory drug use among post-myocardial infarction patients taking antithrombotics

    Olsen, Anne-Marie Schjerning; Lindhardsen, Jesper; Gislason, Gunnar H.;

    2015-01-01

    STUDY QUESTION: What is the effect of proton pump inhibitors (PPIs) on the risk of gastrointestinal bleeding in post-myocardial infarction patients taking antithrombotics and treated with non-steroidal anti-inflammatory drugs (NSAIDs)? METHODS: This was a nationwide cohort study based on linked...... plus antithrombotic therapy was estimated using adjusted time dependent Cox regression models. STUDY ANSWER AND LIMITATIONS: The use of PPIs was independently associated with decreased risk of gastrointestinal bleeding in post-myocardial infarction patients taking antithrombotics and treated...... gastrointestinal bleeds occurred. The crude incidence rates of bleeding (events/100 person years) on NSAID plus antithrombotic therapy were 1.8 for patients taking PPIs and 2.1 for those not taking PPIs. The adjusted risk of bleeding was lower with PPI use (hazard ratio 0.72, 95% confidence interval 0.54 to 0...

  9. Comparison of four technetium-99m radiopharmaceuticals for detection and localization of gastrointestinal bleeding in a sheep model

    Four Tc-99 radiopharmaceuticals, Tc-99m sulphur colloid, Tc-99m red blood cells (RBCs), Tc-99m mercaptoacetyltriglycine (MAG3), and Tc-99m DTPA, were studied in an experimental animal model for detection and localization of gastrointestinal (GI) bleeding site in both the upper and lower abdomen. With Tc-99m sulphur colloid and Tc-99m RBCs, it was possible to detect and localize the GI bleeding site in the lower abdomen. With Tc-99m MAG3, it was possible to visualize the bleeding site in both the upper and lower abdomen. However, Tc-99m MAG3 is partially excreted by the liver into the bile, hence it will be difficult to use Tc-99m MAG3 to localize the GI bleeding site in the lower abdomen. With Tc-99m DTPA, it was possible to detect and localize the GI bleeding site simultaneously in both upper and lower abdomen. The overall background radioactivity was reduced considerably by diuresis with frusemide and catheterization of the urinary bladder

  10. Detection of gastrointestinal bleeding by means of Tc99m-labelled red cells - methodology and results

    Bauer, R.; Kirchmann, K.; Flierdt, E. van de; Langhammer, H.R.; Pabst, H.W.

    1988-12-01

    Tc99m-labelled red cells were applied in 103 investigations of 91 patients to detect and localize occult gastrointestinal (GI) bleeding. In 60 examinations, GI-bleeding was proven. Correct localization of the bleeding site was achieved in 54 investigations. In 3 patients, bleeding from the lower intestinal tract could be positively excluded. These results were obtained in patients representing a negative selection, having undergone repeated endoscopy and angiography without positive result. 40% of all the bleeding sites were detected within 1 h. after tracer application, 25% only after a delay of 6 hrs. or more. To obtain good results, the whole investigation can become very time consuming and has to be performed according to a strict protocol. In addition, a tracer with high specificity to the intravasal space and high long-term stability has to be applied. Those requirements are met best by red cells labelled with Tc99m-according to a mixed in vivo/in vitro protocol.

  11. CT enterography in obscure gastrointestinal bleeding: a systematic review and meta-analysis

    The objective of this article is to provide a comprehensive and update overview of clinical application of CT enterography (CTE) in the evaluation of obscure gastrointestinal bleeding (OGIB). We performed a systematic review of relevant literatures in PubMed, EMBASE and The Cochrane Library and pooled the yield of CTE and the incremental yield (IY) of CTE over an alternate modality. A total of 18 studies (n=660) reported the yield of CTE in evaluating OGIB and the pooled yield was 40% (95% confidence interval (CI): 33–49%). Seven studies (n=279) compared the yield of CTE with capsule endoscopy (CE). The yield for CTE and CE for all findings was 34% and 53%, respectively (IY=−19%, 95% CI=−34% to −4%). When considering the types of identified lesions, the yield was significantly different for vascular and inflammatory lesions but not significantly different for neoplastic or other lesions. Two studies (n=63) compared the yield of CTE with double-balloon enteroscopy (DBE). The yield for CTE and DBE was 38% and 78%, respectively (IY=−40%, 95% CI=−55% to −25%). Three studies (n=49) compared the yield of CTE with digital subtraction angiography. The yield for CTE and digital subtraction angiography was 64% and 60%, respectively (IY=4%, 95% CI=−40% to 47%). CTE is an excellent diagnostic tool in patients with OGIB. It may play a complementary role to CE and can be used as a triage tool prior to DBE in evaluating OGIB.

  12. Comparative study of bacterial infection prevalence between cirrhotic patients with and without upper gastrointestinal bleeding

    Delvone Almeida

    2001-06-01

    Full Text Available Bacterial infection is a frequent complication in patients with chronic liver disease, mainly during the advanced stages. There is evidence that the main factors that contribute to a predisposition to infection in cirrhotic patients are related to hepatic failure with consequent immunodeficiency. Invasive procedures (diagnostic or therapeutic can predispose to bacterial infections, and upper gastrointestinal bleeding (UGB is considered a potentially important risk factor. A group of cirrhotic patients (child B and C Pugh groups were evaluated retrospectively by chart reviews regarding the prevalence of bacterial infection during hospitalization to determine whether UGB was a risk factor. An infection was considered present if a specific organ system was identified or if fever (>38ºC persisted for more than 24 hours with associated leukocytosis. Spontaneous bacterial peritonitis was based on classical criteria. Eighty-nine patients were evaluated. Fourty-six patients presented with UGB, and 43 patients had no UGB (control. There were infections recorded in 25/46 (54% patients with UGB, and 15/43 (35% in those without UGB (p=0.065. The ratio of the number of infections/admitted patients, was significantly larger in the group with UGB (0.78 ± 0.89 vs. 0.39 ± 0.62; p=0.028 since patients had more than one infection. In the UGB group compared to non UGB group, ascites was more frequent (67% vs. 42%; p=0.027; they were more likely to have undergone endoscopic procedures (p<0.001 and the mean ± SD for platelets count was smaller (96,114 ± 57,563 vs. 145,674 ± 104,083; p=0.007. The results show that UGB is an important contribution to bacterial infection among Child B and C cirrhotic patients.

  13. 肝硬化并发上消化道出血的急救与护理进展%The Process of First Aid and Nursing for Cirrhosis Complicated Upper Gastrointestinal Bleeding

    梁彩虹

    2014-01-01

    Upper gastrointestinal bleeding is a common clinical acute disease, and a major cause of mortality in patients with cirrhosis. This article would summarize the process of first aid and nursing for cirrhosis complicated upper gastrointestinal bleeding, investigate the aspects of first aid, medication nursing, diet nursing and psychological nursing for cirrhosis complicated upper gastrointestinal bleeding, in order to predictably observe the condition change of patients under the premise of actively cooperation of rescue, reduce the occurrence of secondary hepatic encephalopathy and infection after bleeding, prevent shock caused by hemorrhoea, and reduce the rebleeding rate of gastrointestinal bleeding and mortality as possible, to improve the quality of living of patients.%上消化道出血是临床常见急性病症,也是肝硬化患者的主要死亡原因之一。本文对肝硬化并发上消化道出血的急救与护理进展进行综述,讨论肝硬化并发上消化道出血的急救、用药护理、饮食护理、心理护理等方面内容,旨在积极配合抢救的前提下,同时预见性地观察患者病情变化,减少出血后继发肝性脑病和感染的发生,防止大出血而出现休克,尽可能降低消化道出血再出血率和死亡率,提高患者的生存质量。

  14. Acute Uterine Bleeding Unrelated to Pregnancy: A Southern California Permanente Medical Group Practice Guideline

    Munro, Malcolm G.

    2013-01-01

    Acute uterine bleeding unrelated to pregnancy has been defined as bleeding “sufficient in volume as to, in the opinion of the treating clinician, require urgent or emergent intervention.” The Southern California Permanente Medical Group updated its guidelines for the management of this condition on the basis of the best available evidence, as identified in a systematic review of the available literature. Given the paucity of studies evaluating this condition, the guidelines, by necessity, inc...

  15. Management of Adult Jehovah's Witness Patients with Acute Bleeding

    K. Berend; M. Levi

    2009-01-01

    Because of the firm refusal of transfusion of blood and blood components by Jehovah's Witnesses, the management of Jehovah's Witness patients with severe bleeding is often complicated by medical, ethical, and legal concerns. Because of a rapidly growing and worldwide membership, physicians working i

  16. Recurrent gastrointestinal bleeding diagnosed by delayed scintigraphy with Tc-99m-labeled red blood cells.

    Nwakanma, Lois; Meyerrose, Gary; Kennedy, Shalyn; Rakvit, Ariwan; Bohannon, Todd; Silva, Micheal

    2003-08-01

    A 56-year-old woman presented with bright-red blood from the rectum. Esophagogastroduodenoscopy revealed mild gastritis. Colonoscopy demonstrated diverticulosis without active bleeding, and in vitro tagged red blood cell scintigraphy was unremarkable. There was no further evidence of bleeding and the patient was discharged home. The patient returned with recurrent bright-red blood from the rectum. Although delayed scintigraphic images seldom demonstrate the site of bleeding, delayed images at 12 hours demonstrated active bleeding near the hepatic flexure in this patient. This was confirmed with selective mesenteric angiography, and was treated with coil embolization of the tertiary branches of the right middle colic artery. PMID:12897664

  17. Endovascular control of the acute bleeding in patients with advanced neoplasms of the neck

    Full text: Introduction: Advanced neoplastic processes in the neck can cause acute life-threatening bleeding. Source of the bleeding can be vessels from a tumor mass or invasion of the main cervical arterial vessels. Poor general condition of the patients and accompanying complications create additional difficulties in getting these situations under control. What you will learn: Endovascular embolization of acute bleeding from advanced cervical neoplasms requires detailed knowledge of anatomical structures in this area and precision equipment with the possibility of super selective catheterization of small caliber vessels. The presentation discusses the various embolization materials and possibilities for their application in the neck. The experience of 5 embolization sessions in 4 patients is presented. An important point is discussion of the possible complications and how to avoid them. Discussion: Acute bleeding from large tumor formation is often a real risk to the life of the patient. Getting these conditions under control usually postpones the poor prognosis of the main disease. Postembolization syndrome and postembolization tissue necrosis define the basic cares in the early and late period after such a procedure. Conclusion: Acute bleeding from advanced neoplastic processes in the neck offers a real challenge. For their successful mastery it is required certain technical skills, unconventional solutions and a wide range of materials for embolization. A multidisciplinary approach is required to view the specific care these patients need and the possible complications

  18. Hypertension and Life-Threatening Bleeding in Children with Relapsed Acute Myeloblastic Leukemia Treated with FLT3 Inhibitors.

    Yılmaz Karapınar, Deniz; Karadaş, Nihal; Önder Siviş, Zühal; Balkan, Can; Kavaklı, Kaan; Aydınok, Yeşim

    2015-09-01

    Experiences with new multikinase inhibitors are limited, especially in children. In this report we summarize our experience with 2 patients with relapsed acute myeloblastic leukemia (AML), one with FMS-like tyrosine kinase-3-internal tandem duplication mutation and the other with a single base mutation (D835Y). Both patients received sorafenib, one for 19 days and the other for 42 days, with clofarabine-including chemotherapy. One additionally received sunitinib for a total of 20 days. Both patients developed severe pancytopenia, hypertension, life-threatening bleedings from the gastrointestinal system, and, finally, intrapulmonary hemorrhage. Although both reached severe aplasia of the bone marrow without blastic infiltration, death occurred with neutropenic sepsis. PMID:25912283

  19. Hypertension and Life-Threatening Bleeding in Children with Relapsed Acute Myeloblastic Leukemia Treated with FLT3 Inhibitors

    Deniz Yılmaz Karapınar

    2015-09-01

    Full Text Available Experiences with new multikinase inhibitors are limited, especially in children. In this report we summarize our experience with 2 patients with relapsed acute myeloblastic leukemia (AML, one with FMS-like tyrosine kinase-3-internal tandem duplication mutation and the other with a single base mutation (D835Y. Both patients received sorafenib, one for 19 days and the other for 42 days, with clofarabine-including chemotherapy. One additionally received sunitinib for a total of 20 days. Both patients developed severe pancytopenia, hypertension, life-threatening bleedings from the gastrointestinal system, and, finally, intrapulmonary hemorrhage. Although both reached severe aplasia of the bone marrow without blastic infiltration, death occurred with neutropenic sepsis.

  20. Strongyloides stercoralis Hyperinfection Syndrome Presenting as Severe, Recurrent Gastrointestinal Bleeding, Leading to a Diagnosis of Cushing Disease.

    Yee, Brittany; Chi, Nai-Wen; Hansen, Lawrence A; Lee, Roland R; U, Hoi-Sang; Savides, Thomas J; Vinetz, Joseph M

    2015-10-01

    A 50-year-old male immigrant from Ethiopia presented for consultation after 3 years of hematochezia/melena requiring > 25 units of blood transfusions. Physical examination revealed severe proximal muscle wasting and weakness, central obesity, proptosis, and abdominal striae, accompanied by eosinophilia, elevated hemoglobin A1c, elevated 24-hour urinary cortisol, lack of suppression of 8 am cortisol levels by 1 mg dexamethasone, and inappropriately elevated random adrenocorticotropic hormone (ACTH) level. Histopathological examination of gastrointestinal biopsies showed large numbers of Strongyloides stercoralis, indicating Strongyloides hyperinfection. Treatment with 2 days of ivermectin led to resolution of gastrointestinal bleeding. This syndrome was due to chronic immunosuppression from a pituitary ACTH (corticotroph) microadenoma, of which resection led to gradual normalization of urine cortisol, improved glycemic control, resolution of eosinophilia, and no recurrence of infection. PMID:26195463

  1. Uso de octreotida na hemorragia digestiva alta secundária à hipertensão portal em pacientes pediátricos: experiência de um serviço terciário Uso de octreotide en la hemorragia digestiva alta secundaria a hipertensión portal en pacientes pediátricos: experiencia de un servicio terciario Octreotide for acute gastrointestinal bleeding secondary to portal hypertension in pediatric patients: experience of a tertiary center

    Daniela Gois Meneses

    2011-12-01

    ños, variación de 7 meses a 18,9 años, en el periodo de 1998 a 2006, en un hospital terciario universitario. El diagnóstico de hipertensión portal fue establecido por ultrasonografía y la cirrosis fue confirmada por la histología y clasificada respecto a la gravedad por el escore Child-Pugh. RESULTADOS: Las causas de la hipertensión portal fueron obstrucción extrahepática de la vena porta en 11/17 casos (64,7% y cirrosis hepática en 6/17 (35,3%. El sangramiento fue controlado en 14/17 pacientes (82,3%. El tiempo de infusión de la droga necesario para control del sangramiento fue semejante entre cirróticos y no cirróticos, pero la caída en los niveles de hemoglobina, el volumen transfusional requerido y el tiempo de internación fueron superiores en los pacientes con cirrosis, aunque sin diferencia estadística. Esas mismas variables no se modificaron respecto a los dos distintos esquemas de infusión de la droga: con dosis de ataque o iniciando con dosis de mantenimiento. Fracaso terapéutico fue observado con mayor frecuencia entre los pacientes cirróticos (33,3%. Hiperglucemia fue el único efecto secundario detectado durante la infusión. CONCLUSIONES: La administración de octreotide en niños y adolescentes con sangramiento digestivo por hipertensión portal fue segura y efectiva en el control del sangramiento agudo, independiente de la causa de la hipertensión portal y del esquema de infusión.OBJECTIVE: To describe clinical data of children and adolescents with portal hypertension, during with and without liver cirrhosis, treated with octreotide during episodes of acute upper gastrointestinal bleeding. METHODS: Retrospective and descriptive study of 26 episodes of gastrointestinal bleeding in 17 patients (mean age: 8.6 years; range: seven months to 18.9 years assisted at a tertiary university hospital from 1996 to 2006. Portal hypertension diagnosis was based on ultrasonography. Liver cirrhosis was confirmed by histology and hepatic function was

  2. Gastrointestinal bleeding due to large bowel infiltration by chronic lymphocytic leukaemia.

    Tucker, J.; Cachia, P. G.

    1986-01-01

    A 66 year old woman with a 9 year history of chronic lymphocytic leukaemia developed intermittent rectal bleeding for 9 months; sigmoidoscopic biopsy proved that this was due to large bowel infiltration by leukaemia. This is a very rare occurrence.

  3. Management of upper gastrointestinal bleeding from portal hypertension: Elective or emergency operation?

    Liu, Sen

    2014-01-01

    Objective : To evaluate the clinical outcome of emergency and elective operation of splenectomy with periesophagogastric devascularization in treating upper gastrointestinal hemorrhage resulted from portal hypertension. Methods : We retrospectively reviewed 219 patients of upper gastrointestinal hemorrhage resulted from portal hypertension treated using emergency or elective operation between Jul 2002 and Aug 2010. The clinical data were collected and analyzed. Results : In the group of elect...

  4. Etiology of gastrointestinal bleeding in elderly patients and nursing strategies%3042例上消化道出血患者病因分析及护理对策

    贺冬梅; 余莲英; 沈爱萍

    2012-01-01

    目的 探讨3042例上消化道出血患者的病因,并提出护理对策.方法 回顾性分析本院1991年3月~2009年3月3042例上消化道出血住院患者的病因,并提出对策.结果 消化性溃疡出血为上消化道出血的主要病因,占46.96%,其中十二指肠溃疡呈下降趋势;急性胃黏膜病变为上消化道出血的第2病因,占28.76%,呈上升趋势;年龄<60岁组患者十二指肠溃疡是上消化道出血的主要病因(占44.35%),年龄≥60岁组患者急性胃黏膜病变为上消化道出血的主要病因(41.21%).结论 消化性溃疡出血与急性胃黏膜病是上消化道出血的主要病因,其中十二指肠溃疡呈下降趋势,其也是年龄< 60岁组患者的主要病因;急性胃黏膜病变呈上升趋势,其也是年龄≥60岁患者的主要病因.在护理工作中,应针对不同年龄患者病因与疾病谱变化情况,开展针对性的健康教育,促进患者行为改变,从而达到防病、治病的目的.%Objective To explore the etiology of gastrointestinal bleeding in elderly patients and propose nursing strategies gastrointestinal bleeding. Method The histories of 3 042 inpatients with upper gastrointestinal bleeding in our hospital between March 1991 to March 2009 were retrospectively analyzed for detection of the etiological factors. Results The main etiological factors included peptic ulcer bleeding (46.96%) and acute gastric mucosal lesion (28.76%) gastrointestinal bleeding; duodenal ulcer (44.35%) in those aged less than 60 years group and the acute gastric mucosal lesion (41.21%) in those aged more than 60 years. Conclusions Acute gastric mucosal lesion and peptic ulcer bleeding are major etiological factors for upper gastrointestinal bleeding in elderly patients. In our nursing work, health education should be done according to the etiological factors and the disease spectrum change to reduce the incidence and mortality from upper gastrointestinal bleeding.

  5. 111In oxine labeled red cells for detection of simulated lower gastrointestinal bleeding in an animal model

    111In oxine in vitro labeled red cells were evaluated in rabbits for the ability to detect gastrointestinal (Gl) bleeding. A mean labeling efficiency of 81% (+- 15.5%) was achieved. Biodistribution and translocation data demonstrated 81% of the activity within the blood pool at four hours after intravenous injection, falling to 29% by 72 hours. Peak urine excretion occurred after 60 to 150 minutes. Normal Gl excretion was less than 1% over 72 hours. Simulated lower Gl bleeding was imaged at 4, 12, and 72 hours, and amounts as small as 2 ml (1% blood volume) were seen. In rabbits the total body dose of injected 111In is 0.15 mGy/MBq (0.56 rad/mCi), and the critical organ is the spleen, which received 0.49 mGy/MBq (1.82 rad/mCi). 111In oxine labeled red cells provide a sustained blood pool label wthout significant accumulation in the Gl tract, and may have a potential use in the detection of intermittent Gl bleeding in humans

  6. Can the vicious cycle of obscure or intractable gastrointestinal bleeding be broken in patients with atrial fibrillation subject to anticoagulant therapy?

    Fernández-Rodríguez, Diego; Martín-Yuste, Victoria; Feu, Faust; Brugaletta, Salvatore; Freixa, Xavier; Regueiro, Ander; Sabaté, Manel

    2014-05-01

    Gastrointestinal bleeding of obscure origin or with an intractable cause is particularly common in patients with atrial fibrillation subject to oral anticoagulant therapy. This condition is highly recurrent and therefore gives rise to high morbidity and mortality rates, thus entailing a vicious cycle that is difficult to solve.Percutaneous left atrial appendage closure has become a therapeutic alternative for patients with atrial fibrillation and a contraindication for oral anticoagulation. This technique would allow the discontinuation of oral anticoagulants, thus helping to reduce the risk for gastrointestinal bleeding, and would also be protective against embolic events in this group of patients, thereby eventually breaking this vicious cycle.We report our experience with percutaneous left atrial appendage closure in the management of patients with atrial fibrillation who are subject to oral anticoagulation therapy and suffer from obscure or intractable gastrointestinal bleeding. PMID:25287239

  7. The Impact of Vascular Access for In-Hospital Major Bleeding in Patients with Acute Coronary Syndrome at Moderate- to Very High-Bleeding Risk

    Park, Keun-Ho; Jeong, Myung Ho; Ahn, Youngkeun; Jung, Sang Sik; Kim, Moo Hyun; Yang, Hyoung-Mo; Yoon, Junghan; Rha, Seung Woon; Park, Keum Soo; Han, Kyoo Rok; Cho, Byung Ryul; Cha, Kwang Soo; Kim, Byung Ok; Hyon, Min Soo; Shin, Won-Yong

    2013-01-01

    The aim of our study was to determine the impact of vascular access on in-hospital major bleeding (IHMB) in acute coronary syndrome (ACS). We analyzed 995 patients with non-ST elevation myocardial infarction and unstable angina at the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) moderate- to very high-bleeding risk scores in trans-radial intervention (TRI) retrospective registry from 16 center...

  8. Acute syndrome of radiation: injuries to the gastrointestinal tract

    Acute syndrome of radiation: injuries to the gastrointestinal tract. Exposure to ionising radiation at medium to high doses results in the manifestation of mixed pathologies. Following the analysis of several radiation accidents it is clear that intestinal injury influences patient survival. However the appearance of the classically defined gastrointestinal syndrome is not always evident. Nevertheless injury to the gastrointestinal tract, in particular loss of barrier function, seems to play an important role in the development of Multiple Organ Failure such as reported in the recent accident at Tokai Mura. Ionising radiation overexposure results in changes in intestinal motility and nutrient, fluid and electrolyte absorption and secretion all which may contribute to the genesis of diarrhea. In addition to modified cellular transport properties for nutrients or electrolytes, important loss of epithelial cells is also a major contributing factor. Intestinal functions are controlled by many factors such as neurotransmitters, locally released mediators from endocrine cells or immunocompetent cells in addition to luminal agents. To date, treatment of radiation-induced gastrointestinal injury is mainly symptomatic. However treatments such as growth factors, anti-inflammatory cytokines as well as cellular transplantation remain to be validated in the radiation accident situation. (author)

  9. Acute gastrointestinal permeability responses to different non-steroidal anti-inflammatory drugs

    Smecuol, E; Bai, J.; Sugai, E; Vazquez, H.; Niveloni, S; Pedreira, S; Maurino, E; Meddings, J

    2001-01-01

    BACKGROUND AND AIMS—Non-steroidal anti-inflammatory drugs (NSAIDs) cause gastrointestinal damage both in the upper and lower gastrointestinal tract. New anti-inflammatory drugs have been developed in an attempt to improve their gastrointestinal side effect profile. Our objective was to compare the effect on gastrointestinal permeability of acute equieffective doses of four different NSAIDs; three were designed to reduce gastrointestinal mucosal injury.
MATERIALS—Healthy volunteers underwent s...

  10. Severe Gastrointestinal Bleeding in a Patient With Subvalvular Aortic Stenosis Treated With Thalidomide and Octreotide

    Hvid-Jensen, Helene S; Poulsen, Steen H; Agnholt, Jørgen S

    2015-01-01

    resolve bleeding, especially in patients with large numbers of angiodysplasias. In patients with aortic stenosis and GB, the main treatment is aortic valve replacement but the patients may be unfit to undergo surgery due to the complicating anemia. In this case story, we present a patient with severe, GB...... due to hypertrophic subvalvular obstructive cardiomyopathy. Endoscopic procedures with argon beaming were performed without effect on bleeding. The patient was treated with a combination of both thalidomide and octreotide. Within 3 months, the patient recovered from the anemia and was able to undergo...... transcoronary ethanol ablation. No further bleeding episodes occurred, and thalidomide and octreotide were arrested. To our knowledge, this case report is the first to describe how this new drug combination therapy is an effective treatment of GB from angiodysplasias and can be used to bridge to surgical or...

  11. Real-Time Bleeding Detection in Gastrointestinal Tract Endoscopic Examinations Video

    Adam Blokus

    2013-07-01

    Full Text Available The article presents a novel approach to medical video data analysis and recognition of bleedings.Emphasis has been put on adapting pre-existing algorithms dedicated to the detection of bleedings for realtimeusage in a medical doctor’s office during an endoscopic examination. A real-time system for analyzingendoscopic videos has been designed according to the most significant requirements of medical doctors.The main goal of the performed research was to establish the possibility of ensuring the necessaryperformance of a given class of algorithms to introduce the solution into real life diagnostics.The structures of two exemplary algorithms for bleeding detection have been analyzed to distinguish anddiscuss parallelization options. After applying them to the algorithms, the usage of a supercomputermultimedia processing platform allowed to acquire the throughput and latency values required for realtimeusage. Different configurations of the algorithms have been tested and their measured parametershave been provided and discussed.

  12. Hepatic artery stent-grafts for the emergency treatment of acute bleeding

    Bellemann, Nadine, E-mail: nadine.bellemann@med.uni-heidelberg.de [Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg (Germany); Sommer, Christof-Matthias; Mokry, Theresa; Kortes, Nikolas; Gnutzmann, Daniel; Gockner, Theresa; Schmitz, Anne [Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg (Germany); Weitz, Jürgen [Department of Surgery, University Hospital Heidelberg, INF 110, 69120 Heidelberg (Germany); Department for Visceral, Thoracic and Vascular Surgery at the University Hospital, Technical University Dresden (Germany); Kauczor, Hans-Ulrich; Radeleff, Boris; Stampfl, Ulrike [Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg (Germany)

    2014-10-15

    Highlights: • We report our experiences with stent-grafts for the treatment of acute hemorrhage from the hepatic artery or the stump of the gastroduodenal artery. • The technical success of stent-graft implantation was 88%. • The bleeding ceased immediately after stent-graft implantation in 88%. • The complication rate was 21%. - Abstract: Purpose: We evaluated the technical success and clinical efficacy of stent-graft implantation for the emergency management of acute hepatic artery bleeding. Methods: Between January 2010 and July 2013, 24 patients with hemorrhage from the hepatic artery were scheduled for emergency implantation of balloon expandable stent-grafts. The primary study endpoints were technical and clinical success, which were defined as successful stent-graft implantation with sealing of the bleeding site at the end of the procedure, and cessation of clinical signs of hemorrhage. The secondary study endpoints were complications during the procedure or at follow-up and 30-day mortality rate. Results: In 23 patients, hemorrhage occurred after surgery, and in one patient hemorrhage occurred after trauma. Eight patients had sentinel bleeding. In most patients (n = 16), one stent-graft was implanted. In six patients, two overlapping stent-grafts were implanted. The stent-grafts had a target diameter between 4 mm and 7 mm. Overall technical success was 88%. The bleeding ceased after stent-graft implantation in 21 patients (88%). The mean follow-up was 137 ± 383 days. In two patients, re-bleeding from the hepatic artery occurred during follow-up after 4 and 29 days, respectively, which could be successfully treated by endovascular therapy. The complication rate was 21% (minor complication rate 4%, major complication rate 17%). The 30-day mortality rate was 21%. Conclusions: Implantation of stent-grafts in the hepatic artery is an effective emergency therapy and has a good technical success rate for patients with acute arterial hemorrhage.

  13. Hepatic artery stent-grafts for the emergency treatment of acute bleeding

    Highlights: • We report our experiences with stent-grafts for the treatment of acute hemorrhage from the hepatic artery or the stump of the gastroduodenal artery. • The technical success of stent-graft implantation was 88%. • The bleeding ceased immediately after stent-graft implantation in 88%. • The complication rate was 21%. - Abstract: Purpose: We evaluated the technical success and clinical efficacy of stent-graft implantation for the emergency management of acute hepatic artery bleeding. Methods: Between January 2010 and July 2013, 24 patients with hemorrhage from the hepatic artery were scheduled for emergency implantation of balloon expandable stent-grafts. The primary study endpoints were technical and clinical success, which were defined as successful stent-graft implantation with sealing of the bleeding site at the end of the procedure, and cessation of clinical signs of hemorrhage. The secondary study endpoints were complications during the procedure or at follow-up and 30-day mortality rate. Results: In 23 patients, hemorrhage occurred after surgery, and in one patient hemorrhage occurred after trauma. Eight patients had sentinel bleeding. In most patients (n = 16), one stent-graft was implanted. In six patients, two overlapping stent-grafts were implanted. The stent-grafts had a target diameter between 4 mm and 7 mm. Overall technical success was 88%. The bleeding ceased after stent-graft implantation in 21 patients (88%). The mean follow-up was 137 ± 383 days. In two patients, re-bleeding from the hepatic artery occurred during follow-up after 4 and 29 days, respectively, which could be successfully treated by endovascular therapy. The complication rate was 21% (minor complication rate 4%, major complication rate 17%). The 30-day mortality rate was 21%. Conclusions: Implantation of stent-grafts in the hepatic artery is an effective emergency therapy and has a good technical success rate for patients with acute arterial hemorrhage

  14. Comparison of ACUITY and CRUSADE Scores in Predicting Major Bleeding during Acute Coronary Syndrome

    Luis C. L. Correia

    2015-07-01

    Full Text Available Background:The ACUITY and CRUSADE scores are validated models for prediction of major bleeding events in acute coronary syndrome (ACS. However, the comparative performances of these scores are not known.Objective:To compare the accuracy of ACUITY and CRUSADE in predicting major bleeding events during ACS.Methods:This study included 519 patients consecutively admitted for unstable angina, non-ST-elevation or ST-elevation myocardial infarction. The scores were calculated based on admission data. We considered major bleeding events during hospitalization and not related to cardiac surgery, according to the Bleeding Academic Research Consortium (BARC criteria (type 3 or 5: hemodynamic instability, need for transfusion, drop in hemoglobin ≥ 3 g, and intracranial, intraocular or fatal bleeding.Results:Major bleeding was observed in 31 patients (23 caused by femoral puncture, 5 digestive, 3 in other sites, an incidence of 6%. While both scores were associated with bleeding, ACUITY demonstrated better C-statistics (0.73, 95% CI = 0.63 - 0.82 as compared with CRUSADE (0.62, 95% CI = 0.53 - 0.71; p = 0.04. The best performance of ACUITY was also reflected by a net reclassification improvement of + 0.19 (p = 0.02 over CRUSADE’s definition of low or high risk. Exploratory analysis suggested that the presence of the variables ‘age’ and ‘type of ACS’ in ACUITY was the main reason for its superiority.Conclusion:The ACUITY Score is a better predictor of major bleeding when compared with the CRUSADE Score in patients hospitalized for ACS.

  15. Massive Lower Gastrointestinal Bleeding from Meckel’s Diverticulum with Heterotopic Pancreas: Case Report and a Brief Review of the Literature

    Xing Yang

    2013-05-01

    Full Text Available Context Heterotopic pancreas is defined as pancreatic tissue found out of the pancreas proper with no vascular or anatomical connection. It is a rare clinical entity and can be found at any portion of the alimentary system. Case report We describe a case of Meckel’s diverticulum with heterotopic pancreas who presented massive lower gastrointestinal bleeding. Conclusion Lower gastrointestinal bleeding due to Meckel’s diverticulum with heterotopic pancreas is extremely difficult to make a definitive diagnosis preoperatively especially when it onsets rapidly.

  16. [Antisecretory therapy as a component of hemostasis in acute gastroduodenal ulcer bleedings].

    Gostishchev, V K; Evseev, M A

    2005-01-01

    Results of antisecretory therapy (pyrenzepin, H(2)-blockers, inhibitors of proton pump, octreotid) in 962 patients with acute gastroduodenal ulcer bleedings (AGDUB) were analyzed over 14-years period. Antisecretory treatment in AGDUB has principally different goals and potential depending on risk of bleeding's recurrence and morphological changes in tissue of gastroduodenal ulcer. Antisecretory therapy is the main treatment in high risk of AGDUB recurrence or before urgent surgery. Intravenous infusion of omeprazol has demonstrated the highest clinical efficacy due to maximal inhibition of gastric secretion and absence of negative influences on oxygen regimen in tissue of ulcer. PMID:16091681

  17. Is Occult Obscure Gastrointestinal Bleeding a Definite Indication for Capsule Endoscopy? A Retrospective Analysis of Diagnostic Yield in Patients with Occult versus Overt Bleeding

    Ikue Watari

    2013-01-01

    Full Text Available Background/Aim. Usefulness of capsule endoscopy (CE for diagnosing small-bowel lesions in patients with obscure gastrointestinal bleeding (OGIB has been reported. Most reports have addressed the clinical features of overt OGIB, with few addressing occult OGIB. We aimed to clarify whether occult OGIB is a definite indication for CE. Methods. We retrospectively compared the cases of 102 patients with occult OGIB and 325 patients with overt OGIB, all having undergone CE. The diagnostic yield of CE and identification of various lesion types were determined in cases of occult OGIB versus overt OGIB. Results. There was no significant difference in diagnostic yield between occult and overt OGIB. The small-bowel lesions in cases of occult OGIB were diagnosed as ulcer/erosive lesions (n=18, 18%, vascular lesions (n=11, 11%, and tumors (n=4, 3%, and those in cases of overt OGIB were diagnosed as ulcer/erosive lesions (n=51, 16%, vascular lesions (n=31, 10%, and tumors (n=20, 6%. Conclusion. CE detection rates and CE identification of various small-bowel diseases do not differ between patients with occult versus overt OGIB. CE should be actively performed for patients with either occult or overt OGIB.

  18. Severe Gastrointestinal Bleeding in a Patient With Subvalvular Aortic Stenosis Treated With Thalidomide and Octreotide: Bridging to Transcoronary Ablation of Septal Hypertrophy.

