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Sample records for acute gastrointestinal bleeding

  1. Acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Kurien, Matthew; Lobo, Alan J

    2015-10-01

    Acute upper gastrointestinal bleeding (AUGIB) is a frequently encountered medical emergency with an incidence of 84-160/100000 and associated with mortality of approximately 10%. Guidelines from the National Institute for Care and Care Excellence outline key features in the management of AUGIB. Patients require prompt resuscitation and risk assessment using validated tools. Upper gastrointestinal endoscopy provides accurate diagnosis, aids in estimating prognosis and allows therapeutic intervention. Endoscopy should be undertaken immediately after resuscitation in unstable patients and within 24 hours in all other patients. Interventional radiology may be required for bleeding unresponsive to endoscopic intervention. Drug therapy depends on the cause of bleeding. Intravenous proton pump inhibitors should be used in patients with high-risk ulcers. Terlipressin and broad-spectrum antibiotics should be used following variceal haemorrhage. Hospitals admitting patients with AUGIB need to provide well organised services and ensure access to relevant services for all patients, and particularly to out of hours endoscopy.

  2. Helical CT in acute lower gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Ernst, Olivier; Leroy, Christophe; Sergent, Geraldine [Department of Radiology, Hopital Huriez, 1 rue Polonovski, 59037 Lille (France); Bulois, Philippe; Saint-Drenant, Sophie; Paris, Jean-Claude [Department of Gastroenterology, Hopital Huriez, 1 rue Polonovski, 59037 Lille (France)

    2003-01-01

    The purpose of this study was to assess the usefulness of helical CT in depicting the location of acute lower gastrointestinal bleeding. A three-phase helical CT of the abdomen was performed in 24 patients referred for acute lower gastrointestinal bleeding. The diagnosis of the bleeding site was established by CT when there was at least one of the following criteria: spontaneous hyperdensity of the peribowel fat; contrast enhancement of the bowel wall; vascular extravasation of the contrast medium; thickening of the bowel wall; polyp or tumor; or vascular dilation. Diverticula alone were not enough to locate the bleeding site. The results of CT were compared with the diagnosis obtained by colonoscopy, enteroscopy, or surgery. A definite diagnosis was made in 19 patients. The bleeding site was located in the small bowel in 5 patients and the colon in 14 patients. The CT correctly located 4 small bowel hemorrhages and 11 colonic hemorrhages. Diagnosis of the primary lesion responsible for the bleeding was made in 10 patients. Our results suggest that helical CT could be a good diagnostic tool in acute lower gastrointestinal bleeding to help the physician to diagnose the bleeding site. (orig.)

  3. Acute Lower Gastrointestinal Bleeding: Part I

    Directory of Open Access Journals (Sweden)

    Robert Enns

    2001-01-01

    Full Text Available Acute lower gastrointestinal (LGI bleeding is typically caused by vascular malformations, diverticuli and neoplasia. Although endoscopic evaluation of the colon is relatively standard in stable patients with LGI bleeding, those with significant ongoing hemorrhage are often more difficult to evaluate endoscopically. Other investigative techniques such as nuclear scintigraphy, angiography and surgical exploration have been commonly used in unstable patients with LGI bleeding when the exact site is unknown. These investigative techniques have had variable measures of success. This two-part review evaluates the literature in an attempt to review the optimal investigative approach in patients with LGI hemorrhage, in particular patients who have had significant and ongoing bleeding. Part 1 of this article concentrates on the etiology of LGI hemorrhage, followed in a subsequent article by diagnostic and management strategies. Following the review, a consensus update will be included with guidelines for clinical use.

  4. Splenic duplication: a rare cause of acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Sharma, Pankaj; Alkadhi, Hatem; Gubler, Christoph; Bauerfeind, Peter; Pfammatter, Thomas

    2013-02-01

    Acute gastrointestinal bleeding represents a common medical emergency. We report the rare case of acute upper gastrointestinal bleeding caused by varices in the gastric fundus secondary to splenic duplication. Splenic duplication has been only rarely reported in the literature, and no case so far has described the associated complication of gastrointestinal bleeding, caused by venous drainage of the upper spleen via varices in the gastric fundus. We describe the imaging findings from endoscopy, endosonography, computed tomography (CT), flat-panel CT, and angiography in this rare condition and illustrate the effective role of intra-arterial embolization.