    Hvid-Jensen, Helene S; Poulsen, Steen H; Agnholt, Jorgen S

    2015-11-01

    Gastrointestinal bleeding (GB) due to angiodysplasias can cause severe, recurrent bleeding, especially in elderly patients. Angiodysplastic bleedings in the gastrointestinal tract have been associated with aortic stenosis and, more recently, hypertrophic obstructive cardiomyopathy, caused by an acquired coagulopathy known as Heyde's syndrome. Multiple factors are involved in the pathogenesis of angiodysplastic bleeding including genetic factors and increased levels of vascular intestinal growth factor at tissue levels. Endoscopic coagulation therapy is the primary treatment but often fails to resolve bleeding, especially in patients with large numbers of angiodysplasias. In patients with aortic stenosis and GB, the main treatment is aortic valve replacement but the patients may be unfit to undergo surgery due to the complicating anemia. In this case story, we present a patient with severe, GB due to hypertrophic subvalvular obstructive cardiomyopathy. Endoscopic procedures with argon beaming were performed without effect on bleeding. The patient was treated with a combination of both thalidomide and octreotide. Within 3 months, the patient recovered from the anemia and was able to undergo transcoronary ethanol ablation. No further bleeding episodes occurred, and thalidomide and octreotide were arrested. To our knowledge, this case report is the first to describe how this new drug combination therapy is an effective treatment of GB from angiodysplasias and can be used to bridge to surgical or endovascular treatment. PMID:26491506

  19. Cambios en la etiología, resultados y características de los pacientes con hemorragia digestiva aguda grave a lo largo del periodo 1999-2005 Changes in the etiology, outcome, and characteristics of patients with acute gastrointestinal bleeding between 1999 and 2005

    A. Garrido

    2007-05-01

    Full Text Available Objetivos: analizar la evolución, a lo largo del periodo 1999-2005, de las siguientes variables de los pacientes ingresados por hemorragia digestiva (HD en una Unidad de Sangrantes: etiología, patología de base, consumo de AINE/anticoagulación y mortalidad. Material y métodos: durante el periodo 1999-2005 se ha estudiado la evolución de las siguientes causas de HD que requirieron ingreso en la Unidad de Sangrantes: ulcus duodenal (UD, ulcus gástrico (UG, hipertensión portal (HPT y otros. De igual forma se ha analizado la evolución en el porcentaje de enfermos ingresados con patología de base, consumo de fármacos AINE/anticoagulantes y mortalidad. Resultados: se han incluido 1.611 pacientes en el estudio con una edad media de 60,45 años (59,7-61,2, 76,41% hombres (74,3-78,5. La UD fue responsable del 22,20% de episodios (20,2-24,3, la UG del 18,40% (16,6-20,4 y la HPT del 33,60% (31,3-36,0. De forma global realizaban tratamiento con AINE el 34,5% (32,6-37,3, anticoagulación el 7,1% (6,0-8,6, presentaban patología de base el 72,6% (70,4-74,8 y la mortalidad global fue del 6,27% (5,16-7,59. A lo largo del periodo estudiado se constató un aumento de los pacientes con patología de base (p Objectives: to analyze the evolution of the following variables in patients admitted to a Blood Unit for gastrointestinal bleeding throughout 1999-2005: etiology, comorbid diseases, use of NSAIDs/anticoagulants, and mortality. Material and methods: we analyzed the evolution of the following causes of GIB that required admission to the Blood Unit from 1999 to 2005: duodenal ulcer (DU, gastric ulcer (GU, portal hypertension (PHT, and others. We also analyzed changes in the percentage of patients admitted with comorbid disease, use of NSAIDs/anticoagulants, and mortality. Results: 1,611 patients with a mean age of 60.45 years (59.7-61.2 were included in this study; 76.41% were males (74.3-78.5. DU was the cause of bleeding in 22.20% of cases (20

  20. Validation of the Glasgow-Blatchford Scoring System to predict mortality in patients with upper gastrointestinal bleeding in a hospital of Lima, Peru (June 2012-December 2013

    Alessandra Cassana

    2015-08-01

    Full Text Available Background and aim: Upper gastrointestinal bleeding is a major cause of hospitalization and the most prevalent emergency worldwide, with a mortality rate of up to 14%. In Peru, there have not been any studies on the use of the Glasgow-Blatchford Scoring System to predict mortality in upper gastrointestinal bleeding. The aim of this study is to perform an external validation of the Glasgow-Blatchford Scoring System and to establish the best cutoff for predicting mortality in upper gastrointestinal bleeding in a hospital of Lima, Peru. Methods: This was a longitudinal, retrospective, analytical validation study, with data from patients with a clinical and endoscopic diagnosis of upper gastrointestinal bleeding treated at the Gastrointestinal Hemorrhage Unit of the Hospital Nacional Edgardo Rebagliati Martins between June 2012 and December 2013. We calculated the area under the curve for the receiver operating characteristic of the Glasgow-Blatchford Scoring System to predict mortality with a 95% confidence interval. Results: A total of 339 records were analyzed. 57.5% were male and the mean age (standard deviation was 67.0 (15.7 years. The median of the Glasgow-Blatchford Scoring System obtained in the population was 12. The ROC analysis for death gave an area under the curve of 0.59 (95% CI 0.5-0.7. Stratifying by type of upper gastrointestinal bleeding resulted in an area under the curve of 0.66 (95% CI 0.53-0.78 for non-variceal type. Conclusions: In this population, the Glasgow-Blatchford Scoring System has no diagnostic validity for predicting mortality.

  1. State-of-the-art management of acute bleeding peptic ulcer disease

    Hisham Al Dhahab

    2013-01-01

    Full Text Available The management of patients with non variceal upper gastrointestinal bleeding has evolved, as have its causes and prognosis, over the past 20 years. The addition of high-quality data coupled to the publication of authoritative national and international guidelines have helped define current-day standards of care. This review highlights the relevant clinical evidence and consensus recommendations that will hopefully result in promoting the effective dissemination and knowledge translation of important information in the management of patients afflicted with this common entity.

  2. Experience in Diagnosis and Treatment of Bleeding Complications in Severe Acute Pancreatitis by TAE

    2005-01-01

    The experience in diagnosis and treatment of bleeding complications in severe acute pancreatitis (SAP) by transcatheter arterial embolization was summarized. The clinical data of 19 SAP patients complicated with intra-abdominal bleeding in our hospital from Jan. 2000 to Jan. 2003 were analyzed retrospectively and the therapeutic outcome of TAE was evaluated statistically. The results showed that the short-term successful rate of hemostasis by TAE was 89.5 % (17/19), the incidence of re-bleeding after TAE was 36.8 % (7/19) and the successful rate of hemostatis by second TAE was 71.4 % (5/7). It was concluded that the intra-abdominal bleeding in SAP was mainly caused by the rupture of erosive/infected pseudoaneurysm. Mostly, the broken vessels were splenic artery and gastroduodenal artery. In terms of emergence hemostatis, TAE is the most effective method. Surgical hemostasis is necessary if hemostasis by TAE is failed or re-bleeding occurs after TAE.

  3. THE ROLE OF COLORECTAL POLYPS IN THE ETIOLOGY OF LOWER GASTRO-INTESTINAL BLEEDING IN CHILDREN

    Claudia OLARU

    2015-12-01

    Full Text Available In children, colorectal polyps most commonly present with rectal bleeding. The aim of this study was to establish some correlations between clinical, endoscopic/histopathological aspects and therapeutic options in pediatric colorectal polyps. The experimental group included 253 children aged between 1 and 18 years, patients being included based on the presence of rectal bleeding associated with abdominal pain and/or constipation, established through colonoscopic examination. 39 polyps were identified: 37 with single lesions and 2 with multiple lesions. The solitary polyps, located mostly in the rectum and sigmoid, having sizes between 1 and 2.5 cm, were removed during the same colonoscopy. Pathology showed inflammatory aspects and two cases of hamartomatous polyps in a Peutz-Jeghers and a Bannayan-Ryley syndrome. Colonoscopy should routinely be recommended in children with suspected polyps; in multiple lesions, periodic surveillance by colonoscopy and histology is mandatory.

  4. Tc-99m Labeled Red Blood Cell by Ultra Tag RBC Kit in Patients Suspected of Gastrointestinal Bleeding

    Twenty patients suspected of gastrointestinal bleeding who underwent Tc-99m labeled red blood cell (RBC) by ultraTag RBC kit at Division of Nuclear Medicine, Bumrungrad Hospital between January 2000 and December 2002 were studied. The histories of patients together with either endoscopic results or angiographic findings or pathological reports were used as gold standards. Two by Two decision matrix was used for data analysis and the sensitivity together with specificity were calculated. The results show that the sensitivity and specificity of Tc-99m labeled RBC by ultraTag RBC kit are 87.5% and 91.7%, respectively. We conclude that Tc-99m labeled RBC by ultraTag RBC kit gives high percentages of sensitivity and specificity. Moreover, the image quality is improved because of the absence of free Tc-99m pertechnetate uptake in the stomach in all patients

  5. Peptic ulcers accompanied with gastrointestinal bleeding, pylorus obstruction and cholangitis secondary to choledochoduodenal fistula: A case report

    XI, BIN; JIA, JUN-JUN; LIN, BING-YI; GENG, LEI; ZHENG, SHU-SEN

    2016-01-01

    Peptic ulcers are an extremely common condition, usually occurring in the stomach and proximal duodenum. However, cases of peptic ulcers accompanied with multiple complications are extremely rare and hard to treat. The present case reinforces the requirement for the early recognition and correct treatment of peptic ulcers accompanied with multiple complications. A 67-year-old man presented with recurrent abdominal pain, fever and melena. The laboratory results showed anemia (hemoglobin 62 g/l) and hypoproteinemia (23 g/l). Abdominal imaging examinations revealed stones in the gallbladder and right liver, with air in the dilated intrahepatic and extrahepatic bile ducts. Endoscopic retrograde cholangiopancreatography failed due to a deformed pylorus. The patient was finally diagnosed with peptic ulcers accompanied with gastrointestinal (GI) bleeding, pylorus obstruction and cholangitis secondary to a choledochoduodenal fistula during an emergency pancreatoduodenectomy, which was performed due to a massive hemorrhage of the GI tract. The patient recovered well after the surgery. PMID:26870237

  6. Severe gastrointestinal tract bleeding in a two-month-old infant due to congenital intrahepatic arterioportal fistula

    Aarts, R. [Department of Radiology, University Medical Center St. Radboud, P.O. Box 9101, 6500 HB Nijmegen (Netherlands); Ijland, M.M. [Department of Pediatrics, University Medical Center St. Radboud, P.O. Box 9101, 6500 HB Nijmegen (Netherlands); Blaauw, I. de [Department of Pediatric Surgery, University Medical Center St. Radboud, P.O. Box 9101, 6500 HB Nijmegen (Netherlands); Hoogeveen, Y. [Department of Radiology, University Medical Center St. Radboud, P.O. Box 9101, 6500 HB Nijmegen (Netherlands); Boetes, C. [Department of Radiology, University Medical Center St. Radboud, P.O. Box 9101, 6500 HB Nijmegen (Netherlands)]. E-mail: C.Boetes@rad.umcn.nl; van Proosdij, M. [Department of Radiology, University Medical Center St. Radboud, P.O. Box 9101, 6500 HB Nijmegen (Netherlands)

    2006-07-15

    A 2-month-old boy was referred for assessment of severe upper gastrointestinal tract bleeding and melena. On physical examination, a continuous murmur was heard over the right upper quadrant of the abdomen. A splenomegaly and dilated veins were also noted on the abdominal wall. Liver functions were normal. There was no history of trauma or jaundice. Doppler ultrasonography, magnetic resonance arteriography and angiography suggested the presence of an intrahepatic arteriovenous fistula between the phrenic artery and the portal vein. Management consisted of successful embolization by coiling of the phrenic artery. To our knowledge this is the first documented case report of a congenital fistula between the phrenic artery and the portal vein.

  7. Regional and temporal variations in coding of hospital diagnoses referring to upper gastrointestinal and oesophageal bleeding in Germany

    Garbe Edeltraut

    2011-08-01

    Full Text Available Abstract Background Health insurance claims data are increasingly used for health services research in Germany. Hospital diagnoses in these data are coded according to the International Classification of Diseases, German modification (ICD-10-GM. Due to the historical division into West and East Germany, different coding practices might persist in both former parts. Additionally, the introduction of Diagnosis Related Groups (DRGs in Germany in 2003/2004 might have changed the coding. The aim of this study was to investigate regional and temporal variations in coding of hospitalisation diagnoses in Germany. Methods We analysed hospitalisation diagnoses for oesophageal bleeding (OB and upper gastrointestinal bleeding (UGIB from the official German Hospital Statistics provided by the Federal Statistical Office. Bleeding diagnoses were classified as "specific" (origin of bleeding provided or "unspecific" (origin of bleeding not provided coding. We studied regional (former East versus West Germany differences in incidence of hospitalisations with specific or unspecific coding for OB and UGIB and temporal variations between 2000 and 2005. For each year, incidence ratios of hospitalisations for former East versus West Germany were estimated with log-linear regression models adjusting for age, gender and population density. Results Significant differences in specific and unspecific coding between East and West Germany and over time were found for both, OB and UGIB hospitalisation diagnoses, respectively. For example in 2002, incidence ratios of hospitalisations for East versus West Germany were 1.24 (95% CI 1.16-1.32 for specific and 0.67 (95% CI 0.60-0.74 for unspecific OB diagnoses and 1.43 (95% CI 1.36-1.51 for specific and 0.83 (95% CI 0.80-0.87 for unspecific UGIB. Regional differences nearly disappeared and time trends were less marked when using combined specific and unspecific diagnoses of OB or UGIB, respectively. Conclusions During the study

  8. Performance of New Thresholds of the Glasgow Blatchford Score in Managing Patients With Upper Gastrointestinal Bleeding

    Laursen, Stig B; Dalton, Harry R; Murray, Iain A; Michell, Nick; Johnston, Matt R; Schultz, Michael; Hansen, Jane M; Schaffalitzky de Muckadell, Ove B; Blatchford, Oliver; Stanley, Adrian J

    2015-01-01

    BACKGROUND & AIMS: Upper gastrointestinal hemorrhage (UGIH) is a common cause of hospital admission. The Glasgow Blatchford score (GBS) is an accurate determinant of patients' risk for hospital-based intervention or death. Patients with a GBS of 0 are at low risk for poor outcome and could be...

  9. Validation of the Rockall scoring system for outcomes from non-variceal upper gastrointestinal bleeding in a Canadian setting

    Robert A Enns; Yves M Gagnon; Alan N Barkun; David Armstrong; Jamie C Gregor; Richard N Fedorak

    2006-01-01

    AIM: To validate the Rockall scoring system for predicting outcomes of rebleeding, and the need for a surgical procedure and death.METHODS: We used data extracted from the Registry of Upper Gastrointestinal Bleeding and Endoscopy including information of 1869 patients with non-variceal upper gastrointestinal bleeding treated in Canadian hospitals.Risk scores were calculated and used to classify patients based on outcomes. For each outcome, we used x2 goodness-of-fit tests to assess the degree of calibration,and built receiver operating characteristic curves and calculated the area under the curve (AUC) to evaluate the discriminative ability of the scoring system.RESULTS: For rebleeding, the x2 goodness-of-fit test indicated an acceptable fit for the model [x2 (8) = 12.83,P = 0.12]. For surgical procedures [x2 (8) = 5.3, P = 0.73]and death [x2 (8) = 3.78, P = 0.88], the tests showed solid correspondence between observed proportions and predicted probabilities. The AUC was 0.59 (95% CI:0.55-0.62) for the outcome of rebleeding and 0.60 (95% CI: 0.54-0.67) for surgical procedures, representing a poor discriminative ability of the scoring system. For the outcome of death, the AUC was 0.73 (95% CI: 0.69-0.78),indicating an acceptable discriminative ability.CONCLUSION: The Rockall scoring system provides an acceptable tool to predict death, but performs poorly for endpoints of rebleeding and surgical procedures.

  10. Massive upper gastrointestinal bleeding due to esophago- thyroidal artery fistula following foreign body aspiration: a case report

    Bagheri R.

    2007-10-01

    Full Text Available Background: Immediate treatment when an esophageal foreign body is suspected is critical because of the possibility of serious complications. The presence of foreign bodies in the esophagus usually occurs accidentally in children and mentally retarded adults. A greater risk of perforation of the esophagus, development of a mediastinal, as well as airway compromise is present when a foreign body is lodged longer than 24 hours. Furthermore, this condition results in complications, such as hemorrhage or esophageal fistula, when treatment is delayed. We herein report a case of esophageo-thyroidal artery fistula, a rare complication resulting from the delayed removal of an esophageal foreign body. Patient presentation: A 34 year-old female who had swallowed her dental prosthesis one week previously was referred for severe gastrointestinal bleeding. Surgery to remove the foreign body was performed. To determine the cause of continued bleeding after the endoscopy and angiography, we performed a neck exploration, which revealed hemorrhage from a fistula between thyroid vessels and the esophagus. After surgical resection of the fistula, the patient was discharged from the hospital in good condition and has had no related problems for six months.Conclusions: Considering the complications resulting from the delay of the removal of foreign bodies from the esophagus, these objects should be removed as soon as possible.

  11. Huge bilateral polycystic kidneys with suspicion of malignancy, recurrent bleeding in cysts, and acute abdomen

    Bhatty, TAN; Moazin, MS; Haque, R.

    2012-01-01

    We present a case of huge bilateral polycystic kidneys, with suspicion of malignancy and repeated admissions with acute abdomen, secondary to bleeding in cysts, and anaemia, requiring affected side nephrectomy. Key message Autosomal dominant polycystic kidney disease (ADPKD) mostly ends up with end stage renal disease (ESRD), requiring haemodialysis, with increased risk of malignancy and enlargement of kidneys with its associated complications, mostly dealt with conservatively, except maligna...

  12. New Evidence on the Impact of Antithrombotics in Patients Submitted to Small Bowel Capsule Endoscopy for the Evaluation of Obscure Gastrointestinal Bleeding

    Pedro Boal Carvalho

    2014-01-01

    Full Text Available Objectives. Small bowel capsule endoscopy (SBCE plays a decisive role in the obscure gastrointestinal bleeding (OGIB diagnosis. Antithrombotics may increase bleeding risk in patients with preexistent lesions or through direct mucosal aggression. We aimed to correlate antithrombotics usage with lesions with bleeding potential found in SBCE. Methods. Retrospective single-center study including 274 consecutive SBCE performed over 7 years for OGIB. The lesions were classified as P0 (no bleeding potential, P1 (uncertain bleeding potential: erosions, and P2 (high bleeding potential: angioectasias, ulcers, and tumors. We assessed antiplatelet and anticoagulant drug use during the 60 days preceding SBCE. Results. One-third of the patients were under antithrombotic therapy. The diagnostic yield of SBCE for P2 lesions was 30.0%. Angioectasias (20.4% were the most frequently observed lesions. There was a significant correlation between anticoagulant drug use and a higher incidence of P2 lesions in the small bowel (43.2% versus 26.5%; OR = 2.11, P=0.026. We found no significant correlation between antiplatelets and lesions with bleeding potential in SBCE. Conclusions. Small bowel lesions with high bleeding potential were more frequently detected when the patient was on anticoagulant drugs, resulting in a twofold risk. Antiplatelet drugs were not associated with small bowel lesions.

  13. Successful treatment of bleeding gastro-intestinal angiodysplasia in hereditary haemorrhagic telangiectasia with thalidomide

    Alam, Mohamed Aftab; Sami, Sarmad; Babu, Sathish

    2011-01-01

    Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterised by epistaxis, cutaneous telangiectasia and visceral arterio-venous malformations (AVMs). It affects approximately one in 5000 people. Control of sustained and repeated haemorrhages from telangiectasias in the nose and gut in patients who may be transfusion dependent is clinically challenging. After repeated endoscopic coagulations, multiple lesions often recur at other sites of gastro-intestinal tract...

  14. Hemorragia digestiva baja masiva en pacientes con enfermedad de Crohn Major acute bleeding in patients with Crohn's disease

    M. Barreiro de Acosta

    2007-07-01

    Full Text Available Objetivo: analizar la frecuencia de las hemorragias masivas en la EC e intentar determinar sus potenciales factores de riesgo (ambientales, propios de la enfermedad y genéticos. Material y métodos: se estudió de manera retrospectiva una cohorte de 174 pacientes -103 mujeres (59% y 71 hombres (41%, edad media de 37 años- con EC, analizándose las hemorragias digestivas masivas que se habían producido en relación con su enfermedad. Se revisaron asimismo potenciales factores de riesgo como hábito tabáquico, localización de la enfermedad y presencia de mutaciones genéticas en CARD15, RTL-4 y CD14, entre otros. Resultados: tres pacientes (1,7% presentaron una hemorragia digestiva masiva que precisó intervención quirúrgica para su resolución. Esta indicación de cirugía supone el 3,4% de las cirugías en relación con la EC. Todos los pacientes eran jóvenes y su enfermedad seguía un patrón inflamatorio y estaba localizada en el íleon. No se ha evidenciado asociación estadísticamente significativa entre las hemorragias digestivas masivas y los potenciales factores de riesgo analizados. Conclusiones: la hemorragia digestiva baja masiva es una complicación poco común, aunque grave de la EC. Se trata habitualmente de pacientes con patrón inflamatorio de la enfermedad y afectación ileal. Para su diagnóstico resulta clave la asociación de endoscopia y arteriografía, y su resolución suele ser quirúrgica.Objective: we aimed at evaluating the frequency of acute severe bleeding in CD and its potential association to some risk factors, including clinical features of CD, environmental factors, and genetic alterations. Material and methods: 174 consecutive patients with CD (103 female (59% and 71 men (41%, with a mean age of 37 years were included. We analyzed all major acute lower gastrointestinal (GI hemorrhage related to CD. Potential risk factors like smoking, site of disease, and presence of gene mutations in CARD15, TLR-4, and

  15. Determination of frequency and treatment outcome in patients of fundal varices presenting with upper gastrointestinal bleeding

    Objective: To determine the frequency of fundal varices and treatment outcome with histoacryl in patients presenting with upper GI bleeding. Design: Single centre, retrospective study. Place and duration of study: Military Hospital Rawalpindi from Jan 2009 to July 2011. Methods: Total 1327 patients were included in the study. In 41(3.1%) patients fundal varices were diagnosed on upper GI endoscopy. The mean age of the patients was 48.1+-16.96 years. Minimum age was 12 years and maximum age was 85 years. Out of 41 patients 29 (70.73%) were male and 12 (29.3%) were female. GOV1 was seen in 28 (68.3%) patients, GOV2 in 10 (24.4%) patients, IGV1 in 2 (4.87%) patients, and IGV2 in 1 patient (2.43%). Conclusion: The frequency of fundal varices in our study was 3.1%, diagnosed on upper GI endoscopy. N-butyl-2-cyanoacrylate sclerotherapy was found to be highly effective for the treatment of active bleeding gastric varices. (author)

  16. X-ray diagnostic features of acute bleeding ulcers of the stomach and duodenum

    The paper is based on the analysis of clinical, X-ray, and morphological studies in 74 patients with massive gastrointestinal hemorrhage. The paper presents the specific features of X-ray studies of patients with bleeding gastroduodenal ulcers. X-ray studies shout be twice performed in these patients. The first study is conducted if gastroscopic findings are unclear, the repeated one is carried out while assessing changes in disease regression. X-ray diagnosis of bleeding ulcers is determined by their sites and the nature of an ulcerous process. The X-ray diagnosis of chronic callous gastric ulcers accompanied by hemorrhage was based on the detection of two direct symptoms of a niche on the gastric outlines and configuration and an inflammatory mound on the gastric outline and configuration. That of chronic bleeding ulcers of the duodenal bulb is based not only on searches niche, but other signs of the disease - the deformed organ, and the magnitude of a periprocess. 10 refs., 5 figs

  17. Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding? ¿Tiene aún sentido la enteroscopia intraoperatoria en pacientes con hemorragia gastrointestinal de origen oscuro?

    Pedro Monsanto

    2012-04-01

    Full Text Available Background: in 21st century, endoscopic study of the small intestine has undergone a revolution with capsule endoscopy and balloon-assisted enteroscopy. The difficulties and morbidity associated with intraoperative enteroscopy, the gold-standard in the 20th century, made this technique to be relegated to a second level. Aims: evaluate the actual role and assess the diagnostic and therapeutic value of intraoperative enteroscopy in patients with obscure gastrointestinal bleeding. Patients and methods: we conducted a retrospective study of 19 patients (11 males; mean age: 66.5 ± 15.3 years submitted to 21 IOE procedures for obscure GI bleeding. Capsule endoscopy and double balloon enteroscopy had been performed in 10 and 5 patients, respectively. Results: with intraoperative enteroscopy a small bowel bleeding lesion was identified in 79% of patients and a gastrointestinal bleed-ing lesion in 94%. Small bowel findings included: angiodysplasia (n = 6, ulcers (n = 4, small bowel Dieulafoy's lesion (n = 2, bleed-ing from anastomotic vessels (n = 1, multiple cavernous hemangiomas (n = 1 and bleeding ectopic jejunal varices (n = 1. Agreement between capsule endoscopy and intraoperative enteroscopy was 70%. Endoscopic and/or surgical treatment was used in 77.8% of the patients with a positive finding on intraoperative enteroscopy, with a rebleeding rate of 21.4% in a mean 21-month follow-up period. Procedure-related mortality and postoperative complications have been 5 and 21%, respectively. Conclusions: intraoperative enteroscopy remains a valuable tool in selected patients with obscure GI bleeding, achieving a high diagnostic yield and allowing an endoscopic and/or surgical treatment in most of them. However, as an invasive procedure with relevant mortality and morbidity, a precise indication for its use is indispensable.

  18. An unusual cause of overt gastrointestinal bleeding in a malnourished child.

    Zanwar, Vinay G; Pawar, Sunil V; Jain, Samit S; Rathi, Surabhi P; Contractor, Qais Q; Rathi, Pravin M

    2016-04-01

    Trichuris trichiura (T. Trichiura) is a known parasite infestation among tropical children. Humans acquire Trichuriasis infection after ingestion of embryonated eggs via contaminated food or water. Most of them are asymptomatic. A severe form of trichuris infestation is known as Trichuris dysentery syndrome (TDS). It manifests as mucous diarrhoea, bleeding, malnutrition and stunting, or even life-threatening anaemia. We are reporting an interesting case of a 7-year-old girl who presented with bloody diarrhoea for 2 years. Her growth was stunted as she was not gaining weight. Severe inflammatory bowel disease was suspected clinically. Physical examination revealed marked pallor, pedal oedema and koilonychia along with sparse and hypopigmented hair. On evaluationT. Trichiurahelminths were seen on stool examination and massive worm load was visualised directly on colonoscopy. A diagnosis of TDS was made. She was successfully treated with oral Albendazole (400 mg) and blood transfusion. PMID:26264463

  19. Emergency Pancreatoduodenectomy with Preservation of Gastroduodenal Artery for Massive Gastrointestinal Bleeding due to Duodenal Metastasis by Clear Cell Renal Cell Carcinoma in a Patient with Celiac Artery Stenosis

    Kyriakos Neofytou

    2014-01-01

    Full Text Available Duodenal metastasis from renal cell carcinoma is rare, and even rarer is a massive gastrointestinal bleeding from such tumours. Coeliac occlusive disease, although rarely symptomatic, can lead to ischaemic changes with anastomotic dehiscence and leaks when a patient undergoes pancreatoduodenectomy. A 41-year-old man with known metastasis to the adrenal glands and the second part of the duodenum close to the ampulla of Vater from clear cell renal cell carcinoma was admitted to our department due to massive gastrointestinal bleeding from the duodenal metastasis. Endoscopic control of the bleed was not possible, while the bleeding vessel embolization was able to control the haemorrhage only temporarily. An angiography during the embolization demonstrated the presence of stenosis of the coeliac artery and also hypertrophic inferior pancreaticoduodenal arteries supplying the proper hepatic artery via the gastroduodenal artery (GDA. The patient underwent emergency pancreatoduodenectomy with preservation of the gastroduodenal artery. The patient had an uneventful recovery and did not experience further bleeding. Also the blood flow to the liver was compromised as shown by the normal liver function tests (LFTs postoperatively. To the best of our knowledge, this is the first report of a preservation of the GDA during an emergency pancreatoduodenectomy.

  20. Onyx (ethylene-vinyl-alcohol-copolymer). A novel approach to the endovascular treatment of acute bleeding

    Purpose: The purpose of our retrospective study was to determine the feasibility and efficacy of the endovascular embolization of peripheral acute arterial hemorrhage using Onyx. Materials and Methods: Between October 2003 and February 2007, 14 patients with acute arterial bleeding underwent percutaneous arterial embolization using Onyx. Bleeding was caused by iatrogenic vessel injury (6 patients), malignancy/inflammation (5 patients) and trauma (3 patients). Hematomas were located in the pelvis (5 patients), followed by liver (3 patients), retroperitoneal space (2 patients), thorax (2 patients), pancreas (1 patient), and thigh (1 patient). The number of embolized arteries, the volume and viscosity of embolic agent (Onyx), the number of additionally used coils, the embolization time, and the technical and clinical outcome were documented. Procedure-related complications, recurrent bleeding during hospital stay and outcome were recorded. Results: In 14 patients selective endovascular embolization of 15 arteries was performed. The average volume of injected Onyx was 1.3 ± 0.8 ml. In 6 cases (42.9%) Onyx was used in conjunction with coils. The average time between the correct placement of microcatheter and complete embolization was 24.9 ± 12.6 minutes. In 13 of 14 patients (92.8%), embolization was technically successful. In one case, procedure-related complications occurred and embolization was performed in a second session a day later. After technically successful embolization, no recurrent bleeding occurred during hospitalization. Out of 14 patients, six (42.9%) died 1 - 38 days after technically successful embolization due to multiple organ failure (2 patients), hypoxic brain injury (2 patients), septic shock (1 patient) or malignancy-associated death (1 patient). (orig.)

  1. High-dose vs low-dose proton pump inhibitors for upper gastrointestinal bleeding: A meta-analysis

    Liu-Cheng Wu, Yun-Fei Cao, Jia-Hao Huang, Cun Liao, Feng Gao

    2010-05-01

    Full Text Available AIM: To evaluate the efficacy of high-dose proton pump inhibitors (PPIs vs low-dose PPIs for patients with upper gastrointestinal bleeding.METHODS: PubMed, Embase, the Cochrane Library, and Web of Science were searched to identify relevant randomized controlled trials (RCTs. Eligible trials were RCTs that compared high-dose PPI with low-dose PPI following endoscopic hemostasis. The primary endpoint was rebleeding; secondary endpoints were patient numbers that needed surgery, and mortality. The meta-analysis was performed with a fixed effects model or random effects model.RESULTS: Nine eligible RCTs including 1342 patients were retrieved. The results showed that high-dose intravenous PPI was not superior to low-dose intravenous PPI in reducing rebleeding [odds ratio (OR = 1.091, 95% confidential interval (CI: 0.777-1.532], need for surgery (OR = 1.522, 95% CI: 0.643-3.605 and mortality (OR = 1.022, 95% CI: 0.476-2.196. Subgroup analysis according to different region revealed no difference in rebleeding rate between Asian patients (OR = 0.831, 95% CI, 0.467-1.480 and European patients (OR = 1.263, 95% CI: 0.827-1.929.CONCLUSION: Low-dose intravenous PPI can achieve the same efficacy as high-dose PPI following endoscopic hemostasis.

  2. Complimentary Imaging Modalities for Investigating Obscure Gastrointestinal Bleeding: Capsule Endoscopy, Double-Balloon Enteroscopy, and Computed Tomographic Enterography.

    Chu, Ye; Wu, Sheng; Qian, Yuting; Wang, Qi; Li, Juanjuan; Tang, Yanping; Bai, Tingting; Wang, Lifu

    2016-01-01

    Objectives. The complimentary value of computed tomographic enterography (CTE) and double-balloon enteroscopy (DBE) combined with capsule endoscopy (CE) was evaluated in the diagnosis of obscure gastrointestinal bleeding (OGIB). Methods. Patients who received CE examinations at Ruijin Hospital between July 2007 and July 2014 with the indication of OGIB were identified, and those who also underwent DBE and/or CTE were included. Their clinical information was retrieved, and results from each test were compared with findings from the other two examinations. Results. The overall diagnostic yield of CE was comparable with DBE (73.9% versus 60.9%) but was significantly higher than the yield of CTE (87% versus 25%, p < 0.001). The diagnostic yield of angiodysplasia at CE was significantly higher than CTE (73% versus 8%, p < 0.001) and DBE (39.1% versus 17.4%, p = 0.013), while no significant difference was found between the three approaches for small bowel tumors. DBE and CTE identified small bowel diseases undetected or undetermined by CE. Conversely, CE improved diagnosis in the cases with negative CTE and DBE, and findings at initial CE directed further diagnosis made by DBE. Conclusions. Combination of the three diagnostic platforms provides complementary value in the diagnosis of OGIB. PMID:26858753

  3. Complimentary Imaging Modalities for Investigating Obscure Gastrointestinal Bleeding: Capsule Endoscopy, Double-Balloon Enteroscopy, and Computed Tomographic Enterography

    Ye Chu

    2016-01-01

    Full Text Available Objectives. The complimentary value of computed tomographic enterography (CTE and double-balloon enteroscopy (DBE combined with capsule endoscopy (CE was evaluated in the diagnosis of obscure gastrointestinal bleeding (OGIB. Methods. Patients who received CE examinations at Ruijin Hospital between July 2007 and July 2014 with the indication of OGIB were identified, and those who also underwent DBE and/or CTE were included. Their clinical information was retrieved, and results from each test were compared with findings from the other two examinations. Results. The overall diagnostic yield of CE was comparable with DBE (73.9% versus 60.9% but was significantly higher than the yield of CTE (87% versus 25%, p<0.001. The diagnostic yield of angiodysplasia at CE was significantly higher than CTE (73% versus 8%, p<0.001 and DBE (39.1% versus 17.4%, p=0.013, while no significant difference was found between the three approaches for small bowel tumors. DBE and CTE identified small bowel diseases undetected or undetermined by CE. Conversely, CE improved diagnosis in the cases with negative CTE and DBE, and findings at initial CE directed further diagnosis made by DBE. Conclusions. Combination of the three diagnostic platforms provides complementary value in the diagnosis of OGIB.

  4. Antiagregation and anticoagulation, relationship with upper gastrointestinal bleeding Antiagregación y anticoagulación, relación con la hemorragia digestiva alta

    Philip Wikman-Jorgensen; Eva López-Calleja; Pablo Safont-Gasó; Mariano Matarranz-del-Amo; Raquel Andrés-Navarro; Jaime Merino-Sánchez

    2011-01-01

    Introduction: the high prevalence of cardiovascular diseases in the modern society brings a high prescription of platelet antiaggregation and anticoagulant medications. These treatments have been related to an increased incidence of upper gastrointestinal bleedings (UGB). Our aim was to estimate the fraction of UGB's presented to our hospital that was related to this kind of treatments and describe their clinical features in our environment. Material and methods: a retrospective search was pe...

  5. Spontaneous intra-peritoneal bleeding secondary to warfarin, presenting as an acute appendicitis: a case report and review of literature

    Shah Dharmendra K; Kumar Vikas; Sagar Jayesh; Bhatnagar Ashok

    2006-01-01

    Abstract Background Warfarin is a coumarin anti-coagulant, used widely for the therapeutic and prophylactic anticoagulation. Although, it is considered as a life saving medicine, it is associated with the significant adverse effects including intra-abdominal bleeding, which have been very well documented in literature. However, the presentation of warfarin induced intra-peritoneal bleeding as an acute appendicitis has not been reported in English literature. We report this rare, spontaneous i...

  6. Systematic Review of the Relationship between Acute and Late Gastrointestinal Toxicity after Radiotherapy for Prostate Cancer

    Matthew Sean Peach

    2015-01-01

    Full Text Available A small but meaningful percentage of men who are treated with external beam radiation therapy for prostate cancer will develop late gastrointestinal toxicity. While numerous strategies to prevent gastrointestinal injury have been studied, clinical trials concentrating on late toxicity have been difficult to carry out. Identification of subjects at high risk for late gastrointestinal injury could allow toxicity prevention trials to be performed using reasonable sample sizes. Acute radiation therapy toxicity has been shown to predict late toxicity in several organ systems. Late toxicities may occur as a consequential effect of acute injury. In this systematic review of published reports, we found that late gastrointestinal toxicity following prostate radiotherapy seems to be statistically and potentially causally related to acute gastrointestinal morbidity as a consequential effect. We submit that acute gastrointestinal toxicity may be used to identify at-risk patients who may benefit from additional attention for medical interventions and close follow-up to prevent late toxicity. Acute gastrointestinal toxicity could also be explored as a surrogate endpoint for late effects in prospective trials.