  5. Multidetector CT angiography for acute gastrointestinal bleeding: technique and findings.

    Science.gov (United States)

    Artigas, José M; Martí, Milagros; Soto, Jorge A; Esteban, Helena; Pinilla, Inmaculada; Guillén, Eugenia

    2013-01-01

    Acute gastrointestinal bleeding is a common reason for emergency department admissions and an important cause of morbidity and mortality. Factors that complicate its clinical management include patient debility due to comorbidities; intermittence of hemorrhage; and multiple sites of simultaneous bleeding. Its management, therefore, must be multidisciplinary and include emergency physicians, gastroenterologists, and surgeons, as well as radiologists for diagnostic imaging and interventional therapy. Upper gastrointestinal tract bleeding is usually managed endoscopically, with radiologic intervention reserved as an alternative to be used if endoscopic therapy fails. Endoscopy is often less successful in the management of acute lower gastrointestinal tract bleeding, where colonoscopy may be more effective. The merits of performing bowel cleansing before colonoscopy in such cases might be offset by the resultant increase in response time and should be weighed carefully against the deficits in visualization and diagnostic accuracy that would result from performing colonoscopy without bowel preparation. In recent years, multidetector computed tomographic (CT) angiography has gained acceptance as a first-line option for the diagnosis and management of lower gastrointestinal tract bleeding. In selected cases of upper gastrointestinal tract bleeding, CT angiography also provides accurate information about the presence or absence of active bleeding, its source, and its cause. This information helps shorten the total diagnostic time and minimizes or eliminates the need for more expensive and more invasive procedures.

  6. Multidetector computed tomography in acute lower gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    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

  7. Diagnostic accuracy of CT angiography in acute gastrointestinal bleeding.

    Science.gov (United States)

    Chua, A E; Ridley, L J

    2008-08-01

    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 2 x 2 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 (chi(2) = 3.5, P = 0.6) and (chi(2) = 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.

  8. Gastrointestinal bleeding

    Science.gov (United States)

    ... refers to any bleeding that starts in the gastrointestinal tract. Bleeding may come from any site along the GI tract, but is often divided into: Upper GI bleeding: The upper GI tract includes the ...

  9. Acute gastrointestinal bleeding: CT angiography with multi-planar reformatting.

    Science.gov (United States)

    Steiner, Kate; Gollub, Frank; Stuart, Sam; Papadopoulou, Anthie; Woodward, Nick

    2011-04-01

    Acute gastrointestinal bleeding is a common medical emergency, which carries a significant mortality. CT Angiography is an important non-invasive diagnostic tool, which can be used to plan subsequent endovascular or surgical management. The cases presented demonstrate that a meticulous and systematic approach to image interpretation is necessary, in particular, to detect focal sites of contrast extravasation and small pseudoaneurysms.

  10. Acute radiologic intervention in gastrointestinal bleeding

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    Lesak, F.

    1986-01-01

    A case of embolization of the gastroduodenal artery in a 38-year old man with chronic pancreatitis and uncontrollable bleeding is presented. The advantage of this interventional radiologic procedure is discussed and in selective cases it seems to be the choice of treatment.

  11. Acute upper gastrointestinal bleeding (UGIB) - initial evaluation and management.

    Science.gov (United States)

    Khamaysi, Iyad; Gralnek, Ian M

    2013-10-01

    Acute upper gastrointestinal bleeding (UGIB) is the most common reason that the 'on-call' gastroenterologist is consulted. Despite the diagnostic and therapeutic capabilities of upper endoscopy, there is still significant associated morbidity and mortality in patients experiencing acute UGIB, thus this is a true GI emergency. Acute UGIB is divided into non-variceal and variceal causes. The most common type of acute UGIB is 'non-variceal' and includes diagnoses such as peptic ulcer (gastric and duodenal), gastroduodenal erosions, Mallory-Weiss tears, erosive oesophagitis, arterio-venous malformations, Dieulafoy's lesion, and upper GI tract tumours and malignancies. This article focuses exclusively on initial management strategies for acute upper GI bleeding. We discuss up to date and evidence-based strategies for patient risk stratification, initial patient management prior to endoscopy, potential causes of UGIB, role of proton pump inhibitors, prokinetic agents, prophylactic antibiotics, vasoactive pharmacotherapies, and timing of endoscopy.