  7. Non Peptic Ulcer Upper Gastrointestinal Bleeding in Patients Treated with Non-Steroidal Anti-inflammatory Drugs for Musculo-articular Disorders

    Simona Mureşan

    2015-08-01

    Full Text Available Introduction: Complications in the evolution of digestive tract benign pathology leads to symptoms: hemorrhagic, occlusive or perforative syndrome. Method: We present three cases of gastrointestinal (GI hemorrhage with a different pathology and rarely seen in clinical practice in patients treated with non-steroidal anti-inflammatory drugs for muscular-articular pathology. Cases’ presentation: (1 A 47 years old man known with recurrent episodes of upper GI bleeding was admitted for a new massive hemorrhage; the emergency laparotomy revealed a splenic arteriovenous fistula penetrating the Wirsung duct. A splenopancreatectomy was performed with uneventful recovery. (2 A 57 years old woman with chronic anemia, nausea, weight loss and vomiting was admitted for intermittent recurrent episodes of melena. The exploratory laparotomy revealed several jejunal diverticulum with active bleeding; a segmental enterectomy was performed with uneventful recovery. (3 A 24 year old patient was admitted for massive inaugural melena. The upper GI tract endoscopy was negative; due to hemorrhagic shock an emergency exploratory laparotomy was performed and revealed a jejunal GIST. The resection was performed with uneventful recovery. The histo-pathologic exam confirmed a benign GIST. Conclusions: During Non-Steroidal Anti-inflammatory Drugs (NSAID therapy anemia and upper GI bleeding are usually considered as common disorders related with peptic ulcer. However NSAID therapy can hide another more complex causes of bleeding. In majority of cases the bleeding is brutal and surgical approach remains the only alternative to perform the diagnosis and to cure the patient.

  8. Observational study of upper gastrointestinal tract bleeding events in patients taking duloxetine and nonsteroidal anti-inflammatory drugs: a case-control analysis

    Li H

    2014-10-01

    Full Text Available Hu Li, Yingkai Cheng, Jonna Ahl, Vladimir SkljarevskiNeurosciences, Eli Lilly and Company, Indianapolis, IN, USAPurpose: To determine whether the concomitant use of duloxetine with prescription nonsteroidal anti-inflammatory drugs (NSAIDs or aspirin was associated with an increased risk for upper gastrointestinal (UGI bleeding compared with taking these analgesics alone.Methods: Truven Health Analytics MarketScan Research Databases were examined for hospital admissions of adult patients indexed from January 1, 2007–December 31, 2011. Cases were patients with UGI hemorrhage or peptic ulcer disease. Controls were randomly selected from the remaining admissions to match 10:1 with cases based on age, sex, and admission date. Prescription medication exposure groups of interest were: 1 no exposure to duloxetine, NSAIDs or aspirin; 2 duloxetine only; 3 NSAIDs or aspirin only; 4 duloxetine plus NSAIDs or aspirin. Logistic regression and relative excess risk due to interaction was utilized to estimate any increased risk of UGI bleeding for patients prescribed these medications across these groups.Results: There were 33,571 cases and 335,710 controls identified. Comparing exposure group 2 and group 4, the adjusted odds ratio was 1.03 (95% confidence interval [CI], 0.94, 1.12, and the adjusted relative excess risk due to interaction was 0.352 (95% CI: –0.18, 0.72 for risk of UGI bleeding, neither of which support an increased risk or an interaction between duloxetine and prescription NSAID or aspirin for these events.Conclusion: There was no evidence of an increased risk for UGI bleeding when duloxetine was taken with prescription NSAIDs or aspirin. In addition, there was no evidence of an interaction between duloxetine and prescription NSAIDs or aspirin for an increased risk of these events.Keywords: duloxetine, upper gastrointestinal bleeding, NSAIDs, aspirin

  9. Does recombinant human erythropoietin accelerate correction of post-ulcer-bleeding anaemia A pilot study

    Ladas, Spiros D.; Polymeros, Dimitrios; Pagonis, Thomas; Triantafyllou, Konstantinos; Paspatis, Gregorios; Hatziargiriou, Maria; Raptis, Sotirios A.

    2004-01-01

    AIM: Anaemia caused by acute upper gastrointestinal bleeding is treated with blood transfusion or iron, but patients usually face a two-month recovery period from post-haemorrhage anaemia. This prospective, randomised, open, pilot study was designed to investigate whether recombinant human erythropoietin (Epoetin) therapy accelerate haematocrit increase in the post-bleeding recovery period.

  10. Clinical outcomes of patients with major bleeding after primary coronary intervention for acute ST-segment elevation myocardial infarction

    Objective: To evaluate the clinical outcomes of patients complicated with major bleeding after primary coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods: During the period of January 2004-January 2008, primary PCI was performed in 412 consecutive patients with acute STEMI at Shanghai Ruijin Hospital. The clinical data were retrospectively analyzed. Major adverse cardiac events (MACE), including death, reoccurrence of myocardial infarction and target vessel revascularization, in patients with major bleeding were compared with that in patients without major bleeding. Results: Compared to patients without bleeding, the patients with bleeding were older (70.0 ± 8.9 years vs 64.9 ± 12.7 years, P=0.04), mainly the females (51.9% vs 23.1%, P=0.001) and treated more often with glycoprotein (GP) IIb / IIIa receptor inhibitor (88.9% vs 69.4%, P=0.03) or intra-aortic balloon pump (7.4% vs 1.3%, P=0.02). In-hospital and one-year MACE rate in the patients with bleeding was 18.5% and 37.0% respectively,which were significantly higher than that in the patients without bleeding (5.7% and 14.3%, with P=0.008 and P=0.002, respectively). Multivariate analysis indicated that patient aged over 70 years, feminine gender and use of GP IIb/IIIa receptor inhibitor were independent predictors for the occurrence of major bleeding. The occurrence of major bleeding after primary PCI was significantly correlated with MACE occurred within one year after the procedure (OR 2.79, 95% CI: 2.21-5.90, P<0.001). Conclusion: In patients with acute STEMI, the occurrence of major bleeding after primary PCI is closely linked to the increased MACE rate within one year after the treatment.Feminine gender, aged patient and use of GPIIb/IIIa receptor inhibitor are independent predictors to increase the danger of major bleeding. (authors)

  11. Evaluation of Superselective Transcatheter Arterial Embolization with n-Butyl Cyanoacrylate in Treating Lower Gastrointestinal Bleeding: A Retrospective Study on Seven Cases

    Zhao, Yuan; Li, Gang; Yu, Xiang

    2016-01-01

    Background. To investigate the safety and efficacy of superselective transcatheter arterial embolization (TAE) with n-butyl cyanoacrylate (NBCA) in treating lower gastrointestinal bleeding caused by angiodysplasia. Methods. A retrospective study was performed to evaluate the clinical data of the patients with lower gastrointestinal bleeding caused by angiodysplasia. The patients were treated with superselective TAE with NBCA between September 2013 and March 2015. Angiography was performed after the embolization. The clinical signs including melena, anemia, and blood transfusion treatment were evaluated. The complications including abdominal pain and intestinal ischemia necrosis were recorded. The patients were followed up to evaluate the efficacy in the long run. Results. Seven cases (2 males, 5 females; age of 69.55 ± 2.25) were evaluated in the study. The embolization was successfully performed in all cases. About 0.2–0.8 mL (mean 0.48 ± 0.19 mL) NCBA was used. Immediate angiography after the embolization operation showed that the abnormal symptoms disappeared. The patients were followed up for a range of 2–19 months and six patients did not reoccur. No serious complications, such as femoral artery puncture point anomaly, vascular injury, and intestinal necrosis perforation were observed. Conclusion. For the patients with refractory and repeated lower gastrointestinal hemorrhage due to angiodysplasia, superselective TAE with NBCA seem to be a safe and effective alternative therapy when endoscopy examination and treatment do not work. PMID:27528867

  12. Extensive hemangiomatosis diagnosed by scintigraphy with 99mTc-labeled red blood cells in a patient with lower gastrointestinal bleeding

    Full text: Introduction: The gastrointestinal bleeding may be caused by vascular tumors and other lesions like inflammatory disorders, intestinal obstruction or vascular malformation. The Klippel-Trenaunay syndrome and blue rubber bleb nevus syndrome are hemangiomatosis diseases that may involve the gastrointestinal tract and cause recurrent hemorrhage. The signs and symptoms usually appear at childhood. Case report: male patient, 31 years old, presenting three days of gastrointestinal bleeding and an hemorrhage shock (Hb=3,9). Previous reports of small volume bleeding since childhood and schistossomosis. Dilated veins, hemorrhoid and port wine stain lesions were detected at physical examination in perineal region, penis and scrotum. Inferior limbs were symmetric at inspection. The upper endoscopy showed esophageal varices with no signs of active bleeding. The scintigraphy with 99mTc-labeled red blood cells showed active hemorrhage at recto-sigmoid topography during the first hour of study. Extensive and heterogeneous uptake was seen in gluteus, posterior right thigh and scrotum at the second and fifth hours of study. Then the hypothesis of vascular tumor was considered. The magnetic resonance (MR) of pelvis demonstrated extensive hemangiomatosis at the regions described by the scintigraphy. The clinical and imaging findings suggested the diagnosis of Klippel-Trenaunay syndrome. Discussion: The Klippel-Trenaunay syndrome is a rare disease characterized by congenital vascular and lymphatic malformations (port wine stain lesions, congenital varices) and bone growth and soft tissue disorder. Dilated veins may involve abdominal and pelvic structures, with rectal bleeding and haematuria occurring on average of 20%. The clinical investigation must approach the type, the extent and the severity of the malformation, since the morbidity and the mortality depends on the visceral involvement. The Doppler ultrasound, scanometry of lower extremities, MR, angiography and

  13. Extensive hemangiomatosis diagnosed by scintigraphy with 99mTc-labeled red blood cells in a patient with lower gastrointestinal bleeding

    Souza, D.S.F.; Ichiki, W.A.; Borges, A.C.; Coura Filho, G.B.; Vecchia, J.F.; Sapienza, M.T.; Ono, C.R.; Watanabe, T.; Costa, P.L.A.; Hironaka, F.; Cerri, G.G.; Buchpiguel, C.A. [Universidade de Sao Paulo (FM/USP), SP (Brazil). Inst. de Radiologia. Servico de Medicina Nuclear

    2008-07-01

    Full text: Introduction: The gastrointestinal bleeding may be caused by vascular tumors and other lesions like inflammatory disorders, intestinal obstruction or vascular malformation. The Klippel-Trenaunay syndrome and blue rubber bleb nevus syndrome are hemangiomatosis diseases that may involve the gastrointestinal tract and cause recurrent hemorrhage. The signs and symptoms usually appear at childhood. Case report: male patient, 31 years old, presenting three days of gastrointestinal bleeding and an hemorrhage shock (Hb=3,9). Previous reports of small volume bleeding since childhood and schistossomosis. Dilated veins, hemorrhoid and port wine stain lesions were detected at physical examination in perineal region, penis and scrotum. Inferior limbs were symmetric at inspection. The upper endoscopy showed esophageal varices with no signs of active bleeding. The scintigraphy with {sup 99m}Tc-labeled red blood cells showed active hemorrhage at recto-sigmoid topography during the first hour of study. Extensive and heterogeneous uptake was seen in gluteus, posterior right thigh and scrotum at the second and fifth hours of study. Then the hypothesis of vascular tumor was considered. The magnetic resonance (MR) of pelvis demonstrated extensive hemangiomatosis at the regions described by the scintigraphy. The clinical and imaging findings suggested the diagnosis of Klippel-Trenaunay syndrome. Discussion: The Klippel-Trenaunay syndrome is a rare disease characterized by congenital vascular and lymphatic malformations (port wine stain lesions, congenital varices) and bone growth and soft tissue disorder. Dilated veins may involve abdominal and pelvic structures, with rectal bleeding and haematuria occurring on average of 20%. The clinical investigation must approach the type, the extent and the severity of the malformation, since the morbidity and the mortality depends on the visceral involvement. The Doppler ultrasound, scanometry of lower extremities, MR, angiography and

  14. Segmental embolization of the gastroduodenal artery in a case of a perforated pseudoaneurysm and gastrointestinal bleeding; Segmentembolisation der Arteria gastroduodenalis bei perforiertem Pseudoaneurysma und gastrointestinaler Massivblutung

    Schmitt, R. [Inst. fuer Diagnostische Radiologie der Friedrich-Alexander-Univ. Nuernberg-Erlangen (Germany); Inst. fuer Diagnostische und Interventionelle Radiologie der Herz- und Gefaessklinik GmbH, Bad Neustadt an der Saale (Germany); Cavallaro, A.; Bautz, W. [Inst. fuer Diagnostische Radiologie der Friedrich-Alexander-Univ. Nuernberg-Erlangen (Germany)

    2004-07-01

    We present the history of a woman suffering from an extensive gastrointestinal bleeding due to liver cirrhosis and chronic pancreatitis. Selective angiogram of the celiac artery revealed a pseudoaneurysm of the gastroduodenal artery caused by inflammatory wall penetration. The life-threatening hemorrhage was completely stopped by embolization with three stainless steel coils after microcatheter engagement of the gastroduodenal artery. The particularity of this case is the restricted embolization of the aneurysm vessel segment, so the collateral circulation of the gastroduodenal and pancreaticoduodenal artery could be preserved. (orig.)

  15. Recombinant coagulation factor VIIa labelled with the fac-99 mTc(CO)3-core: synthesis and in vitro evaluation of a putative new radiopharmaceutical for imaging in acute bleeding lesion

    Madsen, Jacob; Christensen, Jesper B.; Olsen, Ole H.;

    2011-01-01

    Coagulation in blood is initiated when coagulation factor VII (FVII) binds to exposed TF and is activated to FVIIa, and the TF/ FVIIa complex may therefore provide a marker of vascular injury potentially applicable in diagnostic imaging of acute gastrointestinal (GI) bleeding. Methods: Recombinant...... yield and in 495% radiochemical purity. Pull down experiments showed that the biological activity (binding to tissue factor and to anti-FVII antibody) of the radiolabelled product remained intact in the formulation mixture as well as in human serum. By computer modeling analysis, two candidate sites for...

  16. Nursing Care of Upper Gastrointestinal Bleeding after Endoscopic Treatment%上消化道大出血内镜治疗后的护理

    贺娟

    2014-01-01

    目的:探讨上消化道大出血患者的内镜下治疗后的护理。方法分析35例消化道大出血患者内镜治疗后的护理要点。结果显效21例,有效8例,无效10例。结论胃镜下止血术配合有效护理治疗上消化道大出血效果显著。%Objective To explore the nursing digestion tract bleeding patients after endoscopic treatment. Methods Analysis of nursing of 35 cases of gastrointestinal bleedingafter endoscopic treatment. Results The effect of 21 cases,effective in 8 cases,invalid 10 cases. Conclusion Endoscopic hemostasis with effective nursing care in the treatment of massive hemorrhage of upper gastrointestinal tract effect.

  17. Coagulation factors and recurrence of ischemic and bleeding adverse events in patients with acute coronary syndromes.

    Campo, Gianluca; Pavasini, Rita; Pollina, Alberto; Tebaldi, Matteo; Ferrari, Roberto

    2013-08-01

    In the last years, management and prognosis of patients with acute coronary syndromes (ACS) are significantly improved. Nowadays antithrombotic (antiplatelet plus anticoagulant drugs) therapy represents the main treatment of ACS patients. Anticoagulant drugs are particularly helpful in the acute phase of ACS, whereas in the chronic phase are maintained only in selected cases. Many studies demonstrate that exists a significant variability in the coagulation factor levels between patients affected by ACS. This variation on coagulation factors levels is due to environmental (smoking, inflammation, sex, oral contraceptive, triglycerides, diabetes mellitus) and genetic determinants. Particularly several gene polymorphisms have been selected and clearly associated with significant variations in the coagulation factors values. The heightened levels of tissue factor, factor VII and fibrinogen are related with a "hypercoagulable status" and with a higher occurrence of ischemic complications after ACS and/or PCI. On the contrary, less data are available regarding the relationship between coagulation factors levels (or their gene polymorphisms) and bleeding complications. Recently, new anticoagulant drugs have been developed. They show less side effects and a better tolerability and, probably, their selected use in patients with a "hypercoagulable status" may improve the clinical outcome after ACS. In this review we analyze the current available data and we discuss how this finding may be useful for planning future studies to optimize the treatment of ACS patients. PMID:23827698

  18. Difficult diagnosis of invasive fungal infection predominantly involving the lower gastrointestinal tract in acute lymphoblastic leukaemia

    Gulhadiye Avcu

    2016-03-01

    Full Text Available Invasive fungal infections are most commonly seen in immunocompromised patients and usually affect the respiratory system. Gastrointestinal system involvement of mucormycosis and invasive aspergillosis is rarely reported in childhood. Here we describe a 5 year old boy with acute lymphoblastic leukaemia who developed invasive fungal infection particularly affecting the lower gastrointestinal system to emphasise the difficulties in diagnosis and management of invasive fungal infections in immunocompromised patients.

  19. Difficult diagnosis of invasive fungal infection predominantly involving the lower gastrointestinal tract in acute lymphoblastic leukaemia

    Avcu, Gulhadiye; Karapinar, Deniz Yilmaz; Yazici, Pinar; Duyu, Muhterem; Polat, Suleyha Hilmioglu; Atabay, Berna; Doganavsargil, Basak; Karapinar, Bulent

    2016-01-01

    Invasive fungal infections are most commonly seen in immunocompromised patients and usually affect the respiratory system. Gastrointestinal system involvement of mucormycosis and invasive aspergillosis is rarely reported in childhood. Here we describe a 5 year old boy with acute lymphoblastic leukaemia who developed invasive fungal infection particularly affecting the lower gastrointestinal system to emphasise the difficulties in diagnosis and management of invasive fungal infections in immun...

  20. Spontaneous Perforation of Pyometra Presenting as Acute Abdomen and Pneumoperitoneum Mimicking Those of Gastrointestinal Origin

    Takahiro Yamada; Nanako Ando; Naoshi Shibata; Motomu Suitou; Hiroshi Takagi; Kazutoshi Matsunami; Satoshi Ichigo; Atsushi Imai

    2015-01-01

    Gastrointestinal (GI) perforation accounts for over 90% of acute abdomen and pneumoperitoneum. The presence of pneumoperitoneum secondary to spontaneously perforated pyometra is an interesting yet confusing finding given the absence of gastrointestinal (GI) perforation, because pyometra is more common in postmenopausal women. We report an instructive case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 70-year-old postmenopausal female was admitted to surgical emergenc...

  1. Upper gastrointestinal bleeding in a Brazilian hospital: a retrospective study of endoscopic records Sangramento digestivo alto em um hospital brasileiro: estudo retrospectivo de registros endoscópicos

    Cyrla ZALTMAN

    2002-04-01

    Full Text Available Background - Upper gastrointestinal bleeding is a frequent and potentially severe complication of most digestive diseases of the upper gastrointestinal tract. Upper endoscopy has a crucial role in the diagnosis and treatment of upper gastrointestinal bleeding, however epidemiological studies are still limited in our country. Aims - To assess the clinical characteristics, endoscopic accuracy, treatment efficiency and clinical outcome of patients admitted to the endoscopic unit with upper gastrointestinal bleeding. Methods - A retrospective study of consecutive records from patients who underwent emergency endoscopy for upper gastrointestinal bleeding was performed during a period of 2 years. Results - Most patients were male 68.7%, with a mean age of 54.5 ± 17.5 years. A bleeding site could be detected in 75.6% of the patients. Diagnostic accuracy was greater within the first 24 hours of the bleeding onset, and in the presence of hematemesis. Peptic ulcer was the main cause of upper gastrointestinal bleeding (35%. The prevalence of variceal bleeding (20.45% indicates a high rate of underlying liver disease. Endoscopic treatment was performed in 23.86% of the patients. Permanent hemostasis was achieved in 86% of the patients at the first endoscopic intervention, and in 62.5% of the patients after rebleeding. Emergency surgery was seldom necessary. The average number of blood units was 1.44 ± 1.99 per patient. The average length of hospital stay was 7.71 ± 12.2 days. Rebleeding was reported in 9.1% of the patients. The overall mortality rate of 15.34% was significantly correlated with previous liver disease. Conclusions - Diagnostic accuracy was related to the time interval between the bleeding episode and endoscopy, and to clinical presentation. Endoscopic therapy was an effective tool for selected patients. The resulting increased duration of hospitalization and higher mortality rate in the patients submitted to therapeutic endoscopy were

  2. 56例上消化道出血患者的护理体会%Nursing Gastrointestinal Bleeding in Patients on 56 Cases

    孙丽霞

    2015-01-01

    Objective To evaluate the nursing care of patients with gastrointestinal bleeding.Methods56 cases of upper gastrointestinal bleeding in patients with February 2011~October 2011 in our hospital were retrospectively analyzed data.ResultsThe patients were closely observed, strict care, cure 46 cases, surgical therapy in 5 cases, 5 cases improved.Conclusion The clinical nursing observation is an important guarantee of clinical diagnosis and treatment.%目的:探讨上消化道出血患者的护理体会。方法对2011年2月~2011年10月我院收治的56例上消化道出血患者进行回顾性资料分析。结果通过对患者进行密切的观察、严密的护理等,治愈46例,转外科治疗5例,好转5例。结论临床护理观察是临床诊断治疗的一项重要保障。

  3. The predictive capacity of the Glasgow-Blatchford score for the risk stratification of upper gastrointestinal bleeding in an emergency department

    José Manuel Recio-Ramírez

    2015-05-01

    Full Text Available Objectives: To assess the ability of the Glasgow Blatchford Score (GBS system to identify the need for urgent upper gastrointestinal endoscopy (UGIE in patients with upper gastrointestinal bleeding (UGIB. Methods: An observational, retrospective study was carried out in all patients attended at the ER for suspected UGIB in one year. Patients were split into two categories -high-risk (>2 and low-risk (≤2- by means of the GBS system. Results: A total of 60 patients were included. Of these, 46 were classified as "high-risk" (> 2 and 14 as "low-risk" (≤ 2 subjects. The characteristics of patients in the low-risk group included: Mean age: 46.6 ± 13.7 (18-88 years. Males/females: 7/7. Urgent endoscopy revealed: normal (50%; n = 7; esophagitis (21.4%; n = 3; gastritis (14.2%; n = 2; Mallory-Weiss syndrome (7.1%; n = 1; non-bleeding varices (7.1%; n = 1. The characteristics of patients in the high-risk group included: Mean age: 68.7 ± 19.8 (31-91 years. Males/females: 30/16. Digestive endoscopy revealed: Gastric/duodenal ulcer (56.52%; n = 26; normal (17.39%; n = 8; esophagitis (8.69%; n = 4; gastritis (8.69%; n = 4; angioectasia (4.34%; n = 2; bleeding varices (4.34%; n = 2. Low-risk patients exhibited no lesions requiring urgent management during endoscopy, and the sensitivity of the GBS scale for high-risk UGIB detection was found to be 100% (95% CI: 86.27%, 99.71%, with a specificity of 48.28% (95% CI: 29.89, 67.1%. Conclusions: The GBS scale seems to accurately identify patients with low-risk UGIB, who may be managed on an outpatient basis and undergo delayed upper GI endoscopy at the outpatient clinic.

  4. [Acute gastrointestinal involvement in dengue disease by serotype 4: a case report and literature review].

    Marín, Johan; Vilcarromero, Stalin; Forshey, Brett M; Celis-Salinas, Juan C; Ramal-Asayag, Cesar; Morrison, Amy C; Laguna-Torres, Alberto; Casapía, Martín; Halsey, Eric S

    2013-10-01

    Dengue fever is the world's most important arboviral disease, presenting a wide clinical spectrum. We report for the first time in Peru, a case caused by dengue virus serotype 4 with significant gastrointestinal involvement (acute acalculous cholecystitis and acute hepatitis). In addition we carried out a review of the literature atypical presentation illustrating the importance of the characteristics of abdominal pain (right upper quadrant); presence of Murphy's sign, ultrasound, and liver enzymes levels, for appropriate diagnosis and clinical management. PMID:24248170

  5. Role of toll-like receptors in acute gastrointestinal radiation syndrome

    Ionizing radiation induces various disorders according to the radiation sensitivity of each organ. Acute gastrointestinal radiation syndrome is a serious illness that is caused by exposure of gastrointestinal tract to high amounts of ionizing radiation in radiation accidents or radiation therapy in cancer treatment. Although the pathological mechanism have been well studied in human and animals, no effective treatments have been developed to date. The Toll-like receptor (TLR) family is one of the best-characterized families of innate immune receptors, which induce innate immune response against pathogen infection. However, contrary to their protective function, recent studies have suggested that immune responses triggered by TLRs play deleterious roles by aggravating tissue inflammation in some inflammatory and autoimmune diseases. This review describes recent advancement of our understanding of acute gastrointestinal radiation syndrome and the contributions of TLR to its pathological mechanisms. (author)

  6. Balancing Potency of Platelet Inhibition with Bleeding Risk in the Early Treatment of Acute Coronary Syndrome

    Slattery, David E

    2009-08-01

    Full Text Available Objective: To review available evidence and examine issues surrounding the use of advanced antiplatelet therapy in an effort to provide a practical guide for emergency physicians caring for patients with acute coronary syndromes (ACS.Data Sources: American College of Cardiology/American Heart Association (ACC/AHA 2007 guidelines for the management of patients with unstable angina (UA and non-ST-segment elevation myocardial infarction (NSTEMI, AHA/ACC 2007 focused update for the management of patients with STEMI, selected clinical articles identified through the PubMed database (1965-February 2008, and manual searches for relevant articles identified from those retrieved.Study Selection: English-language controlled studies and randomized clinical trials that assessed the efficacy and safety of antiplatelet therapy in treating patients with all ACS manifestations.Data Extraction and Synthesis: Clinical data, including treatment regimens and patient demographics and outcomes, were extracted and critically analyzed from the selected studies and clinical trials. Pertinent data from relevant patient registries were also evaluated to assess current clinical practice.Conclusions: As platelet activation and aggregation are central to ACS pathology, antiplatelet agents are critical to early treatment. A widely accepted first-line treatment is aspirin, which acts to decrease platelet activation via inhibition of thromboxane A2 synthesis. Thienopyridines, which inhibit ADP-induced platelet activation, and glycoprotein (GP receptor antagonists, which bind to platelet GP IIb/IIIa receptors and hinder their role in platelet aggregation and thrombus formation, provide complementary mechanisms of platelet inhibition and are often employed in combination with aspirin. While the higher levels of platelet inhibition that accompany combination therapy improve protection against ischemic and peri-procedural events, the risk of bleeding is also increased. Thus, the

  7. Mesenteric pseudoaneurysm in a 12-year-old girl with abdominal tuberculosis presenting with massive lower gastrointestinal bleeding

    We report a case of a 12-year-old girl with a mesenteric pseudoaneurysm and abdominal tuberculosis presenting with massive lower gastrointestinal hemorrhage requiring multiple blood transfusions. The pseudoaneurysm was treated successfully with transarterial microcoil embolization. Pseudoaneurysms are a rare and life-threatening complication of tuberculosis and understanding the imaging characteristics and treatment options will help to guide appropriate therapy. (orig.)

  8. Mesenteric pseudoaneurysm in a 12-year-old girl with abdominal tuberculosis presenting with massive lower gastrointestinal bleeding

    Corby, Rodney; Cranford, Caroline; Ha, Thuong Van; Yousefzadeh, David [University of Chicago Hospitals, Department of Radiology, Chicago, IL (United States)

    2006-05-15

    We report a case of a 12-year-old girl with a mesenteric pseudoaneurysm and abdominal tuberculosis presenting with massive lower gastrointestinal hemorrhage requiring multiple blood transfusions. The pseudoaneurysm was treated successfully with transarterial microcoil embolization. Pseudoaneurysms are a rare and life-threatening complication of tuberculosis and understanding the imaging characteristics and treatment options will help to guide appropriate therapy. (orig.)

  9. Acute interventional diagnosis and treatment of upper gastrointestinal arterial hemorrhage: its clinical value and influence factors

    Objective: To evaluate emergent angiography and interventional management in treating massive upper gastrointestinal (GI) arterial hemorrhage, and to discuss the factors influencing the angiographic bleeding signs and the interventional therapeutic results. Methods: The clinical data of 56 patients with massive upper GI arterial hemorrhage, who underwent diagnostic arteriography and interventional management with trans-catheter vasopressin infusion and embolization, were retrospectively analyzed. Systolic blood pressure of both pre-and post-interventional therapy was recorded and statistically analyzed. The arteriographic positive rates were separately calculated according to the catheter tip's location, being placed at the 2nd grade branch or at the 3 rd -4 th grade branch of the artery, and the relation of the positive rate with the tip's location was analyzed. A comparison of the hemostatic effect between trans-catheter vasopressin infusion and trans-catheter embolization was made. Results: The average systolic blood pressure of pre-and post-procedure was (93.14 ± 18.63) mmHg and (11.64 ± 13.61) mmHg respectively, with a significant difference (P = 0.023). The angiographic bleeding signs were demonstrated in 12 cases (21.4%) with the catheter's tip at the 2nd grade branch and in 56 cases (100%) with the catheter's tip at the 3 rd -4 th grade branch,the difference between the two was of statistically significance (P < 0.05). The technical success rate and the clinical hemostasis rate of via catheter vasopressin infusion was 80% (16 / 20) and 55% (11/20) respectively. Of nine re-bleeding cases, seven were successfully controlled with embolization therapy by using microcatheter and two had to receive surgery because of arterial rupture which was proved by angiography. The technical and the clinical rates of success for transcatheter embolization therapy were 93% (42 / 45) and 89% (40 / 45) respectively. Recurrence of bleeding was seen in two patients who got

  10. Relation Between Red Blood Cell Omega-3 Fatty Acid Index and Bleeding During Acute Myocardial Infarction

    Salisbury, Adam C.; Harris, William S.; Amin, Amit P.; Reid, Kimberly J.; O’Keefe, James H; Spertus, John A.

    2011-01-01

    Omega-3 fatty acids have multiple cardiovascular benefits, but may also inhibit platelet aggregation and increase bleeding risk. If this platelet inhibition is clinically meaningful, patients with the highest omega-3 indices (red blood cell eicosapentaenoic [EPA] plus docosahexaenoic acid [DHA]), which reflect long-term omega-3 fatty acid intake, should be at the greatest bleeding risk. We studied 1,523 patients from 24 US centers who had their omega-3 index assessed at the time of AMI. The r...

  11. Hombre de 75 años con edemas y sangrado digestivo inferior A 75 years old man with edema and inferior gastrointestinal bleeding

    Alberto Carlos Reino Buelvas

    2004-02-01

    Full Text Available Se presenta el caso de un hombre de 75 años, quien consultó por edemas generalizados originados en un síndrome nefrótico, secundario a una glomerulopatía clasificada como de cambios mínimos. Se le iniciaron esteroides con mejoría de su proteinuria, pero al disminuir las dosis de éstos, recayó, por lo que requirió nueva hospitalización en la que se le documentaron trombosis venosa profunda y sangrado por tracto gastrointestinal inferior. Se le implantó un filtro de vena cava inferior y se le practicó una colonoscopia, en la que se encontró poliposis coli. Al estudio histológico se reportó un linfoma no Hodgkin compatible con un linfoma del manto (poliposis linfomatoide versus linfoma marginal tipo MALT de bajo grado. The case of a 75 year old man is presented. He consulted because of generalized edema and the diagnosis of nephrotic syndrome was done. Histologic study of a renal biopsy reported a glomerulopathy of minimal changes. Treatment with steroids improved of proteinuria, but on reducing the doses, proteinuria returned. In a second hospitalization deep venous thrombosis and gastrointestinal bleeding were diagnosed. A cava vein filter was implanted, colonoscopy was performed and Polyposis Coli was found. A non Hodgkin lymphoma compatible with MANTLE CELL lymphoma (lymphomatous polyposis vs MALT lymphoma was reported in the colonic biopsy.

  12. Acute respiratory failure and active bleeding are the important fatality predictive factors for severe dengue viral infection.

    Kamolwish Laoprasopwattana

    Full Text Available To determine the outcome of severe dengue viral infection (DVI and the main dengue fatality risk factors.The medical records of patients aged <15 years admitted to Songklanagarind Hospital in southern Thailand during 1989-2011 were reviewed. Patients who had dengue hemorrhagic fever (DHF grades III-IV, organ failure (cardiovascular, respiratory, liver, renal or hematologic, impaired consciousness, or aspartate aminotransferase more than 1,000 units/L, were classified as having severe DVI. To determine the fatality risk factors of severe DVI, the classification trees were constructed based on manual recursive partitioning.Of the 238 children with severe DVI, 30 (12.6% died. Compared to the non-fatal DVI cases, the fatal cases had higher rates of DHF grade IV (96.7% vs 24.5%, repeated shock (93.3% vs 27.9%, acute respiratory failure (ARF (100% vs 6.7%, acute liver failure (ALF (96.6% vs 6.3%, acute kidney injury (AKI (79.3% vs 4.5%, and active bleeding requiring blood transfusion (93.3% vs 5.4%, all p<0.01. The combined risk factors of ARF and active bleeding considered together predicted fatal outcome with sensitivity, specificity, and negative and positive predictive values of 0.93 (0.78-0.99, 0.97 (0.93-0.99, 0.99 (0.97-1.00, and 0.82 (0.65-0.93, respectively. The likelihood ratios for a fatal outcome in the patients who had and did not have this risk combination were 32.4 (14.6-71.7 and 0.07 (0.02-0.26, respectively.Severe DVI patients who have ARF and active bleeding are at a high risk of death, while patients without these things together should survive.

  13. Acute viral infections with combined involvement of the respiratory and gastrointestinal tracts in children. Therapy with interferon.

    Dondurei, E A; Osidak, L V; Golovacheva, E G; Golovanova, A K; Amosova, I V; Gladchenko, L N

    2009-08-01

    We evaluated the percent of acute respiratory viral infections with gastrointestinal syndrome in the structure of morbidity in babies aging 6 months and elder. Therapeutic efficiency and safety of anaferon (pediatric formuation) as a component of complex therapy of acute respiratory viral infections with involvement of the gastrointestinal tract were proven; more rapid disappearance of all symptoms and improvement of the immune status parameters were demonstrated. PMID:20027348

  14. Analysis of the causes of liver cirrhosis complicated with upper gastrointestinal bleeding in 126 patients and nursing care%肝硬化并发上消化道出血126例诱因分析及护理

    孙娟; 习羽

    2012-01-01

    目的:探讨肝硬化患者并发上消化道出血的诱因并提出护理对策.方法:对126例肝硬化患者进行上消化道出血诱因分析,并给予抢救配合、病情观察、心理护理、用药护理等针对性护理措施.结果:本组98例出血停止,7例放弃治疗出院,6例死于多脏器功能衰竭.结论:针对肝硬化患者发生上消化道出血的诱因给予针对性护理,可有效减少并发症发生,降低病死率.%Objective: To analyze the causes of liver cirrhosis complicated with upper gastrointestinal bleeding and put forward nursingcountermeasures. Methods: 126 liver cirrhosis patients complicated with upper gastrointestinal bleeding were given emergency treatment,close observation, psychological care and medication care according to the analysis of the causes. Results: The bleeding of 98 patients wasstopped; 7 patients abandoned treatment; 6 patients died of multiple organ failure. Conclusion: The appropriate nursing measures aimingat the causes of upper gastrointestinal bleeding due to liver cirrhosis can effectively reduce the occurrence of complications and fatalityrate.

  15. Effect of recombinant Factor VIIa on outcome of acute variceal bleeding

    Bendtsen, Flemming; D'Amico, Gennaro; Rusch, Ea; de Franchis, Roberto; Andersen, Per Kragh; Lebrec, Didier; Thabut, Dominique; Bosch, Jaime

    2014-01-01

    BACKGROUND & AIMS: Two randomized controlled studies have evaluated the effect of recombinant Factor VIIa (rFVIIa) on variceal bleeding in cirrhosis without showing significant benefit. The aim of the present study was to perform a meta-analysis of the two trials on individual patient data with s...

  16. The secondary prophylactic efficacy of beta-blocker after endoscopic gastric variceal obturation for first acute episode of gastric variceal bleeding

    Choi, Moon Han; Kim, Young Seok; Kim, Sang Gyune; Lee, Yun Nah; Seo, Yu Ri; Kim, Min Jin; Lee, Sae Hwan; Jeong, Soung Won; Jang, Jae Young; Kim, Hong Soo; Kim, Boo Sung

    2013-01-01

    Background/Aims The most appropriate treatment for acute gastric variceal bleeding (GVB) is currently endoscopic gastric variceal obturation (GVO) using Histoacryl®. However, the secondary prophylactic efficacy of beta-blocker (BB) after GVO for the first acute episode of GVB has not yet been established. The secondary prophylactic efficacy of BB after GVO for the first acute episode of GVB was evaluated in this study. Methods Ninety-three patients at Soonchunhyang University Hospital with ac...

  17. Development of a Set of Nomograms to Predict Acute Lower Gastrointestinal Toxicity for Prostate Cancer 3D-CRT

    Purpose: To predict acute Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) and Subjective Objective Signs Management and Analysis/Late Effect of Normal Tissue (SOMA/LENT) toxicities of the lower gastrointestinal (LGI) syndrome in patients with prostate cancer undergoing three-dimensional conformal radiotherapy using a tool (nomogram) that takes into account clinical and dosimetric variables that proved to be significant in the Italian Association for Radiation Oncology (AIRO) Group on Prostate Cancer (AIROPROS) 0102 trial. Methods and Materials: Acute rectal toxicity was scored in 1,132 patients by using both the RTOG/EORTC scoring system and a 10-item self-assessed questionnaire. Correlation between clinical variables/dose-volume histogram constraints and rectal toxicity was investigated by means of multivariate logistic analyses. Multivariate logistic analyses results were used to create nomograms predicting the symptoms of acute LGI syndrome. Results: Mean rectal dose was a strong predictor of Grade 2-3 RTOG/EORTC acute LGI toxicity (p 0.0004; odds ratio (OR) = 1.035), together with hemorrhoids (p = 0.02; OR 1.51), use of anticoagulants/antiaggregants (p = 0.02; OR = 0.63), and androgen deprivation (AD) (p = 0.04; OR = 0.65). Diabetes (p = 0.34; OR 1.28) and pelvic node irradiation (p = 0.11; OR = 1.56) were significant variables to adjust toxicity prediction. Bleeding was related to hemorrhoids (p = 0.02; OR = 173), AD (p = 0.17; OR = 0.67), and mean rectal dose (p 0.009; OR = 1.024). Stool frequency was related to seminal vesicle irradiation (p = 0.07; OR = 6.46), AD administered for more than 3 months (p = 0.002; OR = 0.32), and the percent volume of rectum receiving more than 60 Gy (V60Gy) V60 (p = 0.02; OR = 1.02). Severe fecal incontinence depended on seminal vesicle irradiation (p = 0.14; OR = 4.5) and V70 (p = 0.033; OR 1.029). Conclusions: To the best of our knowledge, this work presents the

  18. New Insight for the Diagnosis of Gastrointestinal Acute Graft-versus-Host Disease

    Florent Malard

    2014-01-01

    Full Text Available Allogeneic stem cell transplantation (allo-SCT is a curative therapy for different life-threatening malignant and nonmalignant hematologic disorders. Graft-versus-host disease (GVHD remains a major source of morbidity and mortality following allo-SCT, which limits the use of this treatment in a broader spectrum of patients. Early diagnostic of GVHD is essential to initiate treatment as soon as possible. Unfortunately, the diagnosis of GVHD may be difficult to establish, because of the nonspecific nature of the associated symptoms and of the numerous differential diagnosis. This is particularly true regarding gastrointestinal (GI acute GVHD. In the recent years many progress has been made in medical imaging test and endoscopic techniques. The interest of these different techniques in the diagnosis of GI acute GVHD has been evaluated in several studies. With this background we review the contributions, limitations, and future prospect of these techniques in the diagnosis of GI acute GVHD.

  19. Bleeding time

    Bleeding time is a medical test that measures how fast small blood vessels in the skin stop bleeding. ... until the bleeding stops. The provider records the time it takes for the cuts to stop bleeding.

  20. Upper gastrointestinal findings detected by capsule endoscopy in obscure gastrointestinal bleeding Hallazgos digestivos altos de la cápsula endoscópica en la hemorragia digestiva de origen oscuro

    B. Velayos

    2009-01-01

    Full Text Available Objective: we analyzed our experience with the use of capsule endoscopy in areas that can be explored with gastroscopy to justify obscure bleeding, as well as the outcome after a new recommended gastroscopy in order to determine if a second gastroscopy before the capsule study can provide any benefit in the management of this disease. Methods: we retrospectively studied 82 patients who were explored with capsule endoscopy for obscure gastrointestinal bleeding who had undergone previously only one gastroscopy. Findings in the zones which were accessible by gastroscopy were normal, mild/known and severe/unknown. In the latter cases we recommended a second gastroscopy, and their treatment and outcome were subjected to further study. Results: capsule endoscopy did not find any unknown esophageal findings. In 63% of cases, no gastric or duodenal lesions were shown; in 20%, lesions were mild or had been previously diagnosed, and in 17%, a new gastroscopy was recommended due to the discovery of an unknown condition which could be the cause of the obscure bleeding. This new information brought about a change in treatment for 78% of patients in this group, all of whom improved from their illness. Capsule endoscopy found significant intercurrent alterations in the small intestine in only 14% of cases. Conclusions: the performance of a second gastroscopy, previous to capsule endoscopy, in the study of obscure gastrointestinal bleeding can offer benefits in diagnostic terms and may introduce therapeutic changes. A detailed analysis of the upper tract frames in intestinal capsule endoscopy studies is mandatory since it may provide relevant information with clinical impact on the management of these patients.Objetivo: hemos analizado los hallazgos que la cápsula endoscópica aportó de las zonas accesibles a una gastroscopia que podrían justificar un sangrado digestivo oscuro, así como la evolución de estos enfermos tras la nueva gastroscopia recomendada

  1. Localization of the acute lower gastrointestinal hemorrhage in vivo-in vitro labeling of red blood cells with sup(99m)Tc

    For the detection and localization of acute lower gastrointestinal hemorrhage in vivo-in vitro labeling of red blood cells with sup(99m)Tc and sup(99m)Tc sulfur colloid has been sugested. The procedure for labeling RBC with sup(99m)Tc consisted in injecting IV 1 mg of ClSn; 20 minutes after injection of tin 10 cc of blood were withdrawn in a syringe containing 20 mCi of sup(99m)Tc; this was incubated for 10 minutes and then injected IV. Scintigraphy of the abdominal cavity was done in supine position and performed with a large field gamma camera with a parallel hole-low energy colimator. Computer adquisition of images was started 5 minutes after RBC injection and made at the rate of one enery 5 minutes for 45 minutes. 14 patients were studied divided in: a) control: 6 patients. b) with active gastrointestinal hemorrhage: 4 patients had positive scintigraphy. The hemorrhage was documented with superior mesenteric arteriography, endoscopy and/or necropsy. The sensitivity was 100%. In 4 out of 14 patients scintigraphy with sup(99m)Tc RBC compared with simultaneous sup(99m)Tc sulfur colloid demonstrated that all patients with positive sup(99m)Tc RBC had also positive sup(99m)Tc sulfur colloid scintigraphy. c) without active gastrointestinal hemorrhage: all of them had negative scintigraphy (specificity 100%). Abdominal scintigraphy with sup(99m)Tc RBC or sulfur colloid are both sensitive for detection and localization of lower gastrointestinal bleeding and the negative study suggests the absence of active hemorrhage. It is suggested that the sup(99m)Tc sulfur colloid scintigraphy should be the initial procedure to study these patients and abdominal arteriography should be performed only in patients with positive abdominal scintigraphy. (M.E.L.)

  2. Reirradiation to the abdomen for gastrointestinal malignancies

    Reirradiation to the abdomen could potentially play a role in palliation of symptoms or local control in patients with gastrointestinal malignancies. Our goal was to retrospectively determine rates of toxicity, freedom from local progression and overall survival in gastrointestinal cancer patients treated with reirradiation to the abdomen. Between November 2002 and September 2008, 13 patients with a prior history of abdominal radiotherapy (median dose 45 Gy) were treated with reirradiation for recurrent or metastatic gastrointestinal malignancies. The median interval between the two courses of radiotherapy was 26 months. Patients were treated with a hyperfractionated accelerated regimen, using 1.5 Gy fractions twice daily, with a median dose of 30 Gy (range 24-48 Gy). Concurrent chemotherapy was administered to 8 (62%) patients. The 1-year rate of freedom from local progression was 50%, and the median duration of freedom from local progression was 14 months. The 1-year rate of overall survival was 62%, and the median duration of overall survival was 14 months. One patient developed grade 3 acute toxicity (abdominal pain and gastrointestinal bleeding), requiring hospitalization during radiotherapy; subsequently, that patient experienced a grade 4 late toxicity (gastrointestinal bleeding). No other patients developed grade 3-4 acute or late toxicity or required hospitalization during radiotherapy. Hyperfractionated accelerated reirradiation to the abdomen was well-tolerated with low rates of acute and late toxicity. Reirradiation could play a role in providing a limited duration of local control in gastrointestinal cancer patients with a history of prior abdominal radiotherapy

  3. Upper gastrointestinal bleeding: risk factors for mortality in two urban centers in Latin America Hemorragia digestiva alta: factores de riesgo para mortalidad en dos centros urbanos de América Latina

    C. H. Morales Uribe; S. Sierra Sierra; A. M. Hernández Hernández; A. F. Arango Durango; Lopez, G.A.

    2011-01-01

    Objective: to describe the experience with upper gastrointestinal bleeding (UGIB) in two major Latin American hospitals; its main cuses, treatment and prognosis, while exploring some risk factors associated with death. Design: prospective cohort study. Patients and methods: We included 464 patients older than 15 years of age from two reference centers. We studied some demographic variables, history, clinical presentation, treatment and mortality. We explored the association betwen those varia...

  4. 非静脉曲张性上消化道出血内镜下止血的护理配合%Nursing cooperation during endoscopic treatment of non-varicose upper gastrointestinal bleeding

    尹玲; 陈先红

    2012-01-01

    目的:总结内镜下注射组织粘合剂、局部注射止血合剂和电凝三联疗法治疗非静脉曲张性上消化道出血的治疗和护理效果.方法:对273例非静脉曲张性上消化道出血患者进行内镜下三联疗法止血,术前、术中、术后给予了相应的护理措施.结果:273例患者中,无效4例,内镜下止血成功269例,有效治疗率为98.53%.结论:三联疗法是非静脉曲张性上消化道出血内镜下紧急止血的有效方法,而有效的护理措施是内镜下止血的重要保障.%Objective: To discuss nursing cooperation during endoscopic treatment of non -varicose upper gastrointestinal bleeding. Methods: Triple therapy ( injection of tissue adhesive and hemostatic mixture + electric coagulation ) was done in 273 non - varicose upper gastrointestinal bleeding patients with the cooperation of doctors and nurses. Results: The triple therapy was effective for 269 non - varicose upper gastrointestinal bleeding patients and the success rate of hemostasis was 98. 5%. Conclusion:The triple therapy was effective for the non - varicose upper gastrointestinal bleeding patients. The cooperation and nursing play an important part during the procedure.

  5. Mobilization of xanthine oxidase from the gastrointestinal tract in acute pancreatitis

    Closa Daniel

    2004-01-01

    Full Text Available Abstract Background Xanthine oxidoreductase has been proposed to play a role in the development of local and systemic effects of acute pancreatitis. Under physiologic conditions, the enzyme exists mainly as xanthine dehydrogenase (XDH but can be converted by proteolytic cleavage to its superoxide-generating form xanthine oxidase (XOD. In addition to its intracellular location XDH/XOD is also associated to the polysaccharide chains of proteoglycans on the external endothelial cell membrane. In the early stages of acute pancreatitis, this enzyme seems to be arising from its mobilization from the gastrointestinal endothelial cell surface. Taking into account the ability of α-amylase to hydrolyze the internal α-1,4 linkages of polysaccharides, we wanted to elucidate the involvement of α-amylase in XDH/XOD mobilization from the gastrointestinal endothelial cell surface and the relevance of the ascitic fluid (AF as the source of α-amylase in experimental acute pancreatitis. Methods Acute pancreatitis was induced in male Wistar rats by intraductal administration of 5% sodium taurocholate. In another experimental group 3000 U/Kg α-amylase was i.v. administered. The concentrations of XDH, XOD and α-amylase in plasma and AF and myeloperoxidase (MPO in lung have been evaluated. In additional experiments, the effect of peritoneal lavage and the absorption of α-amylase present in the AF by an isolated intestine have been determined. Results Similar increase in XDH+XOD activity in plasma was observed after induction of acute pancreatitis and after i.v. administration of α-amylase. Nevertheless, the conversion from XDH to XOD was only observed in the pancreatitis group. Lung inflammation measured as MPO activity was observed only in the pancreatitis group. In addition peritoneal lavage prevented the increase in α-amylase and XDH+XOD in plasma after induction of pancreatitis. Finally, it was observed that α-amylase is absorbed from the AF by the

  6. 肝癌介入治疗病人围术期合并上消化道出血的护理%The nursing methods for liver cancer interventional treatment patients with upper gastrointestinal bleeding in the perioperative

    龚美霞; 洪侠; 徐艳莉; 陈川

    2011-01-01

    Objective:To study the nursing methods for liver cancer interventions! Treatment patients with upper gastrointestinal bleeding in the periopera-tive. Methods:To analyzing the nursing experience of 42 liver cancer interventional treatment patients with upper gastrointestinal bleeding in January 2005 -December 2010 and summarizing the care nursing experience points. Results:Thirty - nine of forty - two patients survived after clinical rescue and nursing, while there were 3 cases of death. Conclusions: liver interventional perioperative with upper gastrointestinal bleeding is in critical need of professional and careful nursing, and has a bit inadvertent, serious consequences.%目的:探讨介入治疗肝癌病人围术期合并上消化道出血的护理方法.方法:分析2005年1月~2010年12月42例肝癌介入治疗病人围术期合并上消化道出血的护理经验,总结其护理要点.结果:42例病人经临床抢救及护理,存活39例,死亡3例.结论:肝癌介入治疗围术期合并上消化道出血病情危重,需要专业和细心的护理,稍有不慎,后果严重.

  7. Acute lower gastrointestinal hemorrhage originating in the small intestine Hemorragia digestiva baja severa originada en el intestino delgado

    A. Ríos; M. J. Montoya; Rodríguez, J M; P. Parrilla

    2006-01-01

    Introduction: lower gastrointestinal hemorrhage (LGIH) is generally self-limiting, and the most frequent etiologies are located at colonic level. The objective here is to analyze the diagnostic and therapeutic handling of acute LGIH when its etiology was located in the small intestine. Patients and methods: between 1975 and March 2002, 12 acute cases of LGIH originating in the small intestine were admitted to our service. All consulted the hospital with acute rectorrhage, requiring a transfus...

  8. The role of angiography in the diagnosis and therapy of gastrointestinal hemorrhage

    Purpose: Evaluation of angiography in the diagnosis and treatment of acute and chronic gastrointestinal bleeding. Materials and Methods: Thirty-seven consecutive patients with clinically suspected gastrointestinal bleeding underwent selective angiography of the visceral arteries. If technically possible, patients with radiologically proven hemorrhage underwent selective embolization with microcoils. Not all angiographically detected bleeding vessels were embolized. Clinical outcome was determined from a review of the medical records. Results: 37 patients underwent 43 angiographies, which demonstrated 25 bleedings considered acute and 18 considered chronic. Seventeen patients had previous intestinal surgery. In 9 of the 37 patients, 12 of the 43 (sensitivity: 28%) hemorrhages were detected. A postoperative bleeding was found in 6 patients. With one exception, all angiographically positive cases were clinically considered to be acute. Transcatheter embolization of the bleeding vessels with microcoils was performed in 6 patients, with 3 patients having the bleeding stopped permanently and 3 patients requiring further surgical treatment. In 3 patients, embolization was not possible for technical reasons. No complications attributable to angiography were seen. Conclusion: Angiography should be performed in patients with spontaneous and postoperative gastrointestinal bleeding. Transcatheter embolization is an effective and safe therapeutical option in both clinical settings. (orig.)

  9. Life threatening bleeding from duodenal ulcer after Roux-en-Y gastric bypass: Case report and review of the literature

    Arpad; Ivanecz; Marko; Sremec; Davorin; ?erani?; Stojan; Potr?; Pavel; Skok

    2014-01-01

    Acute upper gastrointestinal bleeding is a rare, but serious complication of gastric bypass surgery. The inaccessibility of the excluded stomach restrains postoperative examination and treatment of the gastric remnant and duodenum, and represents a major challenge, especially in the emergency setting. A 59-year-old patient with previous history of peptic ulcer disease had an upper gastrointestinal bleeding from a duodenal ulcer two years after having a gastric bypass procedure for morbid obesity. After negative upper endoscopy finding, he was urgently evaluated for gastrointestinal bleeding. At emergency laparotomy, the bleeding duodenal ulcer was identified by intraoperative endoscopy through gastrotomy. The patient recovered well after surgical hemostasis, excision of the duodenal ulcer and completion of the remnant gastrectomy. Every general practitioner, gastroenterologist and general surgeon should be aware of growing incidenceof bariatric operations and coherently possible complications after such procedures, which modify patient’s anatomy and physiology.

  10. Fístula colecistocólica: una causa poco frecuente de hemorragia digestiva baja Cholecistocolic fistula: an uncommon cause of lower gastrointestinal bleeding

    M. Ostiz

    2012-12-01

    Full Text Available La fístula colecistocólica es un tipo poco común de fístula bilioentérica que tiene una presentación clínica variable y que generalmente aparece como complicación de la enfermedad litiásica biliar. Puede manifestarse en forma de dolor abdominal, náuseas, pérdida de peso, diarrea con o sin esteatorrea asociada, clínica dispéptica y más raramente como hemorragia digestiva baja, colangitis de repetición o incluso como un ileo biliar. Las técnicas más útiles para el diagnóstico son el TC abdominal, los estudios baritados y la colangiopancreatografía retrógrada endoscópica (CPRE. Describimos el caso de una mujer de edad avanzada, pluripatológica, con fístula colecistocólica, que se presentó en forma de hemorragia digestiva baja. Fue estudiada mediante colonoscopia, TC abdominal y enema de bario. Durante el ingreso requirió transfusión de 4 concentrados de hematíes, desestimándose el tratamiento invasivo debido a su comorbilidad de base. Evolucionó favorablemente, con resolución espontanea del cuadro. Dos meses después permanecía asintomática.Cholecystocolic fistula is an uncommon biliary-enteric fistula with a variable clinical presentation that usually appears as a rare complication of gallstone disease. It can present with abdominal pain, nausea, weight loss, diarrhoea with or without associated steatorrhea, and dyspeptic symptoms. Rare cases have been reported with lower gastrointestinal haemorrhage and even with a gallstone ileous. The most useful techniques for diagnosis are CT, barium studies, and ERCP. We report a case of a cholecistocolic fistula in an eldery woman with multiple medical comorbidities that presented as lower gastrointestinal bleeding. She was explored with colonoscopy, abdominal CT and barium enema. She required a total of 4 units of whole blood and because of her comorbidities a decision was made not to proceed with invasive treatment. She had a good evolution and was asymptomatic two months

  11. Spontaneous Perforation of Pyometra Presenting as Acute Abdomen and Pneumoperitoneum Mimicking Those of Gastrointestinal Origin

    Takahiro Yamada

    2015-01-01

    Full Text Available Gastrointestinal (GI perforation accounts for over 90% of acute abdomen and pneumoperitoneum. The presence of pneumoperitoneum secondary to spontaneously perforated pyometra is an interesting yet confusing finding given the absence of gastrointestinal (GI perforation, because pyometra is more common in postmenopausal women. We report an instructive case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 70-year-old postmenopausal female was admitted to surgical emergency with signs of diffuse peritonitis. After resuscitation, an emergency laparotomy was performed because of suspicion of GI perforation. At laparotomy, about 2,000 mL of purulent fluid was found to be present in peritoneal cavity, while GI tract was intact. A rent with a diameter of 5 mm was found on anterior fundus of uterus. A total abdominal hysterectomy with a bilateral salpingo-oophorectomy was performed. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on postoperative day 16. Our case illustrates the importance of clinical knowledge of acute gynecological diseases, which are not uncommonly encountered by the general surgeon. Moreover, good appreciation of pelvic anatomy and close collaboration with gynecology and GI surgery colleagues is essential as operative intervention is often required.

  12. Spontaneous perforation of pyometra presenting as acute abdomen and pneumoperitoneum mimicking those of gastrointestinal origin.

    Yamada, Takahiro; Ando, Nanako; Shibata, Naoshi; Suitou, Motomu; Takagi, Hiroshi; Matsunami, Kazutoshi; Ichigo, Satoshi; Imai, Atsushi

    2015-01-01

    Gastrointestinal (GI) perforation accounts for over 90% of acute abdomen and pneumoperitoneum. The presence of pneumoperitoneum secondary to spontaneously perforated pyometra is an interesting yet confusing finding given the absence of gastrointestinal (GI) perforation, because pyometra is more common in postmenopausal women. We report an instructive case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 70-year-old postmenopausal female was admitted to surgical emergency with signs of diffuse peritonitis. After resuscitation, an emergency laparotomy was performed because of suspicion of GI perforation. At laparotomy, about 2,000 mL of purulent fluid was found to be present in peritoneal cavity, while GI tract was intact. A rent with a diameter of 5 mm was found on anterior fundus of uterus. A total abdominal hysterectomy with a bilateral salpingo-oophorectomy was performed. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on postoperative day 16. Our case illustrates the importance of clinical knowledge of acute gynecological diseases, which are not uncommonly encountered by the general surgeon. Moreover, good appreciation of pelvic anatomy and close collaboration with gynecology and GI surgery colleagues is essential as operative intervention is often required. PMID:25628913

  13. Radiological study of gastrointestinal motor activity after acute cisplatin in the rat. Temporal relationship with pica.

    Cabezos, Pablo Antonio; Vera, Gema; Castillo, Mónica; Fernández-Pujol, Ramón; Martín, María Isabel; Abalo, Raquel

    2008-08-18

    Nausea and vomiting are amongst the most severe dose-limiting side effects of chemotherapy. Emetogenic activity in rats can only be evaluated by indirect markers, such as pica (kaolin intake), or delay in gastric emptying. The aim of this work was to study, by radiological methods, the alterations in gastrointestinal motility induced by acute cisplatin in the rat, and to compare them with the development of pica. Rats received cisplatin (0-6 mg kg(-1)) at day 0. In the pica study, individual food ingestion and kaolin intake were measured each day (from day -3 to day 3). In the radiological study, conscious rats received an intragastric dose of medium contrast 0, 24 or 48 h after cisplatin injection, and serial X-rays were taken 0-24 h after contrast. Cisplatin dose-dependently induced both gastric stasis and stomach distension, showing a strict temporal relationship with the induction of both acute and delayed pica. Radiological methods, which are non-invasive and preserve animals' welfare, are useful to study the effect of emetogenic drugs in the different gastrointestinal regions and might speed up the search for new anti-emetics. PMID:18579450

  14. Incidence and predictors of upper gastrointestinal bleeding in patients receiving low-dose aspirin for secondary prevention of cardiovascular events in patients with coronary artery disease

    William Ng; Xi Cheng; Chu-Pak Lau; Wai-Man Wong; Wai-Hong Chen; Hung-Fat Tse; Pui-Yin Lee; Kam-Chuen Lai; Sheung-Wai Li; Matthew Ng; Kwok-Fai Lam

    2006-01-01

    AIM: The use of low-dose aspirin to prevent cardiovascular disease events is well established. However,the incidence and predictors of upper gastrointestinal bleeding (UGIB) with its use are unknown. We studied prospectively the incidence and outcome of peptic ulceration in low-dose aspirin users.METHODS: A total of 991 patients with coronary artery disease (CAD) on low-dose aspirin were prospectively followed-up for two years for the occurrence and clinical features of first hospitalized episode of UGIB.RESULTS: UGIB had a bimodal presentation with 45% occurring within four months of aspirin initiation and had an overall prevalence of 1.5% per year. There was no UGIB-related death. Hypertension (OR = 4.6, 95%CI 1.5 - 14.7, P = 0.009), history of peptic ulceration (OR = 3.1,95%CI 1.1 - 9.0, P = 0.039), tertiary education (OR =3.08, 95%CI 1.1 - 9.0, P = 0.039) and higher lean body mass (P = 0.016) were independent factors associated with UGIB. Use of nitrate did not reduce UGIB.CONCLUSION: The incidence of UGIB in patients with CAD on long-term low-dose aspirin is low, but is accompanied with significant morbidity. With prolonged use of aspirin, UGIB continues to be a problem for those with risk factors and especially in patients with a history of peptic ulcers, in which UGIB tends to occur early after aspirin therapy.

  15. Risk of upper gastrointestinal bleeding in a cohort of new users of low-dose ASA for secondary prevention of cardiovascular outcomes

    LucíaCea Soriano

    2010-10-01

    Full Text Available The Health Improvement Network UK primary care database was used to identify a cohort of 38 077 individuals aged 50–84 years with a first prescription of low-dose acetylsalicylic acid (ASA; 75–300 mg/day for secondary prevention of cardiovascular or cerebrovascular events during 2000–2007. From this cohort, 169 incident cases of upper gastrointestinal bleeding (UGIB were identified. Controls with no UGIB (n = 2000 were frequency-matched to the cases by age, sex and follow-up time. A nested case–control analysis was performed to determine risk factors associated with UGIB. The incidence of UGIB was 1.1 per 1000 person-years (95% CI, 1.0–1.3. Low-dose ASA users with a history of peptic ulcer disease had an increased risk of UGIB compared with those without (rate ratio [RR], 4.59; 95% CI, 2.87–7.33. Concomitant use of ASA and clopidogrel (RR, 1.61; 95% CI, 0.85–3.05 or non-steroidal anti-inflammatory drugs (NSAIDs; RR, 2.92; 95% CI, 1.77–4.82 conferred an increased risk of UGIB compared with ASA monotherapy. Discontinuation of ASA therapy (RR: 0.71, 95% CI, 0.42–1.20 and PPI co-treatment given since the start of ASA therapy (RR, 0.56; 95% CI, 0.33–0.96 were associated with a reduced risk of UGIB. In conclusion, in a cohort of individuals receiving low-dose ASA for secondary prevention of cardiovascular or cerebrovascular events, patients with a history of peptic ulcer disease, or who were receiving clopidogrel or NSAIDs had an increased risk of UGIB. The prescription of PPI therapy at the initiation of low-dose ASA reduced the risk of UGIB by almost half.

  16. Epinephrine plus argon plasma or heater probe coagulation in ulcer bleeding

    Ahmet Karaman; Mevlut Baskol; Sebnem Gursoy; Edip Torun; Alper Yurci; Banu Demet Ozel; Kadri Guven; Omer Ozbakir; Mehmet Yucesoy

    2011-01-01

    AIM: To compare the effectiveness of argon plasma coagulation (APC) and heater probe coagulation (HPC) in non-variceal upper gastrointestinal bleeding. METHODS: Eighty-five (18 female, 67 male) patients admitted for acute gastrointestinal bleeding due to gastric or duodenal ulcer were included in the study. Upper endoscopy was performed and HPC or APC were chosen randomly to stop the bleeding. Initial hemostasis and rebleeding rates were primary and secondary end-points of the study. RESULTS: Initial hemostasis was achieved in 97.7% (42/43) and 81% (36/42) of the APC and HPC groups, respectively (P 0.05). CONCLUSION: APC is an effective hemostatic method in bleeding peptic ulcers. Larger multicenter trials are necessary to confirm these results.

  17. Acute lower gastrointestinal hemorrhage originating in the small intestine Hemorragia digestiva baja severa originada en el intestino delgado

    A. Ríos

    2006-03-01

    Full Text Available Introduction: lower gastrointestinal hemorrhage (LGIH is generally self-limiting, and the most frequent etiologies are located at colonic level. The objective here is to analyze the diagnostic and therapeutic handling of acute LGIH when its etiology was located in the small intestine. Patients and methods: between 1975 and March 2002, 12 acute cases of LGIH originating in the small intestine were admitted to our service. All consulted the hospital with acute rectorrhage, requiring a transfusion of at least 3 units of concentrated red blood cells. The mean age was 54 ± 21 years, 58% were women, and 83% had experienced previous episodes of LGIH. Results: in eleven cases (92% an urgent lower and upper endoscopy was performed without locating the source of bleeding. An arteriography was indicated in 7 patients (58%, which located the bleeding origin in 5 of them. In two cases a scintigraphy was performed, showing a Meckel's diverticulum in one patient and a normal image in another. All were operated on; in 8 cases (67%, surgery was urgent; in 9 cases, a tumor was found, and in three additional patients, a case of Meckel's diverticulum was found, with a resection being carried out for all lesions. Histology showed a leiomyoma in 7 cases, a Meckel's diverticulum in 3 cases, a leiomyoblastoma in 1, and an angioma in the remaining case. After a mean follow-up of 132 ± 75 months, the leiomyoblastoma resulted in death, and there was a relapse in the case of angioma, which was successfully embolized with interventional radiology. Conclusions: acute LGIH originating in the small intestine should be considered a possible etiology when digestive endoscopy does not locate the source of bleeding, with arteriography being a useful diagnostic technique for bleeding localization. Surgery is the definitive treatment - it confirms the etiology and rules out the presence of malignancy.Introducción: la hemorragia digestiva baja (HDB es generalmente autolimitada y

  18. Impact of chronic kidney disease on long-term ischemic and bleeding outcomes in medically managed patients with acute coronary syndromes

    Melloni, Chiara; Cornel, Jan H; Hafley, Gail;

    2016-01-01

    AIMS: We aimed to study the relationship of chronic kidney disease stages with long-term ischemic and bleeding outcomes in medically managed acute coronary syndrome patients and the influence of more potent antiplatelet therapies on platelet reactivity by chronic kidney disease stage. METHODS AND...... RESULTS: We estimated creatinine clearance for 8953 medically managed acute coronary syndrome patients enrolled in the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes trial. Patients were classified by chronic kidney disease stage: normal renal...... of Strategies to Open Occluded Coronary Arteries and Thrombolysis In Myocardial Infarction bleeding) outcomes by chronic kidney disease stage and treatment allocation (prasugrel vs. clopidogrel) within each stage. Adjusted hazard ratios (95% confidence intervals) for moderate and for severe chronic...

  19. A Sporadic Small Jejunal GIST Presenting with Acute Lower Gastrointestinal Hemorrhage: A Review of the Literature and Management Guidelines.

    Govindaraj, Sridar; Dias, Brendan Hermenigildo; Gautham, S L

    2015-04-01

    Gastrointestinal stromal tumors (GISTs) represent the majority of primary nonepithelial neoplasms of the digestive tract, most frequently expressing the KIT protein detected by immunohistochemical staining for the CD117 antigen. Jejunal GISTs account for approximately 10 % of GISTs. Patients usually present with abdominal discomfort. Jejunal GISTs may cause symptoms secondary to obstruction or hemorrhage. Pressure necrosis and ulceration of the overlying mucosa may cause gastrointestinal bleeding, and patients who experience significant blood loss may suffer from malaise and fatigue. Literature has classified small-bowel GISTs on the basis of size, and various established guidelines have advised conservative management of small jejunal GISTs (lower gastrointestinal hemorrhage in a 50-year-old postmenopausal woman necessitating an emergency laparotomy to control the bleed. The management of very small (<2 cm) small-bowel GISTs is controversial. While guidelines are primarily based on the risk of malignancy in GISTs, no guideline predicting the risk of complications in small-bowel GISTs exists. Hence, these tumors should be removed even if incidentally detected. PMID:25972676

  20. Intracerebral Hemorrhage; towards physiological imaging of hemorrhage risk in acute and chronic bleeding.

    Raphael eJakubovic

    2012-05-01

    Full Text Available Despite improvements in management and prevention of intracerebral hemorrhage (ICH, there has been little improvement in mortality over the last 30 years. Hematoma expansion, primarily during the first few hours is highly predictive of neurological deterioration, poor functional outcome and mortality. For each 10% increase in ICH size, there is a 5% increase in mortality and an additional 16% chance of poorer functional outcome. As such, both the identification and prevention of hematoma expansion are attractive therapeutic targets in ICH. Previous studies suggest that contrast extravasation seen on CT Angiography (CTA, MRI, and digital subtraction angiography correlates with hematoma growth, indicating ongoing bleeding. Contrast extravasation on the arterial phase of a CTA has been coined the CTA Spot Sign. These easily identifiable foci of contrast enhancement have been identified as independent predictors of hematoma growth, mortality and clinical outcome in primary ICH. The Spot Sign score, developed to stratify risk of hematoma expansion, has shown high inter-observer agreement. Post-contrast leakage or delayed CTA Spot Sign, on post contrast CT following CTA or delayed CTA respectively are seen in an additional ~8% of patients and explain apparently false negative observations on early CTA imaging in patients subsequently undergoing hematoma expansion. CT perfusion provides an opportunity to acquire dynamic imaging and has been shown to quantify rates of contrast extravasation. Intravenous recombinant factor VIIa(rFVIIa within 4 hours of ICH onset has been shown to significantly reduce hematoma growth. However, clinical efficacy has yet to be proven. There is compelling evidence that cerebral amyloid angiopathy (CAA may precede the radiographic evidence of vascular disease and as such contribute to microbleeding. The interplay between microbleeding, CAA,CTA Spot Sign and genetic composition (ApoE genotype may be crucial in developing a

  1. Acute syndrome of radiation: injuries to the gastrointestinal tract; Syndrome aigu d'irradiation: les atteintes du systeme gastro-intestinal

    Griffiths, N.M.; Dublineau, I.; Lebrun, F.; Linard, C.; Monti, P.; Picard, C.; Scanff, P.; Aigueperse, J. [CEA Fontenay-aux-Roses, 92 (France). Inst. de Radioprotection et de Surete Nucleaire

    2002-06-01

    Acute syndrome of radiation: injuries to the gastrointestinal tract. Exposure to ionising radiation at medium to high doses results in the manifestation of mixed pathologies. Following the analysis of several radiation accidents it is clear that intestinal injury influences patient survival. However the appearance of the classically defined gastrointestinal syndrome is not always evident. Nevertheless injury to the gastrointestinal tract, in particular loss of barrier function, seems to play an important role in the development of Multiple Organ Failure such as reported in the recent accident at Tokai Mura. Ionising radiation overexposure results in changes in intestinal motility and nutrient, fluid and electrolyte absorption and secretion all which may contribute to the genesis of diarrhea. In addition to modified cellular transport properties for nutrients or electrolytes, important loss of epithelial cells is also a major contributing factor. Intestinal functions are controlled by many factors such as neurotransmitters, locally released mediators from endocrine cells or immunocompetent cells in addition to luminal agents. To date, treatment of radiation-induced gastrointestinal injury is mainly symptomatic. However treatments such as growth factors, anti-inflammatory cytokines as well as cellular transplantation remain to be validated in the radiation accident situation. (author)

  2. Dual-source dual-energy CT angiography with virtual non-enhanced images and iodine map for active gastrointestinal bleeding: Image quality, radiation dose and diagnostic performance

    Highlights: • GIB is a common gastrointestinal emergency with a high mortality rate. • Detection and localization of GIB source are important for imaging modality. • DSDECTA using a dual-phase scan protocol is clinically feasible. • DSDECTA with VNE and iodine map images can diagnose the active GIB source accurately. • DSDECTA can reduce radiation dose compared with conventional CT examination in GIB. - Abstract: Objectives: To evaluate the clinical feasibility of dual-source dual-energy CT angiography (DSDECTA) with virtual non-enhanced images and iodine map for active gastrointestinal bleeding (GIB). Methods: From June 2010 to December 2012, 112 consecutive patients with clinical signs of active GIB underwent DSDECTA with true non-enhanced (TNE), arterial phase with single-source mode, and portal-venous phase with dual-energy mode (100 kVp/230 mAs and Sn 140 kVp/178 mAs). Virtual non-enhanced CT (VNE) image sets and iodine map were reformatted from ‘Liver VNC’ software. The mean CT number, noise, signal to noise ratio (SNR), image quality and radiation dose were compared between TNE and VNE image sets. Two radiologists, blinded to clinical data, interpreted images from DSDECTA with TNE (protocol 1), and DSDECTA with VNE and iodine map (protocol 2) respectively, with discordant interpretation resolved by consensus. The standards of reference included digital subtraction angiography, endoscopy, surgery, or final pathology reports. Receiver–operating characteristic (ROC) analysis was undertaken and the area under the curve (AUC) calculated for CT protocols 1 and 2, respectively. Results: There was no significant difference in mean CT numbers of all organs (including liver, pancreas, spleen, kidney, abdominal aorta, and psoas muscle) (P > 0.05). Lower noise and higher SNR were found on VNE images than TNE images (P < 0.05). Image quality of VNE was lower than that of TNE without significant difference (P > 0.05). The active GIB source was identified

  3. Dual-source dual-energy CT angiography with virtual non-enhanced images and iodine map for active gastrointestinal bleeding: Image quality, radiation dose and diagnostic performance

    Sun, Hao, E-mail: sunhao_robert@126.com [Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing 100730 (China); Hou, Xin-Yi, E-mail: hxy_pumc@126.com [Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing (China); Xue, Hua-Dan, E-mail: bjdanna95@hotmail.com [Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing 100730 (China); Li, Xiao-Guang, E-mail: xglee88@126.com [Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing 100730 (China); Jin, Zheng-Yu, E-mail: zhengyu_jin@126.com [Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing 100730 (China); Qian, Jia-Ming, E-mail: qjiaming57@gmail.com [Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing (China); Yu, Jian-Chun, E-mail: yu-jch@163.com [Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing (China); Zhu, Hua-Dong, E-mail: huadongzhu@hotmail.com [Department of Emergency, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing (China)

    2015-05-15

    Highlights: • GIB is a common gastrointestinal emergency with a high mortality rate. • Detection and localization of GIB source are important for imaging modality. • DSDECTA using a dual-phase scan protocol is clinically feasible. • DSDECTA with VNE and iodine map images can diagnose the active GIB source accurately. • DSDECTA can reduce radiation dose compared with conventional CT examination in GIB. - Abstract: Objectives: To evaluate the clinical feasibility of dual-source dual-energy CT angiography (DSDECTA) with virtual non-enhanced images and iodine map for active gastrointestinal bleeding (GIB). Methods: From June 2010 to December 2012, 112 consecutive patients with clinical signs of active GIB underwent DSDECTA with true non-enhanced (TNE), arterial phase with single-source mode, and portal-venous phase with dual-energy mode (100 kVp/230 mAs and Sn 140 kVp/178 mAs). Virtual non-enhanced CT (VNE) image sets and iodine map were reformatted from ‘Liver VNC’ software. The mean CT number, noise, signal to noise ratio (SNR), image quality and radiation dose were compared between TNE and VNE image sets. Two radiologists, blinded to clinical data, interpreted images from DSDECTA with TNE (protocol 1), and DSDECTA with VNE and iodine map (protocol 2) respectively, with discordant interpretation resolved by consensus. The standards of reference included digital subtraction angiography, endoscopy, surgery, or final pathology reports. Receiver–operating characteristic (ROC) analysis was undertaken and the area under the curve (AUC) calculated for CT protocols 1 and 2, respectively. Results: There was no significant difference in mean CT numbers of all organs (including liver, pancreas, spleen, kidney, abdominal aorta, and psoas muscle) (P > 0.05). Lower noise and higher SNR were found on VNE images than TNE images (P < 0.05). Image quality of VNE was lower than that of TNE without significant difference (P > 0.05). The active GIB source was identified

  4. Intensity-Modulated Radiation Therapy Significantly Improves Acute Gastrointestinal Toxicity in Pancreatic and Ampullary Cancers

    Purpose: Among patients with upper abdominal malignancies, intensity-modulated radiation therapy (IMRT) can improve dose distributions to critical dose-limiting structures near the target. Whether these improved dose distributions are associated with decreased toxicity when compared with conventional three-dimensional treatment remains a subject of investigation. Methods and Materials: 46 patients with pancreatic/ampullary cancer were treated with concurrent chemoradiation (CRT) using inverse-planned IMRT. All patients received CRT based on 5-fluorouracil in a schema similar to Radiation Therapy Oncology Group (RTOG) 97-04. Rates of acute gastrointestinal (GI) toxicity for this series of IMRT-treated patients were compared with those from RTOG 97-04, where all patients were treated with three-dimensional conformal techniques. Chi-square analysis was used to determine if there was a statistically different incidence in acute GI toxicity between these two groups of patients. Results: The overall incidence of Grade 3-4 acute GI toxicity was low in patients receiving IMRT-based CRT. When compared with patients who had three-dimensional treatment planning (RTOG 97-04), IMRT significantly reduced the incidence of Grade 3-4 nausea and vomiting (0% vs. 11%, p = 0.024) and diarrhea (3% vs. 18%, p = 0.017). There was no significant difference in the incidence of Grade 3-4 weight loss between the two groups of patients. Conclusions: IMRT is associated with a statistically significant decrease in acute upper and lower GI toxicity among patients treated with CRT for pancreatic/ampullary cancers. Future clinical trials plan to incorporate the use of IMRT, given that it remains a subject of active investigation.