  12. Trends in acute nonvariceal upper gastrointestinal bleeding in dialysis patients.

    Science.gov (United States)

    Yang, Ju-Yeh; Lee, Tsung-Chun; Montez-Rath, Maria E; Paik, Jane; Chertow, Glenn M; Desai, Manisha; Winkelmayer, Wolfgang C

    2012-03-01

    Impaired kidney function is a risk factor for upper gastrointestinal (GI) bleeding, an event associated with poor outcomes. The burden of upper GI bleeding and its effect on patients with ESRD are not well described. Using data from the US Renal Data System, we quantified the rates of occurrence of and associated 30-day mortality from acute, nonvariceal upper GI bleeding in patients undergoing dialysis; we used medical claims and previously validated algorithms where available. Overall, 948,345 patients contributed 2,296,323 patient-years for study. The occurrence rates for upper GI bleeding were 57 and 328 episodes per 1000 person-years according to stringent and lenient definitions of acute, nonvariceal upper GI bleeding, respectively. Unadjusted occurrence rates remained flat (stringent) or increased (lenient) from 1997 to 2008; after adjustment for sociodemographic characteristics and comorbid conditions, however, we found a significant decline for both definitions (linear approximation, 2.7% and 1.5% per year, respectively; Pupper GI bleeding episodes and were more likely to receive blood transfusions during an episode. Overall 30-day mortality was 11.8%, which declined significantly over time (relative declines of 2.3% or 2.8% per year for the stringent and lenient definitions, respectively). In summary, despite declining trends worldwide, crude rates of acute, nonvariceal upper GI bleeding among patients undergoing dialysis have not decreased in the past 10 years. Although 30-day mortality related to upper GI bleeding declined, perhaps reflecting improvements in medical care, the burden on the ESRD population remains substantial.

  13. Factors affecting hospital mortality in acute upper gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    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.

  14. Acute gastrointestinal bleeding: emerging role of multidetector CT angiography and review of current imaging techniques.

    Science.gov (United States)

    Laing, Christopher J; Tobias, Terrence; Rosenblum, David I; Banker, Wade L; Tseng, Lee; Tamarkin, Stephen W

    2007-01-01

    Acute gastrointestinal bleeding is a common cause of hospitalization, morbidity, and mortality in the United States. The evaluation and treatment of acute gastrointestinal bleeding are complex and often require a multispecialty approach involving gastroenterologists, surgeons, internists, emergency physicians, and radiologists. The multitude of pathologic processes that can result in gastrointestinal bleeding, the length of the gastrointestinal tract, and the often intermittent nature of gastrointestinal bleeding further complicate patient evaluation. In addition, there are multiple imaging modalities and therapeutic interventions that are currently being used in the evaluation and treatment of acute gastrointestinal hemorrhage, each with its own strengths and weaknesses. Initial experience indicates that multidetector computed tomographic angiography is a promising first-line modality for the time-efficient, sensitive, and accurate diagnosis or exclusion of active gastrointestinal hemorrhage and may have a profound impact on the evaluation and subsequent treatment of patients who present with acute gastrointestinal bleeding.

  15. Upper gastrointestinal bleeding.

    Science.gov (United States)

    Feinman, Marcie; Haut, Elliott R

    2014-02-01

    Upper gastrointestinal (GI) bleeding remains a commonly encountered diagnosis for acute care surgeons. Initial stabilization and resuscitation of patients is imperative. Stable patients can have initiation of medical therapy and localization of the bleeding, whereas persistently unstable patients require emergent endoscopic or operative intervention. Minimally invasive techniques have surpassed surgery as the treatment of choice for most upper GI bleeding.