  5. Upper gastrointestinal bleeding: risk factors for mortality in two urban centers in Latin America Hemorragia digestiva alta: factores de riesgo para mortalidad en dos centros urbanos de América Latina

    C. H. Morales Uribe

    2011-01-01

    Full Text Available Objective: to describe the experience with upper gastrointestinal bleeding (UGIB in two major Latin American hospitals; its main cuses, treatment and prognosis, while exploring some risk factors associated with death. Design: prospective cohort study. Patients and methods: We included 464 patients older than 15 years of age from two reference centers. We studied some demographic variables, history, clinical presentation, treatment and mortality. We explored the association betwen those variables and death. Results: The mean age was 57.9 years, and the male: female ratio was 1.4:1. Three hundred and fifty nine patients (77.4% were seen for gastrointestinal bleeding (outpatients bleeding and 105 patients (22.6% were inpatients seen for UGIB. A total of 71.6% of patients admitted with the diagnosis of upper GI bleeding underwent upper GI emdoscopy (EGD within 24 hours. The main causes of bleeding were peptic ulcer (190 patients, 40.9%, erosive disease (162 patients, 34.9% and variceal bleeding (47 patients, 10.1%. Forty four patients died (9.5%. Patient who presented with bleeding due to other causes during hospitalization has a higher mortality risk than those whose complaints were related to gastrointestinal bleeding (RR 2.4, 95% CI 1.2-4.6. An increasing number of comorbidities such as those described in the Rockall Score, were also associated with a higher risk of mortality (RR 2.5 95% CI 1.1-5.4. Conclusion: Intrahospital upper GI bleeding and the presence of comorbilities ares risk factors for a fatal outcome. Identifying patients with a higher risk would help improve the management of patients with UGIB.Objetivo: presentar la experiencia con la hemorragia de vías digestivas alta (HDA en dos hospitales centros de referencia de un país latinoamericano, las principales causas, tratamiento, pronóstico y explorar algunos factores de riesgo asociados con la mortalidad. Diseño: estudio de cohortes prospectivo. Pacientes y métodos: se

  6. Direct Economic Burden and Impacts of Hospitalized Patients with Upper Gastrointestinal Bleeding%上消化道出血住院患者直接经济负担及影响因素分析

    林毅

    2014-01-01

    Objective:To assess the direct economic burden and impacts of hospitalized patients with upper gastrointestinal bleeding and to lay the technical foundation for economic control and treatment improving of upper gastrointestinal bleeding. Method:Collected the direct economic burden for patients with upper gastrointestinal bleeding with a kind of table made by authors and analyzed the main influencing factors with a multiple linear regression analysis. Result:The average direct economic burden per case was 13 184.85 yuan RMB,while the drug consumption account for about 57.24%. The main influencing factors were treatment,etiological diagnosis and days stay in hospital.Conclusion:The direct economic burden for the hospitalized patients with upper gastrointestinal bleeding could be reduced by rational medication,cutting down the cost of medicine,controlling the average day stay in hospital. And making a definite etiologic diagnosis as soon as possible is also helpful.%目的:了解上消化道出血住院患者的直接经济负担,探讨其构成特点及影响因素,为优化上消化道出血的治疗方案,减轻患者经济负担提供依据和参考。方法:通过自制表格收集患者的直接经济负担情况,应用多元回归模型分析直接经济负担的影响因素。结果:上消化道出血住院患者的人均直接经济负担为13184.85元,药物费所占比例最高,达57.24%。主要影响因素为治疗方式、病因诊断和住院天数。结论:合理用药、控制药品比例,缩短平均住院天数是降低上消化道住院患者经济负担的重要手段。尽早发现、明确上消化道出血病因也有利于降低上消化道出血住院患者的经济负担。

  7. Scintigraphic diagnosis of lower GI bleeding

    Abdominal scintigraphy with 99mTc HSA, 99mTc Sn colloid, or 99mTc RBC was performed in 28 patients with melena to detect bleeding and determine the bleeding site in the lower gastrointestinal tract. Active bleedings and/or vascular lesions were identified in 16 patients. They were proved by antiography, endoscopy or barium enema in 14. We concluded that scintigraphy was an accurate and effective method to detect the bleeding and determine the bleeding site in the lower gastrointestinal tract. (author)

  8. Antiagregation and anticoagulation, relationship with upper gastrointestinal bleeding Antiagregación y anticoagulación, relación con la hemorragia digestiva alta

    Philip Wikman-Jorgensen

    2011-07-01

    Full Text Available Introduction: the high prevalence of cardiovascular diseases in the modern society brings a high prescription of platelet antiaggregation and anticoagulant medications. These treatments have been related to an increased incidence of upper gastrointestinal bleedings (UGB. Our aim was to estimate the fraction of UGB's presented to our hospital that was related to this kind of treatments and describe their clinical features in our environment. Material and methods: a retrospective search was performed in the archives of our hospital of all the patients with diagnosis of UGB admitted during the period 2004-2007 both years inclusive. Patients on antiplatelet and/or anticoagulant treatment were included. We analyzed the information regarding the use of medication, the bleeding lesion, the severity of the bleeding, recurrences, mortality and their clinical features. Results: we found 523 episodes of UGB. Of these 137 (26.1% were patients receiving platelet antiaggregation or anticoagulant drugs. The patients were male 60.2%, and had a mean age of 75.6 (± 10.8 years. The 65.5% (74 had HBP, 43.4% (49 diabetes mellitus and 37.2% (42 dislypemia and 13.3% (22 dementia. The drug most frequently implicated was ASA in 36.3% (41, followed by acenocumarol in 27.4% (31, clopidogrel 18.6% (21, double therapy (ASA + clopidogrel in 6.2% (7, triple therapy (ASA + clopidogrel + acenocumarol in 0.9% (1, triflusal 4.4% (5, low molecular weight heparin 5.3% (5, and ticlopidine in one patient (0.9%. Only 36.3% (41 were on treatment with proton pump inhibitors. There were 24 recurrences and 4 deaths. Conclusions: the 26.1% of the UGB attended in our environment were of iatrogenic origin. We also found a low use of proton pump inhibitors.Introducción: la alta prevalencia de la patología cardiovascular en las sociedades modernas conlleva una elevada prescripción y uso de medicamentos antiagregantes y anticoagulantes. Estos tratamientos se han relacionado con un aumento

  9. Acute gastrointestinal illness following a prolonged community-wide water emergency.

    Gargano, J W; Freeland, A L; Morrison, M A; Stevens, K; Zajac, L; Wolkon, A; Hightower, A; Miller, M D; Brunkard, J M

    2015-10-01

    The drinking water infrastructure in the United States is ageing; extreme weather events place additional stress on water systems that can lead to interruptions in the delivery of safe drinking water. We investigated the association between household exposures to water service problems and acute gastrointestinal illness (AGI) and acute respiratory illness (ARI) in Alabama communities that experienced a freeze-related community-wide water emergency. Following the water emergency, investigators conducted a household survey. Logistic regression models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for self-reported AGI and ARI by water exposures. AGI was higher in households that lost water service for ⩾7 days (aPR 2·4, 95% CI 1·1-5·2) and experienced low water pressure for ⩾7 days (aPR 3·6, 95% CI 1·4-9·0) compared to households that experienced normal service and pressure; prevalence of AGI increased with increasing duration of water service interruptions. Investments in the ageing drinking water infrastructure are needed to prevent future low-pressure events and to maintain uninterrupted access to the fundamental public health protection provided by safe water supplies. Households and communities need to increase their awareness of and preparedness for water emergencies to mitigate adverse health impacts. PMID:25608522

  10. Additive effect of in-hospital TIMI bleeding and chronic kidney disease on 1-year cardiovascular events in patients with acute coronary syndrome

    Lin, Tsung-Hsien; Lai, Wen-Ter; Kuo, Chi-Tai; Hwang, Juey-Jen; Chiang, Fu-Tien; Chang, Shu-Chen; Chang, Chee-Jen

    2014-01-01

    In-hospital bleeding (IHB) is associated with the risk of subsequent cardiovascular events (CVE) in acute coronary syndrome (ACS). We investigated whether increased risk of CVE by IHB is influenced by chronic kidney disease (CKD) or both have detrimental effects on CVE. In a Taiwan national-wide registry, 2819 ACS patients were enrolled. CKD is defined as an estimated glomerular filtration rate of

  11. Effects of Clopidogrel on Mortality, Cardiovascular and Bleeding Outcomes in Patients with Chronic Kidney Disease - Data from Taiwan Acute Coronary Syndrome Full Spectrum Registry

    Lin, Tsung-Hsien; Lai, Wen-Ter; Hsin, Ho-Tsung; Li, Ai-Hsien; Wang, Chun-Li; Kuo, Chi-Tai; Hwang, Juey-Jen; Chiang, Fu-Tien; Chang, Shu-Chen; ,

    2013-01-01

    Background The efficacy of clopidogrel is inconclusive in the chronic kidney disease (CKD) population with acute coronary syndrome (ACS). Furthermore, CKD patients are prone to bleeding with antiplatelet therapy. We investigated the efficacy and safety of clopidogrel in patients with ACS and CKD. Methods In a Taiwan national-wide registry, 2819 ACS patients were enrolled. CKD is defined as an estimated glomerular filtration rate of less than 60 ml/min per 1.73 m2. The primary endpoints are th...

  12. Vascular gastric anomalies as a cause of relapsing bleeding

    Golubović Gradimir

    2008-01-01

    Full Text Available Background. Although relatively rare, gastric vascular anomalies can be recognized as a source of both chronic and acute blood loss, most often presenting as long term iron deficiency anemia, rarely as severe acute gastrointestinal bleeding. Case report. We present five patients with various gastric vascular anomalies, diagnosed during the year of 2003. in the Clinical Hospital Center Zemun. The diagnosis was based on endoscopic appearances, clinical history and characteristic histological findings. Gastric vascular anomalies presented in our review were: portal hypertensive gastropathy, gastric antral vascular ectasia, angiodysplasia, hereditary hemorrhagic telangiectasia and Dieulafoy lesion. The used treatment modalities included surgery and various endoscopic techniques (schlerotherapy, argon plasma coagulation. Conclusion. Patients presented with chronic iron deficiency anemia or acute and recurrent gastrointestinal hemorrhage should be considered as having one of gastric vascular anomalies.

  13. Dramatic regression and bleeding of a duodenal GIST during preoperative imatinib therapy: case report and review

    Schwandner Thilo

    2010-06-01

    Full Text Available Abstract Background Gastrointestinal stromal tumors (GISTs are the most common mesenchymal tumors of the digestive tract. The majority of GISTs is located in the stomach. Only 3-5% of GISTs are located in the duodenum associated with an increased risk of gastrointestinal bleeding as primary manifestation. With response rates of up to 90%, but complications like bleeding due to tumor necrosis in 3%, imatinib mesylate dramatically altered the pre- and postoperative therapy for GIST patients. Case presentation A 58-year-old female patient presented with acute upper gastrointestinal bleeding 2 weeks after a giant GIST of the duodenum had been diagnosed. Neoadjuvant imatinib therapy had been initiated to achieve a tumor downsizing prior to surgery. During emergency laparotomy a partial duodenopancreatectomy was performed to achieve a complete resection of the mass. Histology revealed a high-malignancy GIST infiltrating the duodenal wall. Adjuvant imatinib therapy was initiated. At follow-up (19 months the patient is still alive and healthy. Conclusion Giant GISTs of the duodenum are rare and - in contrast to other localizations - harbour a higher risk of serious bleeding as primary manifestation. Tumor necrosis and tumor bleeding are rare but typical adverse effects of imatinib therapy especially during treatment of high-malignancy GIST. In GIST patients with increased risk of tumor bleeding neoadjuvant imatinib therapy should thoroughly be performed during hospitalization. In cases of duodenal GIST primary surgery should be considered as treatment alternative.

  14. Diagnostic performance of Baveno IV criteria in cirrhotic patients with upper gastrointestinal bleeding: analysis of the F7 liver-1288 study population

    Thabut, D; D'Amico, G; Tan, P; De Franchis, R; Fabricius, S; Lebrec, D; Bosch, J; Bendtsen, F

    2010-01-01

    The definition of failure to control bleeding agreed upon at the Baveno IV consensus meeting, included the Adjusted Blood Requirement Index [ABRI: number of blood units/(final-initial hematocrit+0.01)]. ABRI ≥0.75 denotes failure. However, timing for hematocrit measurements was not defined. The...... aims of this study were: (1) to assess the Baveno IV criteria performance to classify treatment success or failure to control bleeding at 5 days, (2) to determine the appropriate timing for hematocrit....

  15. Diagnostic performance of Baveno IV criteria in cirrhotic patients with upper gastrointestinal bleeding: analysis of the F7 liver-1288 study population

    Thabut, D; D'Amico, G; Tan, P; De Franchis, R; Fabricius, S; Lebrec, D; Bosch, J; Bendtsen, F

    2010-01-01

    The definition of failure to control bleeding agreed upon at the Baveno IV consensus meeting, included the Adjusted Blood Requirement Index [ABRI: number of blood units/(final-initial hematocrit+0.01)]. ABRI =0.75 denotes failure. However, timing for hematocrit measurements was not defined. The...... aims of this study were: (1) to assess the Baveno IV criteria performance to classify treatment success or failure to control bleeding at 5 days, (2) to determine the appropriate timing for hematocrit....

  16. MR findings of acute graft-versus-host disease involving gastrointestinal tracts

    To evaluate the MR findings of gastrointestinal graft-versus-host disease (GVHD) after allogenic bone marrow transplantation. Five patients (M:F=3:2, age range: 9-58 years) with suspected gastrointestinal GVHD underwent abdominal MRI, and the findings were evaluated. Because of acute myelocytic leukemia (n=4) or non-Hodgkin's lymphoma (n=1), all had undergone allogenic bone marrow transplantation 2-6 (mean, 3.5) weeks earlier. T2-weighted half-fourier acquisition snapshot turbo spin-echo, T1-weighted spoiled gradient-echo (SGE), and postcontrast T1-weighted SGE MR imaging, with and without fat-suppression, was performed. All five patients showed bowel wall thickening and marked contrast enhancement in the jejunum (n=5), ileum (n=4), duodenum (n=3), sigmoid colon (n=3), gastric antrum (n=2), and rectum (n=2). Bowel wall thickening showed a target appearance in the jejunum (n=2, 40.4%), lieum (n=1, 25.0%), sigmoid colon (n=1, 33.3%), and rectum (n=1, 50.0%), while the remaining cases showed diffuse wall thickening without layering. Small amount of ascites was noted in four patients (80%), and multiple small conglomerated retroperitoneal lymph nodes in three (60%). In all patients, a signal intensity of slightly enlarged liver due to iron overload secondary to multiple blood transfusions, gave rise to decreased signal intensity at both T1- and T2-weighted MR imaging. In patients with GVHD, the commonly noted MR findings were bowel was thickening with contrast enhancement, ascites and retroperitoneal lymphadenopathy

  17. Evidence-based nursing in the application of liver cirrhosis upper gastrointestinal bleeding nursing research%循证护理在肝硬化上消化道出血护理中的应用研究

    党惠枝; 黄彬彬

    2014-01-01

    Objective:Analysis and Discussion of evidence-based nursing care of patients with gastrointestinal bleeding clinical application results in cirrhosis.Methods:Choose January 201 2 gastrointestinal bleeding were randomly divided into an upper level in March 201 3 in our hospital treated 5 6 cases of liver cirrhosis in the observation group and control group 28 cases,Evidence-based nursing observation group,the control group received routine care,And to compare the effects of treatments.Result:Ob-servation group hemostasis success rate(70.7%)、Discharge time(8.4 ± 2.4d)、Patient satisfaction(80.5 %)etc Were significantly better than the control group(P<0.05). Conclusion:Upper gastrointestinal bleeding in cirrhosis of the line of evidence - based care,which can effectively improve the success rate of bleeding,shorter hospital stays,improve the therapeutic effect.%目的:分析探讨循证护理在肝硬化上消化道出血患者临床护理中的应用效果.方法:选择2011年1月-2013年5月在我院接受治疗的56例肝硬化上消化道出血患者随机平分为观察组、对照组各28例,观察组给予循证护理,对照组给予常规护理,并对护理效果进行比较.结果:观察组止血成功率(85.7%)、出院时间(8.4±2.4d)、患者满意度(96.4%)等均明显优于对照组(P<0.05).结论:对肝硬化上消化道出血行循证护理,可有效提高止血成功率、缩短住院时间,提高治疗效果.

  18. Bleeding Disorders

    ... as clotting factors. If you have a bleeding disorder, you either do not have enough platelets or ... don't work the way they should. Bleeding disorders can be the result of other diseases, such ...

  19. Protective effect of adeturone on protein assimilation in the gastro-intestinal tract following acute X-irradiation

    The effect of adeturone and AET on the process of assimilation of food stuffs in the gastro-intestinal tract and possibilities for its protection from radiation injury were studied. Comparative assessment of the protective capabilities of adeturone and AET on the process of protein hydrolysis and absorption in the gastro-intestinal tract and the loss of serum proteins in the small intestines in acute X-irradiation revealed that the two radioprotectors adeturone and AET, being chemical agents, induce almost identical and transient changes in the absorption of protein hydrolysis products in the gastro-intestinal tract. These changes seem to have no aggravating effect on the course of radiation injury. In comparison with AET, adeturone exerts superior radioprotective effect on the processes studied, following exposure to a lethal X-ray dose of 800 r. (author)

  20. Transfusion requirements in patients with gastrointestinal bleeding: a study in a Blood Unit at a referral hospital Requerimientos transfusionales en pacientes con hemorragia digestiva: estudio en una Unidad de Sangrantes de un hospital de referencia

    A. Garrido

    2006-10-01

    Full Text Available Objectives: 1. To study transfusion requirements in the Department of Gastroenterology of a Tertiary Referral Hospital, and their evolution over the last seven years. 2. To analyze risk factors associated with greater erythrocyte transfusion requirements. Patients and methods: erythrocyte transfusion requirements were compared for patients admitted to the Department of Gastroenterology at Hospital Virgen del Rocío, Seville, from 1999 to 2005. Clinical data of interest have been analyzed in order to determine factors associated with greater transfusion requirements. Results: 1,611 patients with a mean age of 60.45 years (59.7-61.2 were included in this study; 76.41% were males. Gastric ulcers were the cause of bleeding in 18.4% of cases (with 69% requiring transfusions; duodenal ulcers caused 22.2% of cases (with 52.9% requiring transfusions, and portal hypertension caused 33.6% of cases (with 90.2% requiring transfusions. Upper and lower gastrointestinal bleeding of unknown origin requires transfusions in 88.9 and 96.2% of cases, respectively. A multivariate logistic regression analysis showed that clinical presentations such as hematemesis (odds ratio = 3.12, hematochezia (odds ratio = 33.17, gastrointestinal hemorrhage of unknown origin (odds ratio = 6.57, and hemorrhage as a result of portal hypertension (odds ratio = 3.43 were associated with greater transfusion requirements for erythrocyte concentrates. No significant differences were observed between the percentages of patients who received transfusions from 1999 to 2005. Conclusions: 1. No differences have been observed between the percentages of patients who received transfusions over the last seven years at our Department of Gastroenterology. 2. Patients presenting with hematemesis or hematochezia, in addition to those with bleeding of unknown origin or from portal hypertension, are prone to have greater transfusion requirements.

  1. Hemosuccus Pancreaticus: An Uncommon Cause of Gastrointestinal Hemorrhage. A Case Report

    Chattopadhyay TK

    2004-09-01

    Full Text Available CONTEXT: Pseudoaneurysms of peripancreatic arteries usually arise as a complication of acute and chronic pancreatitis. These pseudoaneurysms may either bleed intra abdominally following rupture or may erode into the adjacent hollow viscera and manifest as gastrointestinal bleeding. Pseudoaneurysms rarely communicate with the pancreatic duct and bleeding occurs from the ampulla of Vater in the form of hemosuccus pancreaticus. CASE REPORT: We report a patient with chronic pancreatitis who presented with hemosuccus pancreaticus. Contrast enhanced computerized tomography and angiography revealed bleeding from a left gastric artery pseudoaneurysm. Despite multiple attempts, embolization was unsuccessful due to arterial spasm. The patient was successfully managed at emergency surgery by excision of the pseudoaneurysm sac and ligation of the left gastric artery. CONCLUSION: Bleeding from visceral artery pseudoaneurysms rarely manifests itself as hemosuccus pancreaticus. Most cases can be managed by angio-embolization. However, in patients with recurrent bleeding or failed embolization, emergency surgery is required.

  2. 舒适护理在上消化道出血患者中的应用效果%Application Effect of Comfortable Nursing in Patients with Upper Gastrointestinal Bleeding

    杨月; 翟晶岩

    2015-01-01

    目的观察并分析舒适护理在上消化道出血患者中的应用效果。方法取100例上消化道出血患者并均分为两组,两组患者均接受常规治疗与护理,观察组同时开展舒适护理服务,评估两组治疗情况、护理满意度。结果与对照组相比,观察组治疗总有效率更高,止血时间以及住院时间更短,组间差异显著而具有统计学意义(<0.05)。结论在上消化道出血临床治疗过程中开展舒适护理有利于改善临床疗效,促进患者康复,值得临床推广使用。%Objective To observe and analyze the application ef ect of comfortable nursing in patients with upper gastrointestinal bleeding. Methods 100 patients with upper gastrointestinal hemor hage and were divided into two groups, two groups of patients were accepted routine treatment and nursing, the observation group of comfortable nursing service at the same time, the evaluation of two groups of treatment and nursing satisfaction. Results Compared with control group and observation group total ef ective rate is higher, the bleeding time and shorter hospitalization time, significant dif erence between groups with statistical significance ( < 0.05). Conclusion In the process of upper gastrointestinal hemor hage clinical treatment in comfortable nursing to improve clinical curative ef ect, promote patients recover, worthy of clinical use.

  3. Use of CO2 as an angiographic contrast material in the diagnosis of acute hepatic hemorrhage a case report

    Selective abdominal arteriography with an iodinated contrast material is the method of choice for detecting the site of bleeding in patients with acute gastrointestinal hemorrhage in whom the results of endoscopic examination were negative CO2, has been used successfully as a contrast material for arteriography of abdomen and lower limbs. We present the case of a patient in whom suspected gastrointestinal bleeding was detected more rapidly and reliably with co2 than with an iodinated contrast material. (Author) 18 Refs

  4. Hydroclimatic variables and acute gastro-intestinal illness in British Columbia, Canada: A time series analysis

    Galway, L. P.; Allen, D. M.; Parkes, M. W.; Li, L.; Takaro, T. K.

    2015-02-01

    Using epidemiologic time series analysis, we examine associations between three hydroclimatic variables (temperature, precipitation, and streamflow) and waterborne acute gastro-intestinal illness (AGI) in two communities in the province of British Columbia (BC), Canada. The communities were selected to represent the major hydroclimatic regimes that characterize BC: rainfall-dominated and snowfall dominated. Our results show that the number of monthly cases of AGI increased with increasing temperature, precipitation, and streamflow in the same month in the context of a rainfall-dominated regime, and with increasing streamflow in the previous month in the context of a snowfall-dominated regime. These results suggest that hydroclimatology plays a role in driving the occurrence and variability of AGI in these settings. Further, this study highlights that the nature and magnitude of the effects of hydroclimatic variability on AGI are different in the context of a snowfall-dominated regime versus a rainfall-dominated regimes. We conclude by proposing that the watershed may be an appropriate context for enhancing our understanding of the complex linkages between hydroclimatic variability and waterborne illness in the context of a changing climate.

  5. Evaluación económica del tratamiento con ácido acetilsalicílico más esomeprazol comparado con clopidogrel en la prevención de la hemorragia gastrointestinal Economic evaluation of the treatment of aspirin plus esomeprazole compared to clopidogrel in gastrointestinal bleeding prevention

    Carme Piñol

    2006-02-01

    Full Text Available Objetivo: Evaluar la eficiencia del ácido acetilsalicílico (AAS más esomeprazol frente a clopidogrel en la prevención de la hemorragia gastrointestinal. Métodos: Análisis coste-efectividad (árbol de decisión de 2 ramas: AAS más esomeprazol y clopidogrel respecto a la evitación de casos de hemorragia gastrointestinal en 2 años, y análisis de sensibilidad. Resultados: El coste total del tratamiento con AAS más esomeprazol (2.865 S por paciente libre de hemorragia fue inferior al clopidogrel (2.965 S. El tratamiento con AAS resultó dominante. En todos los análisis de sensibilidad la combinación siguió siendo dominante. Al sustituir esomeprazol 40 mg por omeprazol 40 mg, el coste del tratamiento combinado descendió hasta 1.934S/por episodio evitado. Conclusiones: La asociación de esomeprazol y AAS es más coste-efectiva que clopidogrel en la prevención de la hemorragia gastrointestinal. La combinación con omeprazol resulta aún más coste-efectiva.Objective: To evaluate the use of aspirin plus esomeprazole vs. clopidogrel in the prevention of gastrointestinal bleeding. Methods: We performed a cost-effectiveness analysis (two-branch decision tree: aspirin plus esomeprazole or clopidogrel of prevention of gastrointestinal bleeding over a 2-year period, as well as sensitivity analyses. Results: The total cost of aspirin plus esomeprazole treatment (2,865S/patient free of hemorrhage was lower than that of clopidogrel (2,965S. Aspirin treatment was dominant. The combination continued to be dominant in all sensitivity analyses. When esomeprazole 40 mg was substituted by omeprazole 40 mg, the cost of combination therapy decreased to 1,934 S/prevented hemorrhage. Conclusions: The association of esomeprazole and aspirin is more cost-effective than clopidogrel in preventing gastrointestinal bleeding. Aspirin plus omeprazole was even more cost-effective.

  6. Volcano-like intermittent bleeding activity for seven years from an arterio-enteric fistula on a kidney graft site after pancreas-kidney transplantation: a case report

    Schölmerich Jürgen

    2010-11-01

    Full Text Available Abstract Introduction We report the first case of a patient who underwent simultaneous kidney and pancreas transplantation and who then suffered from repeated episodes of severe gastrointestinal bleeding over a period of seven years. Locating the site of gastrointestinal bleeding is a challenging task. This case illustrates that detection of an arterio-enteric fistula can be very difficult, especially in technically-challenging situations such as cases of severe intra-abdominal adhesions. It is important to consider the possibility of arterio-enteric fistulas in cases of intermittent bleeding episodes, especially in transplant patients. Case presentation A 40-year-old Caucasian man received a combined pancreas-kidney transplantation as a result of complications from diabetes mellitus type I. Thereafter, he suffered from intermittent clinically-relevant episodes of gastrointestinal bleeding. Repeat endoscopic, surgical, scintigraphic, and angiographic investigations during his episodes of acute bleeding could not locate the bleeding site. He finally died in hemorrhagic shock due to arterio-enteric bleeding at the kidney graft site, which was diagnosed post-mortem. Conclusions In accordance with the literature, we suggest considering the removal of any rejected transplant organs in situations where arterio-enteric fistulas seem likely but cannot be excluded by repeat conventional or computed tomography-angiographic methods. Arterio-enteric fistulas may intermittently bleed over many years.

  7. Acute gastrointestinal, genitourinary, and dermatological toxicity during dose-escalated 3D-conformal radiation therapy (3DCRT) using an intrarectal balloon for prostate gland localization and immobilization

    Purpose: We determined the acute gastrointestinal (GI), genitourinary (GU), and dermatologic (D) toxicity during dose-escalated three-dimensional conformal radiation therapy (3DCRT). A modified intrarectal balloon (Medrad) was used for prostate gland localization and immobilization. Methods: Forty-six men with clinical category T1c to T3a, and at least one high-risk feature (PSA >10, Gleason ≥7, or MRI evidence of extracapsular extension or seminal vesical invasion) comprised the study cohort. Treatment consisted of hormonal therapy and 4-field 3DCRT using an intrarectal balloon for the initial 15 of 40 treatments. Planning treatment volume dose was 72 Gy (95% normalization). A Mantel-Haenzel Chi-square test compared the distribution of GU, GI, and D symptoms at baseline and at end of treatment (EOT). Results: There was no significant difference between the 2 time points in the proportion of patients with bowel symptoms (p = 0.73), tenesmus (p = 0.27), nocturia (p = 1.00), or GU urgency (p = 0.40). However, there was a significant decrease in GU frequency (70% vs. 50%, p = 0.46) as a result of medical interventions and a significant increase in hemorrhoidal irritation (4% vs. 20%, p = 0.02) and anal cutaneous skin reaction (0% vs. 70%, p < 0.001). By 3 months after EOT compared to baseline, there was no significant difference in the proportion of patients experiencing hemorrhoidal bleeding (4% vs. 8%, p = 0.52), requiring intervention for hemorrhoidal symptoms (7% vs. 5%, p = 0.8), or experiencing persistent anal cutaneous skin reaction (0% vs. 3%, p = 0.31). Conclusion: Dose-escalated 3DCRT using an intrarectal balloon for prostate localization and immobilization was well tolerated. Acute GU, GI, and D symptoms resolved with standard dietary or medical interventions by the EOT or shortly thereafter

  8. Trouble with bleeding: risk factors for acute hepatitis C among HIV-positive gay men from Germany--a case-control study.

    Axel J Schmidt

    Full Text Available OBJECTIVES: To identify risk factors for hepatitis C among HIV-positive men who have sex with men (MSM, focusing on potential sexual, nosocomial, and other non-sexual determinants. BACKGROUND: Outbreaks of hepatitis C virus (HCV infections among HIV-positive MSM have been reported by clinicians in post-industrialized countries since 2000. The sexual acquisition of HCV by gay men who are HIV positive is not, however, fully understood. METHODS: Between 2006 and 2008, a case-control study was embedded into a behavioural survey of MSM in Germany. Cases were HIV-positive and acutely HCV-co-infected, with no history of injection drug use. HIV-positive MSM without known HCV infection, matched for age group, served as controls. The HCV-serostatus of controls was assessed by serological testing of dried blood specimens. Univariable and multivariable regression analyses were used to identify factors independently associated with HCV-co-infection. RESULTS: 34 cases and 67 controls were included. Sex-associated rectal bleeding, receptive fisting and snorting cocaine/amphetamines, combined with group sex, were independently associated with case status. Among cases, surgical interventions overlapped with sex-associated rectal bleeding. CONCLUSIONS: Sexual practices leading to rectal bleeding, and snorting drugs in settings of increased HCV-prevalence are risk factors for acute hepatitis C. We suggest that sharing snorting equipment as well as sharing sexual partners might be modes of sexual transmission. Condoms and gloves may not provide adequate protection if they are contaminated with blood. Public health interventions for HIV-positive gay men should address the role of blood in sexual risk behaviour. Further research is needed into the interplay of proctosurgery and sex-associated rectal bleeding.