  16. The role of nuclear medicine in acute gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    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).

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

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

    Science.gov (United States)

    Scheffel, Hans; Pfammatter, Thomas; Wildi, Stefan; Bauerfeind, Peter; Marincek, Borut; Alkadhi, Hatem

    2007-06-01

    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.

  19. Management of acute nonvariceal upper gastrointestinal bleeding: Current policies and future perspectives

    NARCIS (Netherlands)

    I.L. Holster (Ingrid); E.J. Kuipers (Ernst)

    2012-01-01

    textabstractAcute upper gastrointestinal bleeding (UGIB) is a gastroenterological emergency with a mortality of 6%-13%. The vast majority of these bleeds are due to peptic ulcers. Nonsteroidal anti-inflammatory drugs and Helicobacter pylori are the main risk factors for peptic ulcer disease. Endosco

  20. Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: Indications, techniques and outcomes.

    Science.gov (United States)

    Loffroy, R; Favelier, S; Pottecher, P; Estivalet, L; Genson, P Y; Gehin, S; Cercueil, J P; Krausé, D

    2015-01-01

    Over the past three decades, transcatheter arterial embolization has become the first-line therapy for the management of acute nonvariceal upper gastrointestinal bleeding that is refractory to endoscopic hemostasis. Advances in catheter-based techniques and newer embolic agents, as well as recognition of the effectiveness of minimally invasive treatment options, have expanded the role of interventional radiology in the treatment of bleeding for a variety of indications. Transcatheter arterial embolization is a fast, safe, and effective minimally invasive alternative to surgery, when endoscopic treatment fails to control acute bleeding from the upper gastrointestinal tract. This article describes the role of arterial embolization in the management of acute nonvariceal upper gastrointestinal bleeding and summarizes the literature evidence on the outcomes of endovascular therapy in such a setting.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    Institute of Scientific and Technical Information of China (English)

    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 ...

  3. Pitfalls in detection of acute gastrointestinal bleeding with multi-detector row helical CT.

    Science.gov (United States)

    Stuber, T; Hoffmann, M H K; Stuber, G; Klass, O; Feuerlein, S; Aschoff, A J

    2009-07-01

    Contrast-enhanced multi-detector row helical CT angiography is establishing itself as an accurate, rapid, and non-invasive diagnostic modality in patients with acute gastrointestinal bleeding. On arterial phase MDCT images ongoing hemorrhage can be revealed as an area of active extravasation of contrast material within the bowel lumen. This pictorial essay gives a short overview of current diagnostic modalities in assessing acute GI tract bleeding, typical MDCT findings, and depicts potential pitfalls in the detection of acute GI bleeding with MDCT.

  4. Acute upper gastrointestinal bleeding in patients with AIDS: a relatively uncommon condition associated with reduced survival.

    Science.gov (United States)

    Parente, F; Cernuschi, M; Valsecchi, L; Rizzardini, G; Musicco, M; Lazzarin, A; Bianchi Porro, G

    1991-01-01

    To determine the cumulative incidence of acute upper gastrointestinal bleeding and its effect upon survival in patients with AIDS, 453 consecutive AIDS patients diagnosed in our hospital between June 1985 and March 1989 were followed for a median period of six months (maximum 42 months). The cumulative probability of acute gastrointestinal bleeding was 3% at six months and 6% at 14 months. This event was associated with significantly reduced survival. Independent risk factors for bleeding were: severe thrombocytopenia at the time of diagnosis and non-Hodgkin's lymphoma as the first clinical manifestation of AIDS. The potential causes of bleeding were investigated in all cases by emergency endoscopy or by necropsy examination in those patients whose clinical condition precluded the procedure. In nine of 15 patients, bleeding was due to lesions specifically associated with AIDS, but in the remainder the source of bleeding was not a direct consequence of HIV infection. We conclude that acute upper gastrointestinal bleeding rarely complicates the course of AIDS, but its occurrence is associated with decreased survival. As many of the causes are potentially treatable, a complete diagnostic approach is indicated in these patients, except those who are terminally ill. PMID:1916503

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

    DEFF Research Database (Denmark)

    Fabricius, Rasmus; Svenningsen, Peter; Hillingsø, Jens;

    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...