  9. Treatment of Nonvariceal Gastrointestinal Hemorrhage by Transcatheter Embolization

    Purpose. To investigate the sensitivity of mesenteric angiography, technical success of hemostasis, clinical success rate, and complications of transcatheter embolization for the treatment of acute nonvariceal gastrointestinal hemorrhage. Material and Methods. A retrospective review of 200 consecutive patients who underwent mesenteric arteriography for acute nonvariceal gastrointestinal hemorrhage between February 2004 and February 2011 was done. Results. Of 200 angiographic studies, 114 correctly revealed the bleeding site with mesenteric angiography. 47 (41%) patients had upper gastrointestinal hemorrhage and 67 (59%) patients had lower gastrointestinal hemorrhage. Out of these 114, in 112 patients (98%) technical success was achieved with immediate cessation of bleeding. 81 patients could be followed for one month. Clinical success was achieved in 72 out of these 81 patients (89%). Seven patients rebled. 2 patients developed bowel ischemia. Four patients underwent surgery for bowel ischemia or rebleeding. Conclusion. The use of therapeutic transcatheter embolization for treatment of acute gastrointestinal hemorrhage is highly successful and relatively safe with 98% technical success and 2.4% postembolization ischemia in our series. In 89% of cases it was definitive without any further intervention

  10. Treatment of Nonvariceal Gastrointestinal Hemorrhage by Transcatheter Embolization

    Ali, Muhammad; Ul Haq, Tanveer; Salam, Basit; Beg, Madiha; Azeemuddin, Muhammad

    2013-01-01

    Purpose. To investigate the sensitivity of mesenteric angiography, technical success of hemostasis, clinical success rate, and complications of transcatheter embolization for the treatment of acute nonvariceal gastrointestinal hemorrhage. Material and Methods. A retrospective review of 200 consecutive patients who underwent mesenteric arteriography for acute nonvariceal gastrointestinal hemorrhage between February 2004 and February 2011 was done. Results. Of 200 angiographic studies, 114 correctly revealed the bleeding site with mesenteric angiography. 47 (41%) patients had upper gastrointestinal hemorrhage and 67 (59%) patients had lower gastrointestinal hemorrhage. Out of these 114, in 112 patients (98%) technical success was achieved with immediate cessation of bleeding. 81 patients could be followed for one month. Clinical success was achieved in 72 out of these 81 patients (89%). Seven patients rebled. 2 patients developed bowel ischemia. Four patients underwent surgery for bowel ischemia or rebleeding. Conclusion. The use of therapeutic transcatheter embolization for treatment of acute gastrointestinal hemorrhage is highly successful and relatively safe with 98% technical success and 2.4% postembolization ischemia in our series. In 89% of cases it was definitive without any further intervention. PMID:23844289

  11. Treatment of Non variceal Gastrointestinal Hemorrhage by Transcatheter Embolization

    To investigate the sensitivity of mesenteric angiography, technical success of hemostasis, clinical success rate, and complications of transcatheter embolization for the treatment of acute non variceal gastrointestinal hemorrhage. Material and Methods. A retrospective review of 200 consecutive patients who underwent mesenteric arteriography for acute non variceal gastrointestinal hemorrhage between February 2004 and February 2011 was done. Results. Of 200 angiographic studies, 114 correctly revealed the bleeding site with mesenteric angiography. 47 (41%) patients had upper gastrointestinal hemorrhage and 67 (59%) patients had lower gastrointestinal hemorrhage. Out of these 114, in 112 patients (98%) technical success was achieved with immediate cessation of bleeding. 81 patients could be followed for one month. Clinical success was achieved in 72 out of these 81 patients (89%). Seven patients rebled. 2 patients developed bowel ischemia. Four patients underwent surgery for bowel ischemia or rebleeding. Conclusion. The use of therapeutic transcatheter embolization for treatment of acute gastrointestinal hemorrhage is highly successful and relatively safe with 98% technical success and 2.4% post embolization ischemia in our series. In 89% of cases it was definitive without any further intervention.

  12. Gastrointestinal Fistulas in Acute Pancreatitis With Infected Pancreatic or Peripancreatic Necrosis

    Jiang, Wei; Tong, Zhihui; Yang, Dongliang; Ke, Lu; Shen, Xiao; Zhou, Jing; Li, Gang; Li, Weiqin; Li, Jieshou

    2016-01-01

    Abstract Gastrointestinal (GI) fistula is a well-recognized complication of acute pancreatitis (AP). However, it has been reported in limited literature. This study aimed to evaluate the incidence and outcome of GI fistulas in AP patients complicated with infected pancreatic or peripancreatic necrosis (IPN). Between 2010 and 2013 AP patients with IPN who diagnosed with GI fistula in our center were analyzed in this retrospective study. And we also conducted a comparison between patients with and without GI fistula regarding the baseline characteristics and outcomes. Over 4 years, a total of 928 AP patients were admitted into our center, of whom 119 patients with IPN were diagnosed with GI fistula and they developed 160 GI fistulas in total. Colonic fistula found in 72 patients was the most common form of GI fistula followed with duodenal fistula. All duodenal fistulas were managed by nonsurgical management. Ileostomy or colostomy was performed for 44 (61.1%) of 72 colonic fistulas. Twenty-one (29.2%) colonic fistulas were successfully treated by percutaneous drainage or continuous negative pressure irrigation. Mortality of patients with GI fistula did not differ significantly from those without GI fistula (28.6% vs 21.9%, P = 0.22). However, a significantly higher mortality (34.7%) was observed in those with colonic fistula. GI fistula is a common finding in patients of AP with IPN. Most of these fistulas can be successfully managed with different procedures depending on their sites of origin. Colonic fistula is related with higher mortality than those without GI fistula. PMID:27057908

  13. Healthcare use for acute gastrointestinal illness in two Inuit communities: Rigolet and Iqaluit, Canada

    Sherilee L. Harper

    2015-05-01

    Full Text Available Background: The incidence of self-reported acute gastrointestinal illness (AGI in Rigolet, Nunatsiavut, and Iqaluit, Nunavut, is higher than reported elsewhere in Canada; as such, understanding AGI-related healthcare use is important for healthcare provision, public health practice and surveillance of AGI. Objectives: This study described symptoms, severity and duration of self-reported AGI in the general population and examined the incidence and factors associated with healthcare utilization for AGI in these 2 Inuit communities. Design: Cross-sectional survey data were analysed using multivariable exact logistic regression to examine factors associated with individuals’ self-reported healthcare and over-the-counter (OTC medication utilization related to AGI symptoms. Results: In Rigolet, few AGI cases used healthcare services [4.8% (95% CI=1.5–14.4%]; in Iqaluit, some cases used healthcare services [16.9% (95% CI=11.2–24.7%]. Missing traditional activities due to AGI (OR=3.8; 95% CI=1.18–12.4 and taking OTC medication for AGI symptoms (OR=3.8; 95% CI=1.2–15.1 were associated with increased odds of using healthcare services in Iqaluit. In both communities, AGI severity and secondary symptoms (extreme tiredness, headache, muscle pains, chills were significantly associated with increased odds of taking OTC medication. Conclusions: While rates of self-reported AGI were higher in Inuit communities compared to non-Inuit communities in Canada, there were lower rates of AGI-related healthcare use in Inuit communities compared to other regions in Canada. As such, the rates of healthcare use for a given disease can differ between Inuit and non-Inuit communities, and caution should be exercised in making comparisons between Inuit and non-Inuit health outcomes based solely on clinic records and healthcare use.

  14. Bleeding in the Digestive Tract

    ... lining of the esophagus, stomach, or duodenum. The bacteria Helicobacter pylori (H. pylori) and use of nonsteroidal ... paleness shortness of breath vomit that looks like coffee grounds weakness A person with acute bleeding may ...

  15. Single vs double antiplatelet therapy in acute coronary syndrome: Predictors of bleeding after coronary artery bypass grafting

    Vincenzo; Tarzia; Giacomo; Bortolussi; Edward; Buratto; Carla; Paolini; Carlo; Dal; Lin; Giulio; Rizzoli; Tomaso; Bottio; Gino; Gerosa

    2015-01-01

    AIM:To investigate the contribution of anti-platelet therapy and derangements of pre-operative classical coagulation and thromboelastometry parameters to major bleeding post-coronary artery bypass grafting(CABG).METHODS:Two groups of CABG patients were studied:Group A,treated with aspirin alone(n=50),and Group B treated with aspirin and clopidogrel(n=50).Both had similar preoperative,clinical,biologic characteristics and operative management.Classic coagulation parameters and rotational thromboelastometry(ROTEM)profiles were determined preoperatively for both groups and the same heparin treatment was administered.ROTEM profiles(INTEM and EXTEM assays)were analyzed,both for traditional parameters,and thrombin generation potential,expressed by area-under-curve(AUC).RESULTS:There was no significant difference betweenrates of major bleeding between patients treated with aspirin alone,compared with those treated with aspirin and clopidogrel(12%vs 16%,P=0.77).In the 14 cases of major bleeding,pre-operative classic coagulation and traditional ROTEM parameters were comparable.Conversely we observed that the AUC in the EXTEM test was significantly lower in bleeders(5030±1115 Ohm*min)than non-bleeders(6568±548Ohm*min)(P<0.0001).CONCLUSION:We observed that patients with a low AUC value were at a significantly higher risk of bleeding compared to patients with higher AUC,regardless of antiplatelet treatment.This suggests that thrombin generation potential,irrespective of the degree of platelet inhibition,correlates with surgical bleeding.

  16. Acute blood volume expansion delays the gastrointestinal transit of a charcoal meal in awake rats

    de-Oliveira G.R.

    1998-01-01

    Full Text Available The present study evaluates the effect of blood volume expansion on the gastrointestinal transit of a charchoal meal (2.5 ml of an aqueous suspension consisting of 5% charcoal and 5% gum arabic in awake male Wistar rats (200-270 g. On the day before the experiments, the rats were anesthetized with ether, submitted to left jugular vein cannulation and fasted with water ad libitum until 2 h before the gastrointestinal transit measurement. Blood volume expansion by iv infusion of 1 ml/min Ringer bicarbonate in volumes of 3, 4 or 5% body weight delayed gastrointestinal transit at 10 min after test meal administration by 21.3-26.7% (P<0.05, but no effect was observed after 1 or 2% body weight expansion. The effect of blood volume expansion (up to 5% body weight on gastrointestinal transit lasted for at least 60 min (P<0.05. Mean arterial pressure increased transiently and central venous pressure increased and hematocrit decreased (P<0.05. Subdiaphragmatic vagotomy and yohimbine (3 mg/kg prevented the delay caused by expansion on gastrointestinal transit, while atropine (0.5 mg/kg, L-NAME (2 mg/kg, hexamethonium (10 mg/kg, prazosin (1 mg/kg or propranolol (2 mg/kg were ineffective. These data show that blood volume expansion delays the gastrointestinal transit of a charcoal meal and that vagal and yohimbine-sensitive pathways appear to be involved in this phenomenon. The delay in gastrointestinal transit observed here, taken together with the modifications of gastrointestinal permeability to salt and water reported by others, may be part of the mechanisms involved in liquid excess management.

  17. Acute-onset severe gastrointestinal tract hemorrhage in a postoperative patient taking rivaroxaban after total hip arthroplasty: a case report

    Boland Michael

    2012-05-01

    Full Text Available Abstract Introduction Rivaroxaban, a new oral anticoagulant, is currently licensed for use in patients undergoing orthopedic surgery. It is more efficacious than other anticoagulants such as low molecular weight heparin and does not require daily monitoring. It has also been shown to be efficacious in patients with venous thromboembolism and acute coronary syndrome. Although hemorrhage is a known side effect of this new anticoagulant, we could find no case reports in the literature of patients suffering severe hemorrhage whilst taking rivaroxaban. Thus, we describe the first case of potentially fatal hemorrhage in a patient taking rivaroxaban. Case presentation We report the case of a 58-year-old Caucasian man with acute-onset severe per rectal bleeding who had undergone total hip arthroplasty four weeks prior to the onset of symptoms and was taking rivaroxaban in the postoperative period. Rivaroxaban was discontinued immediately but, having required nine units of packed red blood cells in a peripheral hospital due to a rapidly decreasing hemoglobin level, our patient was transferred to our tertiary referral center where he required a further eight units of packed red blood cells over a 48-hour period to manage his ongoing hemorrhage and maintain hemodynamic stability. No source of bleeding was found on computed tomography angiography and our patient’s condition improved over the following 48 hours with cessation of the hemorrhage. Our patient was discharged home well several days later. A follow-up colonoscopy one week after his discharge was normal. Conclusion Although advantageous with regard to its oral availability and ongoing use without the need for daily monitoring, rivaroxaban does not come without rare but severe side effects. When severe per rectal bleeding occurs in a patient taking rivaroxaban, discontinuation of the offending agent and aggressive hematological replacement are the mainstays of treatment, especially when no

  18. Acute-onset severe gastrointestinal tract hemorrhage in a postoperative patient taking rivaroxaban after total hip arthroplasty: a case report

    Boland, Michael

    2012-05-14

    AbstractIntroductionRivaroxaban, a new oral anticoagulant, is currently licensed for use in patients undergoing orthopedic surgery. It is more efficacious than other anticoagulants such as low molecular weight heparin and does not require daily monitoring. It has also been shown to be efficacious in patients with venous thromboembolism and acute coronary syndrome. Although hemorrhage is a known side effect of this new anticoagulant, we could find no case reports in the literature of patients suffering severe hemorrhage whilst taking rivaroxaban. Thus, we describe the first case of potentially fatal hemorrhage in a patient taking rivaroxaban.Case presentationWe report the case of a 58-year-old Caucasian man with acute-onset severe per rectal bleeding who had undergone total hip arthroplasty four weeks prior to the onset of symptoms and was taking rivaroxaban in the postoperative period. Rivaroxaban was discontinued immediately but, having required nine units of packed red blood cells in a peripheral hospital due to a rapidly decreasing hemoglobin level, our patient was transferred to our tertiary referral center where he required a further eight units of packed red blood cells over a 48-hour period to manage his ongoing hemorrhage and maintain hemodynamic stability. No source of bleeding was found on computed tomography angiography and our patient’s condition improved over the following 48 hours with cessation of the hemorrhage. Our patient was discharged home well several days later. A follow-up colonoscopy one week after his discharge was normal.ConclusionAlthough advantageous with regard to its oral availability and ongoing use without the need for daily monitoring, rivaroxaban does not come without rare but severe side effects. When severe per rectal bleeding occurs in a patient taking rivaroxaban, discontinuation of the offending agent and aggressive hematological replacement are the mainstays of treatment, especially when no source of bleeding can be found

  19. Internal Bleeding

    ... 2 Diabetes, Heart Disease a Dangerous Combo Are 'Workaholics' Prone to OCD, Anxiety? ALL NEWS > Resources First ... pelvis, that are broken. Initially, internal bleeding may cause no symptoms, although an injured organ that is ...

  20. Bleeding Disorders

    ... times I'd miss work and skip the gym because I felt so lousy. So I decided ... cell called platelets. Your body also needs blood proteins called clotting factors. In people with bleeding disorders, ...

  1. Clinical Characteristics of Patients with Myocardial Infarction and Gastrointestinal Bleeding%伴消化道出血的急性心肌梗死患者的临床特点研究

    张慧平; 赵迎; 艾虎; 孙福成; 李康; 郑耐心

    2011-01-01

    疗困难,且多预后不良.%Objective To investigate the clinical characteristics and prognosis of patients with acute myocardial infarction ( AMI ) and gastrointestinal bleeding ( GIB ).Methods All 427 patients with AMI were divided into MI group ( n = 404 ,without GIB ).MI - GIB group ( n = 15, AMI followed by GIB ) group and GIB - MI group ( n =8, GIB followed by AMI )group.the clinical characteristics and combined end points of one - year cardiovascular death and hospitalization for recurrent angina pectoris , non - deadly MI, heart failure and stroke were analyzed.Results ( 1 ) Compared with MI group , the percentage of the patients with a history of GIB was higher in both MI - GIB and CJIB - MI groups ( 13.3% , 12.5% vs.5.2%), and the percentage of non - ST - elevation MI was higher in GIB - MI group ( 62.5% vs.43.6% ), but with no statistical differences ( P >0.05 ).( 2 ) The estimated glomerular filtration rate ( eGFR ) in MI - GIB group was significantly lower than that in MI group [( 57.I ±23.5 ) ml · min-1 · 1.73 m -2 vs.( 74.6 ±26.4 ) ml · min-1 · 1.73 m-2, P <0.05].Logostic regression analysis with eGFR revealed that the hazard ratio for patients' development of GIB after AMI was 0.975 [95% CI ( 0.957,0.995 ), P <0.05].( 3 ) The ratio of adopting anti - platelet and anti - coagulant medications in GIB - MI group and the ratio of aspirin usage in MI - GIB group was significant lower as compared with in MI group, respectively ( P < 0.05 ).The level of hemoglohin in GIB - MI group was significantly lower than that in MI - GIB group [( 7.2 ± 1.3 ) g/dl vs.( 11.3 ±2.5 ) g/dl,P <0.01], but the ratio of blood transfusion was significantly higher ( 75.0% vs.26.7% , P < 0.05 ).The ratio of percutane ous coronary intervention ( PCI ) or thrombolytic therapy in GIB - MI group was lower than that in MI group, but with no statistical differences ( 53.3% vs.76.0% , P >0.05 ); while the ratio of adopting PCI or thrombolytic

  2. Effect of Comfortable Nursing on Quality of Life of Patients With Upper Gastrointestinal Bleeding%舒适护理对上消化道出血患者生活质量的影响

    张毅宇

    2015-01-01

    目的:探讨舒适护理对上消化道出血患者生活质量的影响。方法选取我院200例上消化道出血患者,随机分为观察组和对照组,每组患者均为100例,对照组采用常规护理,观察组采用舒适护理,比较两组患者的护理效果。结果观察组护理后的SAS评分低于对照组(P<0.05),护理后生活质量方面的评分均高于对照组(P<0.05)。结论舒适护理可大大改善患者的各项综合要求,提高生理和心理上的舒适度,改善生活质量。%Objective To explore the effect of comfortable nursing on quality of life of patients with upper gastrointestinal bleeding.Methods 200 cases of elderly patients with upper gastrointestinal bleeding were divided into the observation group(n=50)and the control group(n=50),the control group was given routine nursing,the observation group was given comfortable nursing,nursing effects were compared between two groups.Results Anxiety (SAS)score after nursing in the observation group care were significantly lower than those in the control group(P<0.05),life quality score in the observation group were significantly higher than those in the control group(P<0.05).Conclusion Comfortable nursing can greatly improve the comprehensive needs of the patients,improve the physiological and psychological comfort,and improve the quality of life.

  3. High syndecan-1 levels in acute myeloid leukemia are associated with bleeding, thrombocytopathy, endothelial cell damage, and leukocytosis

    Larsen, Anne Mette Vestskov; Leinøe, Eva Birgitte; Johansson, Pär I;

    2013-01-01

    The risk of hemorrhage is influenced by multiple factors in acute myeloid leukemia (AML). We investigated whether hemorrhage in AML patients was associated with endothelial perturbation, potentially caused by thrombocytopenia, platelet dysfunction and leukocytosis. Biomarkers of endothelial pertu...

  4. Heterotopic Ileal Pancreas with Lipoma and Coexisting Fibromatosis Associated with a Rare Case of Gastrointestinal Bleeding. A Case Report and Review of the Literature

    Panagiotis Fikatas

    2008-09-01

    Full Text Available Context The development of pancreatic tissue outside the confines of the main gland represents a congenital abnormality referred to as heterotopic pancreas. This is a rare pathological and surgical entity which remains mostly asymptomatic. Case report We present the case of a 28- year-old male, who was admitted to hospital because of a history of blood in bowel movements. After a normal gastroscopy and colonoscopy, Tc99m-tagged red blood cells scintigraphy showed enrichment in the right lower abdomen. At double-balloon endoscopy, a intraluminal polypoid mass 8 cm in diameter was revealed 120 cm from the ileocecal valve. The initial macroscopic diagnosis was a gastrointestinal stromal tumor. During surgery, the diagnosis of heterotopic pancreas with lipoma and fibromatosis was made. To our knowledge this is the first case of ileal heterotopic pancreatic tissue and lipoma described to date in the literature. Conclusion Ileal heterotopic pancreas is a rare entity with potentially life-threatening complications, local excision being the appropriate indicated treatment.

  5. Neurochemical mechanism of the gastrointestinal interdigestive migrating motor complex in rats with acute inflammatory stomach ache

    Xiaoli Xu; Qin Li; Lv Zhou; Liqiang Ru

    2012-01-01

    The normal gastrointestinal interdigestive migrating motor complex cycle was interrupted, and paroxysmal contraction appeared after formaldehyde-induced stomach ache. Activities of nitric oxide synthase, acetylcholinesterase and vasoactive intestinal peptide neurons were significantly reduced, whereas activities of calcitonin gene-related peptide neurons were significantly increased in the pyloric sphincter muscular layer, myenteric nerve plexus and submucous nerve plexus. Electroacupuncture at Zusanli (ST36) suppressed paroxysmal contraction in rats with formaldehyde-induced stomach ache, and neurons in the enteric nervous system were normal. These results indicated that nitrergic neurons, cholinergic neurons, vasoactive intestinal peptide neurons and calcitonin gene-related peptide neurons in the enteric nervous system may be involved in changes to the gastrointestinal interdigestive migrating motor complex following stomach ache, and that electroacupuncture can regulate this process.

  6. Prospects for management of gastrointestinal injury associated with the acute radiation syndrome

    The effect of total-body ionizing radiation on the digestive tract is dose-dependent and time-dependent. At low doses (1.5 Gy), one observes only a short prodromal syndrome consisting of nausea, vomiting, and gastric suppression. At doses greater than 6 Gy, the prodromal syndrome is more marked, and it is followed after a 2-5-day remission period by a subacute syndrome, characterized by diarrhea and hematochezia. This gastrointestinal syndrome is superimposed onto a radiation-induced bone marrow suppression. The combination of intestinal and hemopoietic syndromes results in dehydration, anemia, and infection, leading eventually to irreversible shock and death. The treatment of prodromal symptoms is based on the administration of antiemetics and gastrokinetics, although an effective treatment devoid of side effects is not yet available for human therapy. The treatment of the gastrointestinal subacute syndrome remains difficult and unsuccessful after exposure to total body doses greater than 8-10 Gy. Supportive therapy to prevent infection and dehydration may be effective if restoration or repopulation of the intestinal and bone marrow stem cells does occur. In addition, bone marrow transplantation may improve the prospect of treating the hemopoietic syndrome, although the experience gained in Chernobyl suggests that this treatment is difficult to apply in the case of nuclear accidents. Administration of radioprotectants before irradiation decreases damage to healthy cells, while not protecting cancerous tissues. In the future, stimulation of gastrointestinal and hemopoietic progenitor cells may be possible using cell growth regulators, but much remains to be done to improve the treatment of radiation damage to the gastrointestinal tract. 77 references

  7. A Review of Bleeding in Acute Coronary Syndrome%急性冠状动脉综合征抗栓治疗中出血的研究进展

    张佳慧

    2012-01-01

    Percutaneous transluminal coronary intervention and antithrombotic therapy have resulted in significant improvement in reducing ischemic events in acute coronary syndrome, while leading to an increase in the risk of bleeding. There has been an increasing amount of data demonstrating that bleeding has a strong association with subsequent adverse outcomes. Therefore, it is imperative to optimize patient outcomes by performing bleeding risk assessment and stratification, adopting pharmacological and nonphannacological strategies to minimize bleeding while maximizing treatment efficacy. This review focuses on the classifications, epidemiology, adverse outcomes, and management of bleeding in patients with acute coronary syndrome.%经皮冠状动脉介入治疗与抗栓药物在显著降低急性冠状动脉综合征患者缺血事件的同时,也相应增加了出血风险.出血发生率增高与患者不良临床预后强烈相关.全面评估患者出血风险进行危险分层,谨慎平衡缺血与出血风险制定治疗策略,预防控制出血并发症,在临床实践中非常重要.现就急性冠状动脉综合征出血分级标准、出血发生率、预后及预防控制做一综述.

  8. Absence of Helicobacter pylori is not protective against peptic ulcer bleeding in elderly on offending agents: lessons from an exceptionally low prevalence population

    Yeong Yeh Lee

    2014-02-01

    Full Text Available Aim. Helicobacter pylori (H. pylori infection is exceptionally rare in population from the north-eastern region of Peninsular Malaysia. This provides us an opportunity to contemplate the future without H. pylori in acute non-variceal upper gastrointestinal (GI bleeding. Methods. All cases in the GI registry with GI bleeding between 2003 and 2006 were reviewed. Cases with confirmed non-variceal aetiology were analysed. Rockall score > 5 was considered high risk for bleeding and primary outcomes studied were in-hospital mortality, recurrent bleeding and need for surgery. Results. The incidence of non-variceal upper GI bleeding was 2.2/100,000 person-years. Peptic ulcer bleeding was the most common aetiology (1.8/100,000 person-years. In-hospital mortality (3.6%, recurrent bleeding (9.6% and need for surgery (4.0% were uncommon in this population with a largely low risk score (85.2% with score ≤5. Elderly were at greater risk for bleeding (mean 68.5 years, P = 0.01 especially in the presence of duodenal ulcers (P = 0.04 despite gastric ulcers being more common. NSAIDs, aspirin and co-morbidities were the main risk factors. Conclusions. The absence of H. pylori infection may not reduce the risk of peptic ulcer bleeding in the presence of risk factors especially offending drugs in the elderly.

  9. Acute right lower quadrant pain beyond acute appendicitis: MDCT in evaluation of benign and malignant gastrointestinal causes

    Reem Hassan Bassiouny

    2014-09-01

    Conclusion: Using a systematic pattern approach MDCT has proved to be an extremely useful noninvasive method for evaluation of patients with acute RLQP, allowing diagnosis and management of not only the most common conditions such as appendicitis but also less common conditions.

  10. Mechanisms of gastric emptying disturbances in chronic and acute inflammation of the distal gastrointestinal tract

    Keller, Jutta; Beglinger, Christoph; Holst, Jens Juul;

    2009-01-01

    It is unclear why patients with inflammation of the distal bowel complain of symptoms referable to the upper gastrointestinal tract, specifically to gastric emptying (GE) disturbances. Thus we aimed to determine occurrence and putative pathomechanisms of gastric motor disorders in such patients....... Thirteen healthy subjects (CON), 13 patients with Crohn's disease (CD), 10 with ulcerative colitis (UC), and 7 with diverticulitis (DIV) underwent a standardized (13)C-octanoic acid gastric emptying breath test. Plasma glucose, CCK, peptide YY, and glucagon-like peptide-1 (GLP-1) were measured periodically...

  11. Mechanisms of Gastric Emptying Disturbances in Chronic and Acute Inflammation of the Distal Gastrointestinal Tract

    Keller, Jutta; Beglinger, Christoph; Holst, Jens Juul;

    2009-01-01

    Objective: It is unclear why patients with inflammation of the distal bowel complain of symptoms referable to the upper gastrointestinal tract, specifically to gastric emptying (GE) disturbances. Thus, we aimed to determine occurrence and putative pathomechanisms of gastric motor disorders...... in such patients. Methods: 13 healthy subjects (CON), 13 patients with Crohn's disease (CD), 10 with ulcerative colitis (UC) and 7 with diverticulitis (DIV) underwent a standardized (13)C-octanoic acid gastric emptying breath test. Plasma glucose, cholecystokinin (CCK), peptide YY (PYY) and glucagon-like peptide-1...

  12. BLEED & BLEND

    Goodfellow, Paul

    2012-01-01

    BLEED & BLEND is an ambient artwork that was commissioned by Digital Media in Newcastle University's Culture Lab, as part of their data visualisation screening project: Data Elements. The aim of the project was to take an unconventional approach to interpreting and displaying scientific data through visual artworks. The work was projected onto Newcastle University's Kings Gate building in Newcastle city centre in October 2012. A useful and succinct description of Ambient Art is found in B...

  13. The crosstalk between gut inflammation and gastrointestinal disorders during acute pancreatitis.

    Guo, Zhen-Zhen; Wang, Pu; Yi, Zhi-Hui; Huang, Zhi-Yin; Tang, Cheng-Wei

    2014-01-01

    The intestinal inflammation caused by intestinal ischemia reperfusion during acute pancreatitis (AP) often leads to multiple organ dysfunction and aggravation of acute pancreatitis. This review concerns up-date progress of the pathophysiology and molecular mechanism of the excessive production of gut-derived cytokines. The regulation effects of immuno-neuro-endocrine network for pancreatic necrosis are the basis for pharmacological therapeutic in AP. The translation from basic research to clinical trials for the prevention or treatment of severe acute pancreatitis (SAP) is of great value. Early enteral nutrition is necessary for the restitution, proliferation, and differentiation of the intestinal epithelial cells adjacent to the wounded area. Clearance of the excess intestinal bacteria and supplement of probiotics may be helpful to prevent bacterial translocation and infection of pancreas. PMID:23782148

  14. The use of basiliximab-infliximab combination for the treatment of severe gastrointestinal acute GvHD.

    Nadeau, M; Perreault, S; Seropian, S; Foss, F; Isufi, I; Cooper, D L

    2016-02-01

    After allogeneic stem cell transplant, severe grade III-IV gastrointestinal (GI) acute GvHD is associated with significant morbidity and mortality, and generally results in poor outcomes. Salvage therapy for patients who fail steroid therapy is not well defined in the literature. In the current retrospective study, we reviewed our experience with the combination of basiliximab and infliximab in 21 patients with severe, grade III-IV GI acute GvHD of whom 16 met the definition for steroid-refractory disease. The overall response rate was 76%, with 43% CR at a median time of 21 days after beginning treatment. The survival at 1 year was 24%, with most deaths due to complications from GvHD and recurrence of primary disease. All five of the long-term survivors have chronic GvHD. On the basis of a review of the literature, this regimen does not seem to be significantly more effective than other strategies for severe GI GvHD and seems to be worse than the results reported for basiliximab alone. Future studies of single-agent basiliximab and newer agents are required. PMID:26479982

  15. Endoscopic Management of Diverticular Bleeding

    Tarun Rustagi

    2014-01-01

    Full Text Available Diverticular hemorrhage is the most common reason for lower gastrointestinal bleeding (LGIB with substantial cost of hospitalization and a median length of hospital stay of 3 days. Bleeding usually is self-limited in 70–80% of cases but early rebleeding is not an uncommon problem that can be reduced with proper endoscopic therapies. Colonoscopy is recommended as first-line diagnostic and therapeutic approach. In the vast majority of patients diverticular hemorrhage can be readily managed by interventional endotherapy including injection, heat cautery, clip placement, and ligation to achieve endoscopic hemostasis. This review will serve to highlight the various interventions available to endoscopists with specific emphasis on superior modalities in the endoscopic management of diverticular bleeding.

  16. Dose–Volume Effects on Patient-Reported Acute Gastrointestinal Symptoms During Chemoradiation Therapy for Rectal Cancer

    Purpose: Research on patient-reported outcomes (PROs) in rectal cancer is limited. We examined whether dose–volume parameters of the small bowel and large bowel were associated with patient-reported gastrointestinal (GI) symptoms during 5-fluorouracil (5-FU)–based chemoradiation treatment for rectal cancer. Methods and Materials: 66 patients treated at the Brigham and Women’s Hospital or Massachusetts General Hospital between 2006 and 2008 were included. Weekly during treatment, patients completed a questionnaire assessing severity of diarrhea, urgency, pain, cramping, mucus, and tenesmus. The association between dosimetric parameters and changes in overall GI symptoms from baseline through treatment was examined by using Spearman’s correlation. Potential associations between these parameters and individual GI symptoms were also explored. Results: The amount of small bowel receiving at least 15 Gy (V15) was significantly associated with acute symptoms (p = 0.01), and other dosimetric parameters ranging from V5 to V45 also trended toward association. For the large bowel, correlations between dosimetric parameters and overall GI symptoms at the higher dose levels from V25 to V45 did not reach statistical significance (p = 0.1), and a significant association was seen with rectal pain from V15 to V45 (p < 0.01). Other individual symptoms did not correlate with small bowel or large bowel dosimetric parameters. Conclusions: The results of this study using PROs are consistent with prior studies with physician-assessed acute toxicity, and they identify small bowel V15 as an important predictor of acute GI symptoms during 5-FU–based chemoradiation treatment. A better understanding of the relationship between radiation dosimetric parameters and PROs may allow physicians to improve radiation planning to optimize patient outcomes.

  17. Dose-Volume Effects on Patient-Reported Acute Gastrointestinal Symptoms During Chemoradiation Therapy for Rectal Cancer

    Chen, Ronald C. [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women' s Hospital, Harvard Medical School, Boston, Massachusetts (United States); Mamon, Harvey J. [Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women' s Hospital, Harvard Medical School, Boston, Massachusetts (United States); Ancukiewicz, Marek [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Killoran, Joseph H. [Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women' s Hospital, Harvard Medical School, Boston, Massachusetts (United States); Crowley, Elizabeth M. [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Blaszkowsky, Lawrence S. [Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Wo, Jennifer Y. [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Ryan, David P. [Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Hong, Theodore S., E-mail: tshong1@partners.org [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States)

    2012-07-15

    Purpose: Research on patient-reported outcomes (PROs) in rectal cancer is limited. We examined whether dose-volume parameters of the small bowel and large bowel were associated with patient-reported gastrointestinal (GI) symptoms during 5-fluorouracil (5-FU)-based chemoradiation treatment for rectal cancer. Methods and Materials: 66 patients treated at the Brigham and Women's Hospital or Massachusetts General Hospital between 2006 and 2008 were included. Weekly during treatment, patients completed a questionnaire assessing severity of diarrhea, urgency, pain, cramping, mucus, and tenesmus. The association between dosimetric parameters and changes in overall GI symptoms from baseline through treatment was examined by using Spearman's correlation. Potential associations between these parameters and individual GI symptoms were also explored. Results: The amount of small bowel receiving at least 15 Gy (V15) was significantly associated with acute symptoms (p = 0.01), and other dosimetric parameters ranging from V5 to V45 also trended toward association. For the large bowel, correlations between dosimetric parameters and overall GI symptoms at the higher dose levels from V25 to V45 did not reach statistical significance (p = 0.1), and a significant association was seen with rectal pain from V15 to V45 (p < 0.01). Other individual symptoms did not correlate with small bowel or large bowel dosimetric parameters. Conclusions: The results of this study using PROs are consistent with prior studies with physician-assessed acute toxicity, and they identify small bowel V15 as an important predictor of acute GI symptoms during 5-FU-based chemoradiation treatment. A better understanding of the relationship between radiation dosimetric parameters and PROs may allow physicians to improve radiation planning to optimize patient outcomes.

  18. Bruising of the esophagus as a cause of gastrointestinal bleeding in a case of heatstroke Hematomas esofágicos como causa de hemorragia digestiva en un caso de golpe de calor

    A. J. Lucendo Villarín

    2005-08-01

    Full Text Available Alterations in blood clotting are a frequent complication of serious heatstroke and may result in gastrointestinal bleeding. We report the case of a 26-year-old man who was admitted to our hospital with symptoms of hyperthermia associated with encephalopathy and disseminated intravascular coagulation (DIC after prolonged exposure to sunlight. He presented hematemesis, after which he was diagnosed with having a bruising of the esophagus that took up the upper and lower thirds, there being no other lesions in the stomach or duodenum. After supportive treatment and following the resolution of the underlying pathology, the endoscopy-revealed injuries healed with a complete normalization of the esophageal mucosa. Esophageal submucosal bruising is an exceptional cause of hematemesis in serious heatstroke not previously described in the literature.Las alteraciones de la coagulación son una complicación frecuente en el golpe de calor grave, y pueden ser causa de hemorragia digestiva. Presentamos el caso de un varón de 26 años que fue admitido en nuestro hospital por un cuadro de hipertermia, asociado con encefalopatía y coagulación intravascular diseminada tras exposición solar prolongada. Presentó hematemesis por la que fue diagnosticado de múltiples hematomas esofágicos que ocupaban los tercios superior e inferior del órgano, en ausencia de otras lesiones en estómago y duodeno. Tras el tratamiento de soporte y la resolución de la patología subyacente, desaparecieron las lesiones endoscópicas, normalizándose la mucosa esofágica.