  6. Telemetric real-time sensor for the detection of acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Schostek, Sebastian; Zimmermann, Melanie; Keller, Jan; Fode, Mario; Melbert, Michael; Schurr, Marc O; Gottwald, Thomas; Prosst, Ruediger L

    2016-04-15

    Acute upper gastrointestinal bleedings from ulcers or esophago-gastric varices are life threatening medical conditions which require immediate endoscopic therapy. Despite successful endoscopic hemostasis, there is a significant risk of rebleeding often requiring close surveillance of these patients in the intensive care unit (ICU). Any time delay to recognize bleeding may lead to a high blood loss and increases the risk of death. A novel telemetric real-time bleeding sensor can help indicate blood in the stomach: the sensor is swallowed to detect active bleeding or is anchored endoscopically on the gastrointestinal wall close to the potential bleeding source. By telemetric communication with an extra-corporeal receiver, information about the bleeding status is displayed. In this study the novel sensor, which measures characteristic optical properties of blood, has been evaluated in an ex-vivo setting to assess its clinical applicability and usability. Human venous blood of different concentrations, various fluids, and liquid food were tested. The LED-based sensor was able to reliably distinguish between concentrated blood and other liquids, especially red-colored fluids. In addition, the spectrometric quality of the small sensor (size: 6.5mm in diameter, 25.5mm in length) was comparable to a much larger and technically more complex laboratory spectrophotometer. The experimental data confirm the capability of a miniaturized sensor to identify concentrated blood, which could help in the very near future the detection of upper gastrointestinal bleeding and to survey high-risk patients for rebleeding.

  7. Multidetector CT angiography in acute gastrointestinal bleeding: why, when, and how.

    Science.gov (United States)

    Geffroy, Yann; Rodallec, Mathieu H; Boulay-Coletta, Isabelle; Jullès, Marie-Christine; Fullès, Marie-Christine; Ridereau-Zins, Catherine; Zins, Marc

    2011-01-01

    Acute gastrointestinal (GI) bleeding remains an important cause of emergency hospital admissions, with substantial related morbidity and mortality. Bleeding may relate to the upper or lower GI tract, with the dividing anatomic landmark between these two regions being the ligament of Treitz. The widespread availability of endoscopic equipment has had an important effect on the rapid identification and treatment of the bleeding source. However, the choice of upper or lower GI endoscopy is largely dictated by the clinical presentation, which in many cases proves misleading. Furthermore, there remains a large group of patients with negative endoscopic results or failed endoscopy, in whom additional techniques are required to identify the source of GI bleeding. Multidetector computed tomography (CT) with its speed, resolution, multiplanar techniques, and angiographic capabilities allows excellent visualization of both the small and large bowel. Multiphasic multidetector CT allows direct demonstration of bleeding into the bowel and is helpful in the acute setting for visualization of the bleeding source and its characterization. Thus, multidetector CT angiography provides a time-efficient method for directing and planning therapy for patients with acute GI bleeding. The additional information provided by multidetector CT angiography before attempts at therapeutic angiographic procedures leads to faster selective catheterization of bleeding vessels, thereby facilitating embolization. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.313105206/-/DC1.

  8. Nonvariceal upper gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  9. An Unusual Cause of Acute Upper Gastrointestinal Bleeding: Acute Esophageal Necrosis

    Directory of Open Access Journals (Sweden)

    Nikhil R. Kalva

    2016-01-01

    Full Text Available Acute esophageal necrosis (AEN, also called “black esophagus,” is a condition characterized by circumferential necrosis of the esophagus with universal distal involvement and variable proximal extension with clear demarcation at the gastroesophageal junction. It is an unusual cause of upper gastrointestinal bleeding and is recognized with distinct and striking mucosal findings on endoscopy. The patients are usually older and are critically ill with shared comorbidities, which include atherosclerotic cardiovascular disease, diabetes mellitus, hypertension, chronic renal insufficiency, and malnutrition. Alcoholism and substance abuse could be seen in younger patients. Patients usually have systemic hypotension along with upper abdominal pain in the background of clinical presentation of hematemesis and melena. The endoscopic findings confirm the diagnosis and biopsy is not always necessary unless clinically indicated in atypical presentations. Herein we present two cases with distinct clinical presentation and discuss the endoscopic findings along with a review of the published literature on the management of AEN.