  19. Digestive bleeding in children Sangrado digestivo en el niño.

    Luis Antonio García Rodríguez

    2005-12-01

    Full Text Available Usually gastrointestinal bleeding doesn't have serious consequences in children, although the newborns and infants are more vulnerable to it. It can appear to any age, with more incidence of acute lesions of gastric and duodenal mucous in bleeding of upper gastrointestinal tract, and fissures and polyps in lower gastrointestinal tract causes. The most serious bleedings are secondary to esophageal varices and Meckel's diverticulum. A good clinical trial, supported by image and endoscopic tests, and standardized therapy, are the key elements for the reduction of mortality in these patients. We presented the Good Clinical Practices Guideline for Gastrointestinal bleeding, approved by consensus in the the 4th National Good Clinical Practices Workshop in Pediatric Surgery (Las Tunas, Cuba; March 2005

    La hemorragia digestiva no suele tener en general consecuencias graves en los niños, aunque los neonatos y lactantes son más vulnerables a ella. Puede aparecer a cualquier edad, con mayor incidencia de las lesiones agudas de la mucosa gastroduodenal en los de origen alto, y las fisuras y los pólipos de recto en los de causas bajas. Los sangrados más graves son los secundarios a rotura de várices esofágicas y divertículos de Meckel. Un juicio clínico certero, apoyado en los estudios imaginológicos y endoscópicos, así como una terapéutica pautada, son elementos claves para la reducción de la morbimortalidad en estos pacientes. Se presenta la Guía de Buenas Prácticas Clínicas para sangrado digestivo, aprobada por consenso en el 4º Taller Nacional de Buenas Prácticas Clínicas en Cirugía Pediátrica (Las Tunas, 2005.

  20. Does recombinant human erythropoietin accelerate correction of post-ulcer-bleeding anaemia? A pilot study

    Spiros D. Ladas; Dimitrios Polymeros; Thomas Pagonis; Konstantinos Triantafyllou; Gregorios Paspatis; Maria Hatziargiriou; Sotirios A.Raptis

    2004-01-01

    AIM: Anaemia caused by acute upper gastrointestinal bleeding is treated with blood transfusion or iron, but patients usually face a two-month recovery period from posthaemorrhage anaemia. This prospective, randomised, open,pilot study was designed to investigate whether recombinant human erythropoietin (Epoetin) therapy accelerate haematocrit increase in the post-bleeding recovery period.METHODS: We studied hospitalised patients admitted because of acute ulcer bleeding or haemorrhagic gastritis,who had a haematocrit of 27-33% and did not receive blood transfusions. One day after the endoscopic confirmation of cessation of bleeding, they were randomised either to erythropoietin (20 000 IU Epoetin alfa subcutaneously, on days 0, 4 and 6) plus iron (100 mg im, on days 1- 6, (G1) or iron only (G2). Haematocrit was measured on days 0, 6, 14,30, 45, and 60, respectively.RESULTS: One patient from G1 and two from G2 were lost to follow-up. Therefore, 14 and 13 patients from G1 and G2respectively were analysed. Demographic characteristics, serum iron, ferritin, total iron binding capacity, reticulocytes, and haematocrit were not significantly different at entry to the study.Median reticulocyte counts were significantly different between groups on day six (G1: 4.0, 3.0-6.4 vsG2: 3.5, 2.1-4.4%,P=0.03) and median haematocrit on day fourteen [G1: 35.9,30.7-41.0 vsG2: 32.5, 29.5-37.0% (median, range), P=0.04].CONCLUSION: Erythropoietin administration significantly accelerates correction of anemia after acute ulcer bleeding.The haematocrit gain is equivalent to one unit of transfused blood two weeks after the bleeding episode.

  1. 21 CFR 876.5980 - Gastrointestinal tube and accessories.

    2010-04-01

    ... mercury weight balloon for intestinal intubation or decompression, and gastro-urological irrigation tray..., gastrointestinal string and tubes to locate internal bleeding, double lumen tube for intestinal decompression...

  2. Catastrophic gastrointestinal complication of systemic immunosuppression.

    Smith, Lyn Alexandra; Gangopadhyay, Mitali; Gaya, Daniel R

    2015-02-28

    We present a case of acute upper gastrointestinal haemorrhage in a patient with systemic vasculitis immunosuppressed on cyclophosphamide and prednisolone. The patient presented with a diffuse haemorrhagic oesophagitis and a non-specific duodenitis. Biopsies taken from the oesophagus and duodenum demonstrated infection with herpes simplex virus (HSV) and cytomegalovirus (CMV) respectively. Viral infection of the upper gastrointestinal tract is a recognised complication of immunosuppression and HSV is one of the most common pathogens. CMV on the other hand most commonly causes a colitis or less commonly oesophagitis. CMV enteritis is rare as is the synchronous infection with two viral agents in an immunocompromised patient having being described in a few case series only. Viral infection of the gastrointestinal tract in immunocompromised patients should be treated with systemic anti-viral medication and consideration to withdrawal of the immunosuppressive therapy if possible and appropriate. The authors highlight the need for a high suspicion of viral infection in immunosuppressed patients presenting with upper gastrointestinal bleeding. PMID:25741165

  3. The association between farming activities, precipitation, and the risk of acute gastrointestinal illness in rural municipalities of Quebec, Canada: a cross-sectional study

    Gosselin Pierre; Gingras Suzanne; Levallois Patrick; Febriani Yossi; Majowicz Shannon E; Fleury Manon D

    2010-01-01

    Abstract Background Increasing livestock density and animal manure spreading, along with climate factors such as heavy rainfall, may increase the risk of acute gastrointestinal illness (AGI). In this study we evaluated the association between farming activities, precipitation and AGI. Methods A cross-sectional telephone survey of randomly selected residents (n = 7006) of 54 rural municipalities in Quebec, Canada, was conducted between April 2007 and April 2008. AGI symptoms and several risk f...

  4. Recurrent gastrointestinal hemorrhage in treatment with dasatinib in a patient showing SMAD4 mutation with acute lymphoblastic leukemia Philadelphia positive and juvenile polyposis hereditary hemorrhagic telangiectasia syndrome

    Chiara Sartor

    2013-07-01

    Full Text Available We report a case of a patient affected by juvenile polyposis and hereditary hemorrhagic telangiectasia linked to a SMAD4 mutation who developed acute lymphoblastic leukemia positive for the Philadelphia chromosome translocation and with a complex karyotype. During the treatment with the tyrosine kinase inhibitor dasatinib the patient presented recurrent severe gastrointestinal hemorrhages linked to the genetic background and aggravated by thrombocytopenia.

  5. Endoscopic management of bleeding peptic ulcers

    Peptic ulcers account for more than half of the cases of non variceal upper gastrointestinal (GI) bleeding and therefore, are the focus of most of the methods of endoscopic hemostasis. Surgical intervention is now largely reserved for patients in whom endoscopic hemostasis has failed. A variety of endoscopic techniques have been employed to stop bleeding and reduce the risk of rebleeding, with no major differences in outcome between these methods. These include injection therapy, fibrin injection, heater probe, mono polar electrocautery, bipolar electrocautery, lasers and mechanical hemo clipping. The most important factor in determining outcome after gastrointestinal bleeding is rebleeding or persistent bleeding. The endoscopic appearance of an ulcer, however, provides the most useful prognostic information for bleeding. Recurrent bleeding after initial endoscopic hemostasis occurs in 15-20% of patients with a bleeding peptic ulcer. The best approach to these patients remains controversial; the current options are repeat endoscopic therapy with the same or a different technique, emergency surgery or semi elective surgery after repeat endoscopic hemostasis. The combination of epinephrine injection with thermal coagulation may be more effective than epinephrine injection alone. Newer modalities such as fibrin injection or the application of hemo clips appear promising and comparative studies are awaited. (author)

  6. Predictive Factors Study Of Rectal Bleeding Radical Radiotherapy In Prostate Cancer

    Full text: Objective: To determine clinical, para clinical or to predict dosimetric the occurrence of rectal bleeding after radical radiotherapy as primary treatment prostate cancer in patients treated at the National Cancer Institute (Inca) dimensional external beam radiation. Materials and Methods: From July 2008 to July 2011 132 patients were recruited, 86 of which met followed for 12 months. Side effect was recorded gastrointestinal track at different times of the patient with classifications RTOG / EORTC ( Radiation Therapy Oncology Group / European Organization for Research and Treatment of Cancer) and SOMA / LENT also used a questionnaire specifically built and tested by the Italian cooperative group. results were correlated with clinical parameters (PSA, Gleason score, clinical T, class risk, hypertension, and diabetes) and dosimetric ( treatment volume, volume rectum, total dose, maximum dose to the rectum mean dose to the rectum) to assess the correlation thereof with the occurrence of rectal bleeding. Results: In a cut to 12 months follow-up, there is a relationship between the appearance bleeding with time. The mean dose to the rectum and the initial PSA showed significance in correlation with the occurrence of rectal bleeding, with a p of 0.01 and 0.54 respectively. Conclusions: The rectal side effect is one of the major side effects both acute and chronic prostate radiotherapy in the present study has failed to demonstrate a correlation between two factors predictive identified as potentially priori significant the occurrence of rectal bleeding, as the initial PSA and the mean dose to the rectum

  7. Tranexamic acid for upper gastrointestinal bleeding

    Gluud, Lise Lotte; Klingenberg, Sarah Louise; Langholz, Ebbe

    2012-01-01

    Tranexamic acid reduces haemorrhage through its antifibrinolytic effects. In a previous version of the present review, we found that tranexamic acid may reduce mortality. The present review includes updated searches of randomised trials on tranexamic acid versus placebo, cimetidine or lansoprazole....

  8. Bleeding Disorders Treatment Options

    ... Pictures Young Voices Compendium of Assessment Tools Educational Games Video Library Find a Treatment Centre Haemophilia Journal About Bleeding Disorders Bleeding Disorders The Clotting Process Drugs That Can Cause Bleeding Hemophilia How Do You ...

  9. Obscure bleeding colonic duplication responds to proton pump inhibitor therapy

    2013-01-01

    We report the case of a 17-year-old male admitted to our academic hospital with massive rectal bleeding. Since childhood he had reported recurrent gastrointestinal bleeding and had two exploratory laparotomies 5 and 2 years previously. An emergency abdominal computed tomography scan, gastroscopy and colonoscopy, performed after hemodynamic stabilization, were considered normal. High-dose intravenous proton pump inhibitor (PPI) therapy was initiated and bleeding stopped spontaneously. Two othe...

  10. Octreotide in the Control of Post-Sclerotherapy Bleeding from Oesophageal Varices, Ulcers and Oesophagitis

    Spencer A. Jenkins

    1996-01-01

    Full Text Available Bleeding from oesophageal varices, oesophageal ulcers or oesophagitis is occasionally massive and difficult to control. Octreotide, a synthetic analogue of somatostin lowers portal pressure and collateral blood flow including that through varices, increases lower oesophageal sphincter pressure, and inhibits the gastric secretion of acid as well as pepsin. Our current experience suggests it is effective in controlling acute variceal haemorrhage. Therefore we have examined the efficacy of octreotide in the control of postsclerotherapy bleeding from oesophageal varices, oesophageal ulcers and oesophagitis. During the study period 77 patients experienced a significant gastrointestinal bleed (blood pressure 100 beats per min or the need to transfuse 2 or more units of blood to restore the haemoglobin level following injection sclerotherapy of oesophageal varices. The source of bleeding was varices in 42 patients, oesophageal ulcers in 31 and oesophagitis in 4. All patients received a continuous intravenous infusion of octreotide (50 μg/h for between 40–140h. If bleeding was not controlled in the first 12h after commencing octreotide hourly bolus doses (50 μg for 24h were superimposed on the continuous infusion. Haemorrhage was successfully controlled by an infusion of octreotide in 38 of the 42 patients with bleeding from varices, in 30 of 31 patients with oesophageal ulceration, and all patients with oesophagitis. In the 1 patient with persistent bleeding from oesophageal ulceration and in 2 of the 4 with continued haemorrhage from varices, haemostasis was achieved by hourly boluses of 50 μg octreotide for 24h in addition to the continuous infusion. No major complications were associated with octreotide administration. The results of this study clearly indicate that octreotide is a safe and effective treatment for the control of severe haemorrhage after technically successful injection sclerotherapy.

  11. Gastrointestinal Fistulas in Acute Pancreatitis With Infected Pancreatic or Peripancreatic Necrosis: A 4-Year Single-Center Experience.

    Jiang, Wei; Tong, Zhihui; Yang, Dongliang; Ke, Lu; Shen, Xiao; Zhou, Jing; Li, Gang; Li, Weiqin; Li, Jieshou

    2016-04-01

    Gastrointestinal (GI) fistula is a well-recognized complication of acute pancreatitis (AP). However, it has been reported in limited literature. This study aimed to evaluate the incidence and outcome of GI fistulas in AP patients complicated with infected pancreatic or peripancreatic necrosis (IPN).Between 2010 and 2013 AP patients with IPN who diagnosed with GI fistula in our center were analyzed in this retrospective study. And we also conducted a comparison between patients with and without GI fistula regarding the baseline characteristics and outcomes.Over 4 years, a total of 928 AP patients were admitted into our center, of whom 119 patients with IPN were diagnosed with GI fistula and they developed 160 GI fistulas in total. Colonic fistula found in 72 patients was the most common form of GI fistula followed with duodenal fistula. All duodenal fistulas were managed by nonsurgical management. Ileostomy or colostomy was performed for 44 (61.1%) of 72 colonic fistulas. Twenty-one (29.2%) colonic fistulas were successfully treated by percutaneous drainage or continuous negative pressure irrigation. Mortality of patients with GI fistula did not differ significantly from those without GI fistula (28.6% vs 21.9%, P = 0.22). However, a significantly higher mortality (34.7%) was observed in those with colonic fistula.GI fistula is a common finding in patients of AP with IPN. Most of these fistulas can be successfully managed with different procedures depending on their sites of origin. Colonic fistula is related with higher mortality than those without GI fistula. PMID:27057908

  12. Two Cases of Acute Abdomen after an Intravitreal Injection of Bevacizumab

    Onoda, Yasutaka; Shiba, Tomoaki; Hori, Yuichi; Maeno, Takatoshi; Takahashi, Mao

    2015-01-01

    We report on a patient with ischemic colitis and another with paralytic ileus, both of whom experienced an acute abdomen after intravitreal injection of bevacizumab (IVB). Case 1 was a 78-year-old woman. Her medical history included surgery for colon carcinoma 10 years earlier. The patient developed acute severe abdominal pain and nausea the day after IVB for retinal vein occlusion with macular edema, and massive lower gastrointestinal bleeding occurred. Ischemic colitis was diagnosed. Case 2...

  13. [Bleeding gastric inflammatory fibroid polyp (Vanek's tumor)].

    Guţu, E; Ghidirim, Gh; Mişin, I; Iakovleva, Iraida; Vozian, M

    2010-01-01

    Inflammatory fibroid polyp's (IFP) or Vanek tumor of the gastrointestinal tract represents a relatively unusual entity. IFP is an extremely rare cause of upper gastrointestinal bleeding. We report herein a case of a 30-year-old woman who had a gastric IFP complicated by gastrointestinal bleeding and obstructive symptoms. The lesion was mistaken on endoscopic, radiologic examination and in the operating room for a gastrointestinal stromal tumor (GIST). Preoperative endoscopic examination revealed a protruding oval-shaped submucosal lesion (approximately 7 cm in size) of the gastric antrum, with ulceration of the mucosal surface. Multiple endoscopic biopsies were negative for neoplastic changes. Barium meal study disclosed a large tumor in the prepyloric area of the stomach. Presumptive preoperative diagnosis was GIST. Subtotal Bilroth II gastrectomy en bloc with the mass and lymphadenectomy was performed. Surprisingly, the final histological diagnosis was IFP. Postoperative course was uneventful and no recurrences were observed during 4 years follow-up. With reference to case report, the etiology, diagnosis and treatment strategy of IFP will be discussed. This case highlights an unusual presentation of IFP. Although bleeding may represent a rare complication due IFP, it should be considered in the differential diagnosis of upper gastrointestinal hemorrhage of uncertain etiology. PMID:20405696

  14. Bleeding from gums: Can it be a dengue

    Rajat Bansal; Purnita Goyel; Dinesh. C. Agarwal

    2014-01-01

    Introduction: Bleeding from gums is a common feature in periodontitis patient. But abnormal bleeding from the gingiva or other areas of the oral mucosa that is difficult to control is an important clinical sign suggesting a hematological disorder. Case Report: A-40-year old male patient reported to our clinic with the chief complaint of acute gingival bleeding. There was continuous bleeding, fever since 3-4 days with weakness, retro orbital pain, and severe backache. Patient gave a history of...

  15. Onyx (ethylene-vinyl-alcohol-copolymer). A novel approach to the endovascular treatment of acute bleeding; Onyx (Ethylen-Vinyl-Alkohol-Kopolymer). Ein neuer Anwendungsbereich in der endovaskulaeren Behandlung akuter peripherer Blutungen

    Mueller-Wille, R.; Herold, T.; Jung, E. M.; Rennert, J.; Heiss, P.; Feuerbach, S.; Zorger, N. [Inst. fuer Roentgendiagnostik, Universitaetsklinikum Regensburg (Germany); Lenhart, M. [Klinik fuer Diagnostische und Interventionelle Radiologie, Sozialstiftung Bamberg (Germany); Paetzel, C. [Inst. fuer Radiologische Diagnostik, Klinikum Weiden (Germany)

    2009-08-15

    Purpose: The purpose of our retrospective study was to determine the feasibility and efficacy of the endovascular embolization of peripheral acute arterial hemorrhage using Onyx. Materials and Methods: Between October 2003 and February 2007, 14 patients with acute arterial bleeding underwent percutaneous arterial embolization using Onyx. Bleeding was caused by iatrogenic vessel injury (6 patients), malignancy/inflammation (5 patients) and trauma (3 patients). Hematomas were located in the pelvis (5 patients), followed by liver (3 patients), retroperitoneal space (2 patients), thorax (2 patients), pancreas (1 patient), and thigh (1 patient). The number of embolized arteries, the volume and viscosity of embolic agent (Onyx), the number of additionally used coils, the embolization time, and the technical and clinical outcome were documented. Procedure-related complications, recurrent bleeding during hospital stay and outcome were recorded. Results: In 14 patients selective endovascular embolization of 15 arteries was performed. The average volume of injected Onyx was 1.3 {+-} 0.8 ml. In 6 cases (42.9%) Onyx was used in conjunction with coils. The average time between the correct placement of microcatheter and complete embolization was 24.9 {+-} 12.6 minutes. In 13 of 14 patients (92.8%), embolization was technically successful. In one case, procedure-related complications occurred and embolization was performed in a second session a day later. After technically successful embolization, no recurrent bleeding occurred during hospitalization. Out of 14 patients, six (42.9%) died 1 - 38 days after technically successful embolization due to multiple organ failure (2 patients), hypoxic brain injury (2 patients), septic shock (1 patient) or malignancy-associated death (1 patient). (orig.)

  16. Renal, gastrointestinal, and hepatic late effects in survivors of childhood acute myeloid leukemia treated with chemotherapy only--a NOPHO-AML study

    Skou, Anne-Sofie; Glosli, Heidi; Jahnukainen, Kirsi; Jarfelt, Marianne; Jónmundsson, Guðmundur K; Malmros-Svennilson, Johan; Nysom, Karsten; Hasle, Henrik

    2014-01-01

    performed. Eighty-five of 94 (90%) eligible sibling controls completed a similar questionnaire. Siblings had no clinical examination or blood sampling performed. RESULTS: At a median of 11 years (range 4-25) after diagnosis, renal, gastrointestinal, and hepatic disorders were rare both in survivors of......BACKGROUND: We investigated the spectrum, frequency, and risk factors for renal, gastrointestinal, and hepatic late adverse effects in survivors of childhood acute myeloid leukemia (AML) without relapse treated with chemotherapy alone according to three consecutive AML trials by the Nordic Society...... childhood AML and in sibling controls, with no significant differences. Ferritin was elevated in 21 (21%) AML survivors but none had biochemical signs of liver damage. Viral hepatitis was present in three and cholelithiasis in two AML survivors. One adult survivor had hypertension, two had slightly elevated...

  17. Obscure bleeding colonic duplication responds to proton pump inhibitor therapy.

    Jacques, Jérémie; Projetti, Fabrice; Legros, Romain; Valgueblasse, Virginie; Sarabi, Matthieu; Carrier, Paul; Fredon, Fabien; Bouvier, Stéphane; Loustaud-Ratti, Véronique; Sautereau, Denis

    2013-09-21

    We report the case of a 17-year-old male admitted to our academic hospital with massive rectal bleeding. Since childhood he had reported recurrent gastrointestinal bleeding and had two exploratory laparotomies 5 and 2 years previously. An emergency abdominal computed tomography scan, gastroscopy and colonoscopy, performed after hemodynamic stabilization, were considered normal. High-dose intravenous proton pump inhibitor (PPI) therapy was initiated and bleeding stopped spontaneously. Two other massive rectal bleeds occurred 8 h after each cessation of PPI which led to a hemostatic laparotomy after negative gastroscopy and small bowel capsule endoscopy. This showed long tubular duplication of the right colon, with fresh blood in the duplicated colon. Obscure lower gastrointestinal bleeding is a difficult medical situation and potentially life-threatening. The presence of ulcerated ectopic gastric mucosa in the colonic duplication explains the partial efficacy of PPI therapy. Obscure gastrointestinal bleeding responding to empiric anti-acid therapy should probably evoke the diagnosis of bleeding ectopic gastric mucosa such as Meckel's diverticulum or gastrointestinal duplication, and gastroenterologists should be aware of this potential medical situation. PMID:24124344

  18. Peri-operative nursing of infants with cavernous transformation of the portal vein and gastrointestinal bleeding undergoing distal splenorenal shunt%小儿门静脉海绵样变并消化道出血行远端脾肾分流术的围手术期护理

    刘新文; 何小琼; 甘红霞

    2014-01-01

    Objective To summarize the nursing of infants with cavernous transformation of the portal vein (CTPV) and gastrointestinal bleeding undergoing distal splenorenal shunt.Methods 3 cases of infants with CTPV and gastrointestinal bleeding were given with preoperative nursing for upper gastrointestinal bleeding,strengthening nutritional support; strengthening prevention measures of thrombosis and bleeding complications,monitoring of urine and urine gravity,completing the artery piezometer tube care,paying attention to the discharge guidance and follow-up work.Results The platelet increased in 3 cases post-operation.1 cases occurred abdominal bleeding,but improved after symptomatic treatment.1 case occurred leakage on the site of venous indwelling needle during intravenous infusion of high nutrient solution.3 cases of children received 3 months to 3 years follow-up after discharge,no complications such as liver,kidney and blood clots occurred.Conclusions Infants with CTPV and gastrointestinal bleeding undergoing distal splenorenal shunt is very rare in clinic.Good perioperative care and strengthening the observation of the postoperative complications,attaching great importance to the discharge guidance and follow-up work,are the assurances of successful treatment.%目的 总结门静脉海绵样变并消化道出血患儿行远端脾肾分流术的护理要点.方法 对3例门静脉海绵样变并消化道出血患儿术前做好上消化道出血的护理,加强营养支持;术后加强血栓和出血等并发症的防范工作,监测尿量和尿密度,做好动脉测压管的护理,重视出院指导和随访工作.结果 本组3例患儿术后均出现不同程度的血小板增高,1例患儿出现腹腔少量出血,经对症处理后好转,1例患儿输注静脉高营养液发生静脉留置针处渗漏;3例患儿出院后跟踪随访3个月~3年,无肝、肾功能异常及血栓等并发症发生.结论 小儿门静脉海绵样变脾肾分流术临床非常少

  19. Applications of Evidence-based Nursing and Foreseeing Nursing in Emergency Treatment of Upper Gastrointestinal Bleeding%循证护理与预见性护理在上消化道出血急救中的应用分析

    金艳瑜; 丛薇; 王沙沙; 刘婷婷; 李玉娇; 卢菲

    2015-01-01

    Objective Applications of Evidence-based Nursing and Foreseeing Nursing in Emergency Treatment of Upper Gastrointestinal Bleeding,for clinical reference.Methods From March 2012 to September 2014,We selected 100 patients with upper gastrointestinal hemorrhage patients in the study. The patients were randomly divided into two groups, each group 50 cases, Foreseeing Nursing in control group, Evidence-based Nursing in experimental group, Two groupsupper gastrointestinal hemorrhage patients were compared in nursing effect and the bleeding time. Results The results of the two groups of patients with hemorrhage of upper digestive tract bleeding time there are significant differences,P0.05.Conclusion In the case of patients with upper gastrointestinal hemorrhage,Effect of the implementation of evidence-based nursing and Foreseeing Nursing care of patients with the same,Nurses can according to the actual situation, choose the most suitable care programmes.%目的:分析循证护理与预见性护理在上消化道出血急救中的应用,为临床提供参考。方法选取我院收治的100例上消化道出血患者作为观察对象,收治时间为2012年3月~2014年9月,将患者随机分成两组,每组50例,对照组采取预见性护理,实验组采取循证护理,观察比较两组上消化道出血患者护理后的疗效及止血时间。结果两组上消化道出血患者止血时间的比较结果存在显著差异,P<0.05;两组上消化道出血患者总有效率的比较结果不存在显著差异,P>0.05。结论对上消化道出血患者而言,对其实施循证护理与预见性护理的效果相当,护理人员可以根据实际情况选择最合适的护理方案。

  20. Embolization for gastrointestinal hemorrhages

    Kraemer, S.C.; Goerich, J.; Rilinger, N.; Aschoff, A.J.; Vogel, J.; Brambs, H.J. [Dept. of Diagnostic Radiology, University of Ulm (Germany); Siech, M. [Dept. of Abdominal Surgery, University of Ulm (Germany)

    2000-05-01

    Retrospective evaluation of interventional embolization therapy in the treatment of gastrointestinal hemorrhage over a long-term observation period from 1989 to 1997. Included in the study were 35 patients (age range 18-89 years) with gastrointestinal bleeding (GI) referred for radiological intervention either primarily or following unsuccessful endoscopy or surgery. Sources of GI bleeding included gastric and duodenal ulcers (n = 7), diverticula (n = 3), erosion of the intestinal wall secondary to malignancy (n = 6), vascular malformations (n = 4), and hemorrhoids (n = 2), as well as from postoperative (n = 6), posttraumatic (n = 2), postinflammatory (n = 4) or unknown (n = 1) causes. Ethibloc (12 cases) or metal coils (14 cases) were predominantly used as embolisates. In addition, combinations of tissue adhesive and gelfoam particles and of coils and Ethibloc were used (six cases). Finally, polyvinyl alcohol particles, a coated stent, and an arterial wire dissection were utilized in one case each. Bleeding was stopped completely in 29 of 35 cases (83 %). In one case (3 %) the source of bleeding was recognized but the corresponding vessel could not be catheterized. In five other cases (14 %) there was partial success with reduced, though still persistent, bleeding. The rate of complications was 14 %, including four instances of intestinal ischemia with fatal outcome in the first years, and, later, one partial infarction of the spleen without serious consequences. Gastrointestinal hemorrhage can be controlled in a high percentage of patients, including the seriously ill and those who had previously undergone surgery, with the use of minimally invasive interventional techniques. The availability of minicoils instead of fluid embolization agents has reduced the risk of serious complications. (orig.)

  1. Embolization for gastrointestinal hemorrhages

    Retrospective evaluation of interventional embolization therapy in the treatment of gastrointestinal hemorrhage over a long-term observation period from 1989 to 1997. Included in the study were 35 patients (age range 18-89 years) with gastrointestinal bleeding (GI) referred for radiological intervention either primarily or following unsuccessful endoscopy or surgery. Sources of GI bleeding included gastric and duodenal ulcers (n = 7), diverticula (n = 3), erosion of the intestinal wall secondary to malignancy (n = 6), vascular malformations (n = 4), and hemorrhoids (n = 2), as well as from postoperative (n = 6), posttraumatic (n = 2), postinflammatory (n = 4) or unknown (n = 1) causes. Ethibloc (12 cases) or metal coils (14 cases) were predominantly used as embolisates. In addition, combinations of tissue adhesive and gelfoam particles and of coils and Ethibloc were used (six cases). Finally, polyvinyl alcohol particles, a coated stent, and an arterial wire dissection were utilized in one case each. Bleeding was stopped completely in 29 of 35 cases (83 %). In one case (3 %) the source of bleeding was recognized but the corresponding vessel could not be catheterized. In five other cases (14 %) there was partial success with reduced, though still persistent, bleeding. The rate of complications was 14 %, including four instances of intestinal ischemia with fatal outcome in the first years, and, later, one partial infarction of the spleen without serious consequences. Gastrointestinal hemorrhage can be controlled in a high percentage of patients, including the seriously ill and those who had previously undergone surgery, with the use of minimally invasive interventional techniques. The availability of minicoils instead of fluid embolization agents has reduced the risk of serious complications. (orig.)

  2. A Sporadic Small Jejunal GIST Presenting with Acute Lower Gastrointestinal Hemorrhage: A Review of the Literature and Management Guidelines

    Govindaraj, Sridar; Dias, Brendan Hermenigildo; Gautham, S. L.

    2015-01-01

    Gastrointestinal stromal tumors (GISTs) represent the majority of primary nonepithelial neoplasms of the digestive tract, most frequently expressing the KIT protein detected by immunohistochemical staining for the CD117 antigen. Jejunal GISTs account for approximately 10 % of GISTs. Patients usually present with abdominal discomfort. Jejunal GISTs may cause symptoms secondary to obstruction or hemorrhage. Pressure necrosis and ulceration of the overlying mucosa may cause gastrointestinal blee...

  3. 循证护理与预见性护理在上消化道出血急救中的应用价值分析%An analysis on Application Value of Evidence-based Nursing and Predictive Nursing During the First Aid for Upper Gastrointestinal Bleeding

    罗明春

    2015-01-01

    Objective:To observe the nursing effect of evidence‐based nursing and predictive nursing during the first aid for upper gastrointestinal bleeding and investigate more scientific nursing mode for upper gastrointestinal bleeding .Methods:Select 100 cases of patients with digestive system disease and accepted first aid for upper gastroin‐testinal bleeding from degestive system department in our hospital during the period from January 2013 to June 2014 , randomly divide them into two nursing groups ,and name them observation group and control group respective .Dur‐ing the first aid for first aid for upper gastrointestinal bleeding for the 50 cases of the patients in the observation group ,the patients were intervened with evidence‐based nursing while the control group were nursed with predictive nursing .Exam and make follow‐up after treatment ,observe nursing effect ,mainly the bleeding times ,haemostasis time and the occurance of symptom of the patients and learn the post‐treatment living habits through follow‐ups , conclude the overall effective rate and patients’ satisfaction degree .Results:Both the 50 cases of patients in the control group or the 50 ones in the observation group had shown the the two nursing effect has their advantages respectively , during the first aid for upper gastrointestinal bleeding ,the bleeding times ,haemostasis time and the occurance of symptoms were obviously lower in the control group ,overall effective rate and patients’ satisfaction degree of the ob‐servation group were all a little higher than that in the control group ,as for the improvement of living habits after the patients left hospital ,the control group was better ,the observation group can keep taking medicine om time .Conclu‐sion:Both evidence‐based nursing and predictive nursing are good nursing mode for the first aid for upper gastrointes‐tinal bleeding ,the joint application would achieve much better nursing effect ,assure the life quality

  4. Efficacy of somatostatin combined with vasopressin for treating cirrhosis combined upper gastrointestinal bleeding%生长抑素联合垂体后叶素治疗肝硬化上消化道出血的疗效观察

    张道铭

    2015-01-01

    目的:探讨生长抑素联合垂体后叶素对肝硬化合并上消化道出血的疗效。方法选取2012年1月~2014年1月在我院就诊的42例肝硬化合并上消化道出血的患者随机分为对照组(20例)及观察组(22例)。对照组给予垂体后叶素持续静脉滴注,观察组予以生长抑素+垂体后叶素持续静脉滴注治疗,观察并比较两组的临床疗效。结果对照组总有效率为70.0%,观察组总有效率为90.9%,两组比较差异具有统计学意义(P<0.05)。结论生长抑素联合垂体后叶素治疗肝硬化合并上消化道出血疗效显著。%Objective To investigate the efficacy of somatostatin combined with vasopressin for treating cirrhosis combined upper gastrointestinal bleeding. Methods Selected 42 cases of cirrhosis with gastrointestinal bleeding from January 2012 to January 2014 in on our hospital, All cases were randomLy divided into control group (20 cases) and the observation group (22 cases). The control group were given continuous intravenous infusion of vasopressin, and the observation group were added the intravenous somatostatin + vasopressin infusion therapy, observe and compare the clinical efficacy of the two groups. Results The total effective rate was 70.0% in the control group, so that was 90.9%in the treatment group, the difference compared between the two groups was statistically significant (P<0.05). Conclusion The combined pituitary hormone somatostatin treatment of upper gastrointestinal bleeding with cirrhosis has significant effect.

  5. Clinical application of gastrointestinal anastomat in surgical treatment of acute perforation of peptic ulcer%消化性溃疡急性穿孔手术中胃肠吻合器的应用价值探讨

    陈宁波; 陈仿; 曾杰; 先迪; 张建成; 李伟; 胡卫建

    2012-01-01

    Objective To discuss the superiority of the gastrointestinal anastomat in surgical treatment of acute perforation of gastroduodenal ulce (APPU) with subtotal gastrectomy. Methods 1067 cases of APPU were analyzed retrospectively in our emergency center from Jan 1995 to Dec 2010.739 patients undergoing subtotal gastrectomy were divided into two groups,appliance group (anastomat anastomosis) with 526 cases and handiwork group (handiwork anastomosis) with 213 cases. In appliance group,485 cases were operated by Billroth I operation,34 cases by Billroth II operation and 2 cases by Roux-en-y stomach intestine anastomosis. In handiwork group, 194 cases were operated by Billroth I operation, 15 cases by Billroth H operation and 4 cases by Roux-en-y stomach intestine anastomosis. Results Differences were significant in mean time of operation and mean functional recovery time of stomach intestine between the appliance group [ (105.0±18.2) min,(41.2±6.4) h] and the handiwork group [(154.0+35.1) min, (65. 6±12. 4) h] ( P < 0.01). Two cases of stomal leak, no case of anastomotic stenosis and 5 cases of bleeding in stoma were found in appliance group. Five cases of stomal leak,2 cases of anastomotic stenosis and 4 cases of bleeding in stoma were found in handiwork group. The complications in handiwork group were significantly lower than those in handiwork group (P < 0. 01). Conclusion The use of gastrointestinal anastomat can shorten operating time and functional recovery time of stomach intestine, which can reduce postoperative complications.%目的 探讨胃肠吻合器在消化性溃疡急性穿孔行胃大部切除手术中的应用价值.方法 1995年1月至2010年12月我院急救中心外科收治的消化性溃疡急性穿孔行胃大部切除术患者739例,其中器械吻合组526例(Billroth Ⅰ术式治疗485例,BillrothⅡ式34例,Roux-en-y胃肠吻合7例),手工吻合组213例(Billroth Ⅰ术式治疗194例,BillrothⅡ式15例,Roux-en-y胃肠吻合4例).结

  6. My Patient Taking A Novel Oral Anticoagulant Presents With Major GI Bleeding

    Amartya Kundu; Partha Sardar; Jessica Huston; Parijat Sen; Saurav Chatterjee; Ramez Nairooz; John J. Ryan; Wilbert S. Aronow

    2015-10-01

    Full Text Available Novel Oral Anticoagulants (NOACs such as Dabigatran, Rivaroxaban, Apixaban and Edoxaban are becoming increasingly popular choices for anticoagulation in place of oral Vitamin K Antagonists in various clinical settings. However, they are thought to be associated with an increased risk of gastrointestinal bleeding. Moreover, no specific antidote is available which can rapidly reverse the anti-coagulant action of NOACs raising concern that gastrointestinal bleeding with NOACs could carry a worse prognosis than that associated with conventional agents. In this review, we describe a case of gastrointestinal bleeding in the setting of NOAC use, followed by a brief overview of the pivotal trials involving NOACs. Clinical issues such as pathophysiology, diagnosis and management of NOAC induced GI bleeding have been described. Future trials will help elucidate the true incidence, risk factors and preventive strategies for NOAC associated gastrointestinal bleeding.

  7. Effects of Acute Bleeding Followed by Hydroxyethyl Starch 130/0.4 or a Crystalloid on Propofol Concentrations, Cerebral Oxygenation, and Electroencephalographic and Haemodynamic Variables in Pigs

    Aura Silva

    2014-01-01

    Full Text Available Bleeding changes the haemodynamics, compromising organ perfusion. In this study, the effects of bleeding followed by replacement with hydroxyethyl starch 130/0.4 (HES or lactated Ringer’s (LR on cerebral oxygenation and electroencephalogram-derived parameters were investigated. Twelve young pigs under propofol-remifentanil anaesthesia were bled 30 mL/kg and, after a 20-minute waiting period, volume replacement was performed with HES (GHES; N=6 or LR (GRL; N=6. Bleeding caused a decrease of more than 50% in mean arterial pressure (P<0.01 and a decrease in cerebral oximetry (P=0.039, bispectral index, and electroencephalogram total power (P=0.04 and P<0.01, resp., while propofol plasma concentrations increased (P<0.01. Both solutions restored the haemodynamics and cerebral oxygenation similarly and were accompanied by an increase in electroencephalogram total power. No differences between groups were found. However, one hour after the end of the volume replacement, the cardiac output (P=0.03 and the cerebral oxygenation (P=0.008 decreased in the GLR and were significantly lower than in GHES (P=0.02. Volume replacement with HES 130/0.4 was capable of maintaining the cardiac output and cerebral oxygenation during a longer period than LR and caused a decrease in the propofol plasma concentrations.

  8. Association of a XRCC3 polymorphism and rectum mean dose with the risk of acute radio-induced gastrointestinal toxicity in prostate cancer patients

    Background and purpose: We have performed a case–control study among prostate cancer patients treated with three-dimensional conformational radiotherapy (3D-CRT) in order to investigate the association between single nucleotide polymorphisms (SNPs), treatment and patient features with gastrointestinal and genitourinary acute toxicity. Material and methods: A total of 698 patients were screened for 14 SNPs located in the ATM, ERCC2, LIG4, MLH1 and XRCC3 genes. Gastrointestinal and genitourinary toxicities were recorded prospectively using the Common Terminology Criteria for Adverse Events v3.0. Results: The XRCC3 SNP rs1799794 (G/G OR = 5.65; 95% CI: 1.95–16.38; G/A OR = 2.75; 95% CI: 1.25–6.05; uncorrected p-value = 2.8 × 10−03; corrected p-value = 0.03; FDR q-value = 0.06) as well as the mean dose received by the rectum (OR = 1.06; 95% CI: 1.02–1.1; uncorrected p-value = 2.49 × 10−03; corrected p-value = 0.03; FDR q-value = 0.06) were significantly associated with gastrointestinal toxicity after correction for multiple testing. Those patients who undergone previous prostatectomy were less prone to develop genitourinary toxicity (OR = 0.38; 95% CI: 0.18–0.71; uncorrected p-value = 4.95 × 10−03; corrected p-value = 0.03; FDR q-value = 0.08). Our study excludes the possibility of a >2-fold risk increase in genitourinary acute toxicity being due to rs1801516 ATM SNP, the rs1805386 and rs1805388 LIG4 markers, as well as all the SNPs evaluated in the ERCC2, MLH1 and XRCC3 genes. Conclusions: The XRCC3 rs1799794 SNP and the mean dose received by the rectum are associated with the development of gastrointestinal toxicity after 3D-CRT.

  9. Otorrhagia bleeding due to leech bite

    Narges Askari; Afrooz Eshaghian

    2012-01-01

    Leeches are blood-sucking hermaphroditic parasites that attach to vertebrate hosts, bite through the skin, and suck out blood. When leeches feed, they secrete an anticoagulant (hirudin), which helps them get a full meal of blood. This is the first report of leech removal from external auditory canal. Previous leech involvement cases were explained in nasopharynx, larynx, pharynx, eye, and gastrointestinal tract. Prominent sign of all cases was active bleeding from the leech attachment site; t...

  10. Risk Factors and Outcome for Massive Intra-Abdominal Bleeding Among Patients With Infected Necrotizing Pancreatitis

    Shen, Xiao; Sun, Jing; Zhang, Jingzhu; Ke, Lu; Tong, Zhihui; Li, Gang; Jiang, Wei; Li, Weiqin; Li, Jieshou

    2015-01-01

    Abstract The incidence of acute bleeding is reported to be 13.5% in patients with acute necrotizing pancreatitis. However, of all the bleeding events, intra-abdominal bleeding was less studied in the literature and its risk factors have not been well defined yet. The purpose of the present study was to investigate the risk factors for massive intra-abdominal bleeding among the patients with infected necrotizing pancreatitis and assessed the outcome of these patients. Both univariate and multi...

  11. Therapeutic angiography for giant bleeding gastro-duodenal artery pseudoaneurysm

    Ram; Elazary; Mahmoud; Abu-Gazala; Avraham; Schlager; Noam; Shussman; Avraham; I; Rivkind; Allan; I; Bloom

    2010-01-01

    We present the case of an 18-year-old female transferred to our center from an outside hospital due to persistent gastrointestinal bleeding. Two weeks prior to her transfer she underwent duodenal omentopexy for a perforated duodenal peptic ulcer. The patient underwent a computed tomography angiogram which identified the source of bleeding as a giant gastroduodenal artery (GDA) pseudoaneurysm. The patient was taken to interventional radiology where successful microcoil embolization was performed. We present ...

  12. Endoscopic hemostasis state of the art - Nonvariceal bleeding.

    Goelder, Stefan Karl; Brueckner, Juliane; Messmann, Helmut

    2016-02-25

    New endoscopic techniques for hemostasis in nonvariceal bleeding were introduced and known methods further improved. Hemospray and Endoclot are two new compounds for topical treatment of bleeding. Initial studies in this area have shown a good hemostatic effect, especially in active large scale oozing bleeding, e.g., tumor bleedings. For further evaluation larger prospective studies comparing the substanced with other methods of endoscopic hemostasis are needed. For localized active arterial bleeding primary injection therapy in the area of ​​bleeding as well as in the four adjacent quadrants offers a good method to reduce bleeding activity. The injection is technically easy to learn and practicable. After bleeding activity is reduced the bleeding source can be localized more clearly for clip application. Today many different through-the-scope (TTS) clips are available. The ability to close and reopen a clip can aid towards good positioning at the bleeding site. Even more important is the rotatability of a clip before application. Often multiple TTS clips are required for secure closure of a bleeding vessel. One model has the ability to use three clips in series without changing the applicator. Severe arterial bleeding from vessels larger than 2 mm is often unmanageable with these conventional methods. Here is the over-the-scope-clip system another newly available method. It is similar to the ligation of esophageal varices and involves aspiration of tissue into a transparent cap before closure of the clip. Thus a greater vascular occlusion pressure can be achieved and larger vessels can be treated endoscopically. Patients with severe arterial bleeding from the upper gastrointestinal tract have a very high rate of recurrence after initial endoscopic treatment. These patients should always be managed in an interdisciplinary team of interventional radiologist and surgeons. PMID:26962402

  13. Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

    Seo, Nieun; Shin, Ji Hoon; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu Bo [Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2012-03-15

    Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE). We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG. The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE. We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.

  14. Nursing care of 37 cases with upper gastrointestinal bleeding in severe craniocerebral injury%重型颅脑损伤并应激性消化道出血37例护理

    张丽宁

    2014-01-01

    目的:重型颅脑损伤常有严重并发症发生,本文就重型颅脑损伤合并应激性消化道出血的护理做一简单阐述,以期对临床护理工作有所帮助。%Severe craniocerebral injury often have serious complications.In this text the nursing care of patients with severe craniocerebral injury combine with stress gastrointestinal hemorrhage do a simple set,in order to help clinical nursing work.

  15. Anaesthesia care with and without tracheal intubation during emergency endoscopy for peptic ulcer bleeding

    Lohse, N; Lundstrøm, L H; Vestergaard, T R; Risom, M; Rosenstock, S J; Foss, N B; Møller, M H

    2015-01-01

    BACKGROUND: Emergency upper gastrointestinal bleeding is a common condition with high mortality. Most patients undergo oesophagogastroduodenoscopy (OGD), but no universally agreed approach exists to the type of airway management required during the procedure. We aimed to compare anaesthesia care...

  16. A large gastrointestinal stromal tumor of duodenum: a case report

    Hadi Ahmadi Amoli

    2014-01-01

    Case presentation: The patient is a forty six years old man. He complained of frequent colic pain in left upper quadrant of abdomen for two months before admitting to the hospital. The pain resolved spontaneously after a few hours. This situation almost has been repeated every week. The patient had severe repeated melena and faint for two weeks. As soon as the patient was entered the Sina Hospital in 2012, supportive care was started. Then upper gastrointestinal endoscopy was performed for him and the bleeding point was detected. Also abdominal and pelvic computed tomography with oral and intravenous contrast was done. Finally the patient was operated on tumor diagnosis in duodenal area according to classic Whipple procedure. Conclusion: Gastrointestinal bleeding is the most common symptom of gastrointestinal stromal tumors. The bleeding is minimal and chronic. It will be progress to sudden and severe bleeding. Diagnosis is done by upper gastrointestinal endoscopy and biopsy. The large tumors with high mitotic

  17. A prospective randomized controlled trial to study the role of sulfasalazine in prevention of acute gastrointestinal toxicity associated with concurrent chemoradiation in carcinoma cervix

    Santanu Pal

    2013-01-01

    Full Text Available Background: The primary aim of the study was to evaluate the effectiveness of sulfasalazine in reducing the incidence of acute radiation-induced enteritis in carcinoma cervix patients receiving pelvic external beam radiotherapy along with concurrent cisplatin-based chemotherapy. Materials and Methods: Between November 2011 and July 2012 a total of 98 patients of locoregionally advanced carcinoma of cervix (49 each in study and control arms were enrolled in this study. Patients in both the arms were treated with whole pelvis external beam radiotherapy with total dose of 50 Gy in conventional fractionation. Along with this inj. cisplatin was given concurrently at the dose of 40 mg/m 2 of body surface area every week during radiation for 5 weeks. Concurrent chemoradiation was followed by brachytherapy after a gap of 2 weeks. Patients in the study arm also received tablet sulfasalazine 1,000 mg orally twice daily from the day of starting of radiotherapy to 1 week after completion of treatment. Weekly follow-up of all patients to assess acute toxicities was done using common toxicity criteria version 4.0 (CTC v4.0 toxicity scores. Data analysis was carried out by SPSS version 20.0 software. Results: Incidence of grade II or higher grade, lower gastrointestinal toxicity was 19.14% (09/47 in study arm and 41.66% (20/48 in control arm which was statistically significant (P = 0.017. Conclusion: The study shows that sulfasalazine can significantly reduce the acute radiation-induced diarrhea (ARID in patients undergoing whole pelvis external beam radiotherapy for carcinoma cervix. The drug is safe, cheap, and readily available.

  18. Early and late-onset acute GvHD following hematopoietic cell transplantation: CT features of gastrointestinal involvement with clinical and pathological correlation

    Objective: With the introduction of non-myeloablative hematopoietic cell transplantation, acute graft-versus-host-disease (GvHD) is frequently observed beyond the traditional 100 days cut-off. The aim of this study was to describe and compare CT features of gastrointestinal early and late-onset GvHD and to correlate findings with clinical and pathology grading. Subjects and methods: Abdominal CT scans were obtained in 20 patients with early and 15 with late-onset GvHD. Examinations were assessed for intestinal and extraintestinal abnormalities and findings compared between the two subgroups of GvHD. Distinct CT abnormalities as well as a CT-score integrating multiple pathologies were correlated with gut, clinical or pathology grading. Results: Frequent intestinal abnormalities included wall thickening, abnormal enhancement, and excessive fluid-filling (94%, 89%, and 94%). 86% of patients showed concomitant small and large bowel involvement. A discontinuous distribution was observed in 54%. Bile tract abnormality was the most common extra-intestinal finding (74%). The distribution of pathologies was equal between subgroups of early or late-onset disease. Wall thickening and mucosal attenuation in non-enhanced scans were significantly related to clinical and pathology scores (P ≤ 0.018). Number of abnormal segments, small bowel dilatation, engorgement of the vasa recta, mesenteric fat stranding and ascites were linked to clinical grading (P ≤ 0.019). A CT-score integrating multiple abnormalities was correlated to gut, overall clinical and pathology grading (r = 0.64, 0.57, 0.50). Conclusion: CT morphology of acute GvHD is independent of its time of onset and, thus, facilitates differential diagnosis of late-onset acute GvHD. Correlation of CT morphology with clinical and pathological grading is important in terms of prognosis and may help guiding the therapeutic approach.

  19. Normal Tissue Complication Probability Analysis of Acute Gastrointestinal Toxicity in Cervical Cancer Patients Undergoing Intensity Modulated Radiation Therapy and Concurrent Cisplatin

    Purpose: To test the hypothesis that increased bowel radiation dose is associated with acute gastrointestinal (GI) toxicity in cervical cancer patients undergoing concurrent chemotherapy and intensity-modulated radiation therapy (IMRT), using a previously derived normal tissue complication probability (NTCP) model. Methods: Fifty patients with Stage I–III cervical cancer undergoing IMRT and concurrent weekly cisplatin were analyzed. Acute GI toxicity was graded using the Radiation Therapy Oncology Group scale, excluding upper GI events. A logistic model was used to test correlations between acute GI toxicity and bowel dosimetric parameters. The primary objective was to test the association between Grade ≥2 GI toxicity and the volume of bowel receiving ≥45 Gy (V45) using the logistic model. Results: Twenty-three patients (46%) had Grade ≥2 GI toxicity. The mean (SD) V45 was 143 mL (99). The mean V45 values for patients with and without Grade ≥2 GI toxicity were 176 vs. 115 mL, respectively. Twenty patients (40%) had V45 >150 mL. The proportion of patients with Grade ≥2 GI toxicity with and without V45 >150 mL was 65% vs. 33% (p = 0.03). Logistic model parameter estimates V50 and γ were 161 mL (95% confidence interval [CI] 60–399) and 0.31 (95% CI 0.04–0.63), respectively. On multivariable logistic regression, increased V45 was associated with an increased odds of Grade ≥2 GI toxicity (odds ratio 2.19 per 100 mL, 95% CI 1.04–4.63, p = 0.04). Conclusions: Our results support the hypothesis that increasing bowel V45 is correlated with increased GI toxicity in cervical cancer patients undergoing IMRT and concurrent cisplatin. Reducing bowel V45 could reduce the risk of Grade ≥2 GI toxicity by approximately 50% per 100 mL of bowel spared.

  20. Acute gastrointestinal and genitourinary toxicity of image-guided intensity modulated radiation therapy for prostate cancer using a daily water-filled endorectal balloon

    Our purpose was to report acute gastrointestinal (GI) and genitourinary (GU) toxicity rates for prostate cancer patients undergoing image-guided intensity modulated radiation therapy (IG-IMRT) with a daily endorectal water-filled balloon (ERBH2O), and assess associations with planning parameters and pretreatment clinical characteristics. The first 100 patients undergoing prostate and proximal seminal vesicle IG-IMRT with indexed-lumen 100 cc ERBH2O to 79.2 Gy in 1.8 Gy fractions at our institution from 12/2008- 12/2010 were assessed. Pretreatment characteristics, organ-at-risk dose volume histograms, and maximum GU and GI toxicities (CTCAE 3.0) were evaluated. Logistic regression models evaluated univariate association between toxicities and dosimetric parameters, and uni- and multivariate association between toxicities and pretreatment characteristics. Mean age was 68 (range 51–88). Thirty-two, 49, and 19 patients were low, intermediate, and high-risk, respectively; 40 received concurrent androgen deprivation. No grade 3 or greater toxicities were recorded. Maximum GI toxicity was grade 0, 1, and 2 in 69%, 23%, and 8%, respectively. Infield (defined as 1 cm above/below the CTV) rectal mean/median doses, D75, V30, and V40 and hemorrhoid history were associated with grade 2 GI toxicity (Ps < 0.05). Maximum acute GU toxicity was grade 0, 1, and 2 for 17%, 41%, and 42% of patients, respectively. Infield bladder V20 (P = 0.03) and pretreatment International Prostate Symptom Scale (IPSS) (P = 0.003) were associated with grade 2 GU toxicity. Prostate IG-IMRT using a daily ERBH2O shows low rates of acute GI toxicity compared to previous reports of air-filled ERB IMRT when using stringent infield rectum constraints and comparable GU toxicities

  1. Henoch-Schönlein purpura in an older man presenting as rectal bleeding and IgA mesangioproliferative glomerulonephritis: a case report

    Howarth Charles B

    2011-08-01

    Full Text Available Abstract Introduction Henoch-Schönlein purpura is the most common systemic vasculitis in children. Typical presentations are palpable purpura, abdominal pain, arthritis, and hematuria. This vasculitic syndrome can present as an uncommon cause of rectal bleeding in older patients. We report a case of an older man with Henoch-Schönlein purpura. He presented with rectal bleeding and acute kidney injury secondary to IgA mesangioproliferative glomerulonephritis. Case presentation A 75-year-old Polish man with a history of diverticulosis presented with a five-day history of rectal bleeding. He had first noticed colicky left lower abdominal pain two months previously. At that time he was treated with a 10-day course of ciprofloxacin and metronidazole for possible diverticulitis. He subsequently presented with rectal bleeding to our emergency department. Physical examination revealed generalized palpable purpuric rash and tenderness on his left lower abdomen. Laboratory testing showed a mildly elevated serum creatinine of 1.3. Computed tomography of his abdomen revealed a diffusely edematous and thickened sigmoid colon. Flexible sigmoidoscopy showed severe petechiae throughout the colon. Colonic biopsy showed small vessel acute inflammation. Skin biopsy resulted in a diagnosis of leukocytoclastic vasculitis. Due to worsening kidney function, microscopic hematuria and new onset proteinuria, he underwent a kidney biopsy which demonstrated IgA mesangioproliferative glomerulonephritis. A diagnosis of Henoch-Schönlein purpura was made. Intravenous methylprednisolone was initially started and transitioned to prednisone tapering orally to complete six months of therapy. There was marked improvement of abdominal pain. Skin lesions gradually faded and gastrointestinal bleeding stopped. Acute kidney injury also improved. Conclusion Henoch-Schönlein purpura, an uncommon vasculitic syndrome in older patients, can present with lower gastrointestinal bleeding

  2. [Obscure digestive bleeding by ileal carcinoid tumor].

    Nelly Manrique, María; Frisancho, Oscar; Zumaeta, Eduardo; Palomino, Américo; Rodriguez, César

    2011-01-01

    The patient is an 82 year-old female with a history of osteoarthritis, hypothyroidism and anemia for 14 years (receiving blood transfusions). She was admited to our hospital with a nine months history of malaise, anorexia, fatigue and weakness, associated with intermitten episodes of abdominal pain. She was diagnosed anemia and occult blood positive stools. Physical examination revealed a patient in generally fair condition, obese, with mild edema of lower limbs, no changes in the evaluation of chest, cardiovascular, abdomen, etc. Laboratory data was unremarkable, except for iron deficiency anemia. The upper endoscopy showed duodenal ulcer scar, fundic polyposis and chronic gastritis. Colonoscopy revealed some diverticula, a small sessile polyp and internal hemorrhoids. The diagnosis of obscure gastrointestinal bleeding was made. The CT scan of the abdomen showed gallstones and fatty liver; a radiograph of intestinal transit detected a lesion apparently protruded intestinal loop for distal jejunum; enteroscopy was performed (with one team ball) anterograde and retrograde achieving assess distal jejunum and distal ileum without observing any injuries. The study of capsule endoscopy showed a polypoid tumor intestinal with evidence of having bleeding. Surgery detected the tumor in proximal ileum. The surgical specimen findings showed three tumors 0.7 mm, 10 mm and 15 mm on the proximal ileum. The microscopic examination revealed that these lesions were neuroendocrine tumors (carcinoid). The Ileal carcinoid tumor may rarely presented with obscure gastrointestinal bleeding. PMID:21544161

  3. Esophageal Dieulafoy's lesion: an exceedingly rare cause of massive upper GI bleeding.

    Malliaras, George P; Carollo, Andrea; Bogen, Gregg

    2016-01-01

    Dieulafoy's lesion, a dilated aberrant submucosal vessel which erodes the overlying epithelium, is a relatively rare but potentially fatal cause of gastrointestinal (Gl) bleeding. The esophagus is a very rare location for the lesion. Here we present a case of massive upper GI bleeding, secondary to this remarkably rare occurrence, which was amendable to endoscopic intervention. PMID:27302497

  4. Colonic diverticular bleeding: urgent colonoscopy without purging and endoscopic treatment with epinephrine and hemoclips

    Ignacio Couto-Worner; Benito González-Conde; Emilio Estévez-Prieto; Pedro Alonso-Aguirre

    2013-01-01

    Diverticular disease is the most frequent cause of lower gastrointestinal bleeding. Most of the times, bleeding stops without any intervention but in 10-20 % of the cases it is necessary to treat the hemorrhage. Several modalities of endoscopic treatment have been described after purging the colon. We present five cases of severe diverticular bleeding treated with injection of epinephrine and hemoclips. All the colonoscopies were performed without purging of the colon in an emergency setting,...

  5. Evaluación económica del tratamiento con ácido acetilsalicílico más esomeprazol comparado con clopidogrel en la prevención de la hemorragia gastrointestinal Economic evaluation of the treatment of aspirin plus esomeprazole compared to clopidogrel in gastrointestinal bleeding prevention

    Carme Piñol

    2006-01-01

    Objetivo: Evaluar la eficiencia del ácido acetilsalicílico (AAS) más esomeprazol frente a clopidogrel en la prevención de la hemorragia gastrointestinal. Métodos: Análisis coste-efectividad (árbol de decisión de 2 ramas: AAS más esomeprazol y clopidogrel) respecto a la evitación de casos de hemorragia gastrointestinal en 2 años, y análisis de sensibilidad. Resultados: El coste total del tratamiento con AAS más esomeprazol (2.865 S por paciente libre de hemorragia) fue inferior al clopidogrel ...

  6. Gastrointestinal Complications and Cardiac Surgery

    Allen, Sara J.

    2014-01-01

    Gastrointestinal (GI) complications are an uncommon but potentially devastating complication of cardiac surgery. The reported incidence varies between .3% and 5.5% with an associated mortality of .3–87%. A wide range of GI complications are reported with bleeding, mesenteric ischemia, pancreatitis, cholecystitis, and ileus the most common. Ischemia is thought to be the main cause of GI complications with hypoperfusion during cardiac surgery as well as systemic inflammation, hypothermia, drug ...

  7. Management of bleeding complications in patients with cancer on DOACs.

    Schulman, Sam; Shrum, Jeffrey; Majeed, Ammar

    2016-04-01

    There has been a concern that major bleeding events (MBE) on direct-acting oral anticoagulants (DOACs) will be more difficult to manage than on vitamin K antagonists. Patients with cancer and DOAC-associated bleeding may be even more of a challenge to manage. We therefore reviewed the literature on bleeding in patients with cancer on DOACs. In addition, we performed an analysis of individual patient data from 5 phase III trials on treatment with dabigatran with focus on those with cancer. In 6 randomized trials the risk of MBE in patients with cancer was similar on treatment with DOACs compared to vitamin K antagonists. Bleeding was in the majority of patients managed with supportive therapy alone. In the individual patient data analysis there were no significant differences in use of hemostatic products, transfusion of red cells, effectiveness of management, bleeding-related mortality or 30-day all-cause mortality between patients with cancer treated with dabigatran or with warfarin. Local hemostatic therapy, including resection of the cancer site was more common in patients with gastrointestinal bleeding with cancer than among those without cancer. We conclude that management of bleeding in patients with cancer and on a DOAC does not pose a greater challenge than management of bleeding in patients without cancer. PMID:27067968

  8. Improved Gastrointestinal Decompression Nursing Experience for the Treatment of Acute Pancreatitis%改良胃肠减压术治疗急性胰腺炎的护理体会

    段家丽

    2015-01-01

    目的探讨置不同胃管长度对急性胰腺炎患者胃肠减压效果观察。方法将40例急性胰腺炎患者,随机分为观察组20例和对照组20例,对于观察组采用常规置胃管术行胃肠减压术,对照组采用改良插胃管术行胃肠减压。结果对照组实施改良胃肠减压术后,满意度明显高于观察组。结论实施改良的胃肠减压术,有利于急性胰腺炎患者的康复,缩短了急性胰腺炎的住院天数,也提高了科室的治疗和护理水平。%Objective To explore the dif erent length of gastric tube to observe the ef ect of gastrointestinal decompression in patients with acute pancreatitis.Methods 40 patients with acute pancreatitis, 20 patients were randomly divided into observation group and control group 20 cases, for the observation group with normal stomach tube insertion.we gastrointestinal decompression, the control group using improved a gastric tube line of gastrointestinal decompression.Results The control group was significantly higher than the observation group after the improvement of gastrointestinal decompression.Conclusion The implementation of improved gastrointestinal decompression, is conducive to the rehabilitation of patients with acute pancreatitis, shorten the length of hospital stay, and improve the level of treatment and nursing.

  9. New techniques in gastrointestinal endoscopic surgery

    Rafael Antonio Luengas Tello

    2012-09-01

    Full Text Available Gastrointestinal endoscopic surgery has been making great progress since the seventies in the management paradigms of conditions such as gastrointestinal bleeding, polyp resection and diagnostic and therapeutic management of the biliary tract. The current challenge is the development of techniques that allow endoscopic treatment of emerging diseases such as cancer, morbid obesity, gastro-esophageal reflux and achalasia. This article reports on new techniques and expectations for the future in the endoscopic management of these diseases.

  10. Approach to bleeding patient

    Ramachandran Gopinath

    2014-01-01

    Full Text Available Managing a bleeding patient is very challenging for the perioperative physician. Bleeding in a patient would be due to inherited or acquired disorders of haemostasis. Identifying the patients at risk of bleeding and utilising prophylactic treatment protocols has good outcomes. Along with clinical signs, trends in monitoring coagulation parameters and analysing blood picture are necessary. Management of patients in the postoperative period and in intensive care unit should be focused on normalization of coagulation profile as early as possible with available blood and its products. Available recombinant factors should be given priority as per the approved indications. Exploring the surgical site should be considered for persistent bleeding because haemodynamic compromise, excessive transfusion of fluids, blood and its products and more inotropic support may have a negative impact on the patient outcome.

  11. Understanding Minor Rectal Bleeding

    ... are the possible causes of minor rectal bleeding? Hemorrhoids Anal fissures Proctitis (inflammation of the rectum) Polyps ... can be cured if detected early. What are hemorrhoids? Hemorrhoids (also called piles) are swollen blood vessels ...

  12. [OMEPRAZOL VS RANITIDINE IN UPPER DIGESTIVE BLEEDING

    Regis R, Regina; Bisso A, Aland; Rebaza, Segundo

    1999-01-01

    Pectic ulcer is the most frequent cause of gastrointestinal bleeding. The homeostatic mechanism of bleeding, and coagulation, does not happen with values of pH less than 5,0. Therefore neutralization of gastric acidity (pH more than 5,0) is a recourse of control, improve the evolution and healing of peptic ulcer and to avoid a new bleeding. The aim of this study was to compare the results of treatment with omeprazole and ranitidine, in 57 patients admitted at emergency room of the Hospital Central de la Polic a Nacional del Per with endoscopic diagnosis of peptic ulcer, using Forrest classification. Patients received omeprazole 40 mg in bolus IV, followed by continuos infusion of 8 mg/hour for 72 hours (group A) or ranitidine 50 mg IV each 8 hours for 72 hours (group B). A new endoscopy was made 72 hours after admission demostrated a succesful therapy in both group. Bleeding stopped in 26/27 patients in group A (96,2%) and in 23/30 patients in group B (76,6%) (pomeprazole IV is more effective than ranitidine IV in the control of UGB because of peptic ulcer and provides a faster healing. PMID:12181579

  13. Acute effects of coffee consumption on self-reported gastrointestinal symptoms, blood pressure and stress indices in healthy individuals

    Papakonstantinou, Emilia; Kechribari, Ioanna; Sotirakoglou, Κyriaki; Tarantilis, Petros; Gourdomichali, Theodora; Michas, George; Kravvariti, Vassiliki; Voumvourakis, Konstantinos; Zampelas, Antonis

    2016-01-01

    Background It has been suggested that coffee may affect the gut-brain axis with conflicting outcomes. Moreover, there is insufficient evidence to determine whether the type or temperature of coffee consumed will have a different impact on the gut-brain axis. The purpose of this study was to investigate the effects of acute coffee consumption on the following: 1. self-reported GI symptoms and salivary gastrin, 2. stress indices [salivary cortisol and alpha-amylase (sAA)] and psychometric measu...

  14. Acute gastro-intestinal illness and its association with hydroclimatic factors in British Columbia, Canada: A time-series analysis

    Galway, L. P.; Allen, D. M.

    2013-12-01

    Rising global temperatures and expected shifts in regional hydroclimatology in a changing climate are likely to influence the risk of infectious waterborne illness. This study examines the role of hydroclimatology as an underlying driver of the epidemiology of waterborne gastro-intestinal illness and contributes to our currently limited understanding of the possible ecosystem-mediated impacts of climate change on health. Using time-series regression analysis, we examine the associations between three hydroclimatic factors (monthly temperature, precipitation, and streamflow) and the monthly occurrence of AGI illness in two communities in the province of British Columbia, Canada. The two communities were selected as study sites to represent the dominant hydroclimatic regimes that characterize the province of BC: the rainfall-dominated hydroclimatic regime and snowmelt-dominated hydroclimatic regime Our results show that the number of monthly cases of AGI increased with increasing temperature, precipitation, and streamflow in the same month in the context of a rainfall-dominated regime and with increasing streamflow in the previous month in the context of a snowfall-dominated regime. These results suggest that hydroclimatic factors play a role in driving the occurrence and variability of AGI illness in this setting. Further, this study has highlighted that the nature and magnitude of the effects of hydroclimatic factors on waterborne illness vary across different hydroclimatic settings. We conclude that the watershed may be an appropriate context within which we can and should enhance our understanding of water-related climate change impacts on health. Examining the role of hydroclimatology as an underlying driver of the epidemiology of infectious disease is key to understanding of the possible ecosystem-mediated impacts of climate change on health and developing appropriate adaptation responses.

  15. Differential Acute Postprandial Effects of Processed Meat and Isocaloric Vegan Meals on the Gastrointestinal Hormone Response in Subjects Suffering from Type 2 Diabetes and Healthy Controls: A Randomized Crossover Study

    Lenka Belinova; Hana Kahleova; Hana Malinska; Ondrej Topolcan; Jindra Vrzalova; Olena Oliyarnyk; Ludmila Kazdova; Martin Hill; Terezie Pelikanova

    2014-01-01

    Background The intake of meat, particularly processed meat, is a dietary risk factor for diabetes. Meat intake impairs insulin sensitivity and leads to increased oxidative stress. However, its effect on postprandial gastrointestinal hormone (GIH) secretion is unclear. We aimed to investigate the acute effects of two standardized isocaloric meals: a processed hamburger meat meal rich in protein and saturated fat (M-meal) and a vegan meal rich in carbohydrates (V-meal). We hypothesized that the...

  16. Blødende gastrointestinal stromatumor i et Meckels divertikel

    Wennervaldt, Kasper; Bisgaard, Thue

    2009-01-01

    We present at rare case of severe upper gastrointestinal bleeding in a 57-year-old patient due to a gastrointestinal stromal tumour located in a Meckel's diverticulum (MD) without ectopic tissue. We discuss indications and pro et cons of prophylactic resection of MD. Udgivelsesdato: 2009-Dec-7...

  17. Bleeding from gums: Can it be a dengue

    Rajat Bansal

    2014-01-01

    Full Text Available Introduction: Bleeding from gums is a common feature in periodontitis patient. But abnormal bleeding from the gingiva or other areas of the oral mucosa that is difficult to control is an important clinical sign suggesting a hematological disorder. Case Report: A-40-year old male patient reported to our clinic with the chief complaint of acute gingival bleeding. There was continuous bleeding, fever since 3-4 days with weakness, retro orbital pain, and severe backache. Patient gave a history of bleeding from gums for last 24 hrs. His blood profile revealed; platelet count of 36,000, total wite blood cell (WBC count of 6000/cumm, differential leukocyte count (DLC (P45, L53, E2, and hemoglobin 12 g/dL. Patient sera was positive for dengue non-structural protein-1 antigen, anti-dengue immunoglobulin M (IgM, and anti-dengue immunoglobulin G (IgG antibodies. Discussion: Here is a case report capable of changing our vision that acute gingival bleeding can also occur in dengue fever. Dengue fever can also be considered as one of the differential diagnosis for the acute gingival bleeding.

  18. Modern issues on the treatment of peptic ulcer bleedings

    Potakhin S.N.

    2014-03-01

    Full Text Available Despite the success of therapeutic treatment of peptic ulcer and the introduction of endoscopic technologies, the problem of peptic ulcer hemorrhage remains valid. A large number of publications in foreign literature are dedicated to epidemiology and prevention of bleeding, evaluation of modern tactics and search for new methods of treatment. The works relating to organization of aid to patients with peptic ulcer bleeding are of particular interest. According to the recent data not all clinics even in economically developed countries manage to follow the recommendations of an international consensus-2010 for non-variceal bleeding treatment of upper gastrointestinal tract. Among the causes of non-compliance of international recommendations there are subjective and objective factors, the understanding of which can significantly affect the optimization of aid to patients with peptic ulcer bleeding.

  19. 护理干预脑出血并发消化道出血40例疗效分析%Nursing Intervention Cerebral Hemorrhage Complicated Analysis of 40 Patients with Gastrointestinal Bleeding

    向旭平

    2012-01-01

      目的探讨护理干预脑出血患者并发消化道出血后的措施及其预后的影响。方法 对40例脑出血并发消化道出血实施护理干预后的病例资料进行回顾性分析,总结其干预成效。结果 40例患者消化道出血总治愈率为95%(38例),其中在1周内痊愈者32例(80%),2例病情未得到控制而死亡。结论 脑出血后并消化道出血者应早期预防,采取积极的护理措施,是保证治疗效率的关键,同时能预防并发症,减少病死率和致残率,提高治愈率。%  Objective Investigate the nursing intervention in patients with cerebral hemorrhage complicated by measures and its prognostic impact of gastrointestinal bleeding. Methods Were retrospectively analyzed 40 cases of cerebral hemorrhage complicated by gastrointestinal bleeding after the application of nursing intervention on clinical data and summary of the intervention effectiveness. Results 40 cases of gastrointestinal bleeding in patients with total cure rate was 95% (38 cases), which recovered within 1 week in 32 cases (80%), two cases of the disease is not brought under control and death. Conclusion After intracerebral hemorrhage and gastrointestinal bleeding early prevention, to take active care measures, to ensure that the treatment efficiency, and can prevent complications, reduce mortality and morbidity, improve the cure rate.

  20. Lower gastrointestinal endoscopies results

    Ahmet Bozdağ

    2014-12-01

    Full Text Available Objectives: Endoscopic examinations have great potential in early diagnosis of colorectal adenomas and carcinomas with reducing to colorectal cancer incidence and mortality. We aimed to evaluate for diagnostic purposeful lower gastrointestinal endoscopic procedures in the second step state hospital retrospectively Methods: Between June 2010 and June 2013, we evaluated 278 patients with rectal bleeding, constipation and abdominal pain detected by lower gastrointestinal endoscopic procedures retrospectively. Results: The mean age of the patients was 54.8 ± 16.8 (15-90 year, respectively. 172 (61.9% of the patients were male and 106 (38.1% of the patients were female. 116 (41.7% of the patients was performed rectosigmoidoscopy and 162 (58.3% of the patients was performed colonoscopy. 51(18.3% of our patients were normal. 10 (3.6% of patients had colorectal cancer, 11(3.9% of patients had inflammatory bowel disease, 8 (2.9% of patients had parasitosis, 31(11.1% of patients had colorectal polyps, 12 (4.3% , in patients had diverticular disease, 2 (0.7% patients had rectal ulcer, 25 (9% patients had anal fissure and 159 (57.2% of the patients had hemorrhoidal disease. Conclusion: Lower gastrointestinal endoscopy is a method been the gold standard with a low complication rate and that can be easily applied in the evaluation to pathology of colorectal and anal canal. J Clin Exp Invest 2014; 5 (4: 580-582