  10. Management of acute nonvariceal upper gastrointestinal bleeding: Current policies and future perspectives

    Institute of Scientific and Technical Information of China (English)

    Ingrid Lisanne Holster; Ernst Johan Kuipers

    2012-01-01

    Acute upper gastrointestinal bleeding (UGIB) is a gastroenterological emergency with a mortality of 6%-13%.The vast majority of these bleeds are due to peptic ulcers.Nonsteroidal anti-inflammatory drugs and Helicobacter pylori are the main risk factors for peptic ulcer disease.Endoscopy has become the mainstay for diagnosis and treatment of acute UGIB,and is recommended within 24 h of presentation.Proton pump inhibitor (PPI) administration before endoscopy can downstage the bleeding lesion and reduce the need for endoscopic therapy,but has no effect on rebleeding,mortality and need for surgery.Endoscopic therapy should be undertaken for ulcers with high-risk stigmata,to reduce the risk of rebleeding.This can be done with a variety of modalities.High-dose PPI administration after endoscopy can prevent rebleeding and reduce the need for further intervention and mortality,particularly in patients with high-risk stigmata.

  11. [Gastrointestinal bleeding: the role of radiology].

    Science.gov (United States)

    Quiroga Gómez, S; Pérez Lafuente, M; Abu-Suboh Abadia, M; Castell Conesa, J

    2011-01-01

    Gastrointestinal bleeding represents a diagnostic challenge both in its acute presentation, which requires the point of bleeding to be located quickly, and in its chronic presentation, which requires repeated examinations to determine its etiology. Although the diagnosis and treatment of gastrointestinal bleeding is based on endoscopic examinations, radiological studies like computed tomography (CT) angiography for acute bleeding or CT enterography for chronic bleeding are becoming more and more common in clinical practice, even though they have not yet been included in the clinical guidelines for gastrointestinal bleeding. CT can replace angiography as the diagnostic test of choice in acute massive gastrointestinal bleeding, and CT can complement the endoscopic capsule and scintigraphy in chronic or recurrent bleeding suspected to originate in the small bowel. Angiography is currently used to complement endoscopy for the treatment of gastrointestinal bleeding.

  12. A therapeutic dose of ketoprofen causes acute gastrointestinal bleeding, erosions, and ulcers in rats.

    Science.gov (United States)

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

    2012-11-01

    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 mortalities was gastrointestinal toxicity caused by ketoprofen (5 mg/kg). We conducted a prospective study evaluating the effect of this therapeutic dose of ketoprofen on the rat gastrointestinal tract within 24 h. Ketoprofen (5 mg/kg SC) was administered to one group of rats that then received gas anesthesia for 30 min and to another group without subsequent anesthesia. A third group was injected with saline followed by 30 min of gas anesthesia. Our primary hypothesis was that noteworthy gastrointestinal bleeding and lesions would occur in both groups treated with ketoprofen but not in rats that received saline and anesthesia. Our results showed marked gastrointestinal bleeding, erosions, and small intestinal ulcers in the ketoprofen-treated rats and minimal damages in the saline-treated group. The combination of ketoprofen and anesthesia resulted in worse clinical signs than did ketoprofen alone. We conclude that a single 5-mg/kg dose of ketoprofen causes acute mucosal damage to the rat small intestine.

  13. [Obscure gastrointestinal bleeding].

    Science.gov (United States)

    Pastor, J; Adámek, S

    2013-08-01

    Obscure gastrointestinal bleeding represents 5% of all cases of bleeding into the gastrointestinal tract (GIT). The cause of this type of bleeding cannot be found by gastroscopy or colonoscopy - the most common cause being bleeding from the source in the small intestine. In other cases it is bleeding from other parts of the digestive tube which has already stopped or was not noticed during admission endoscopy. Imaging methods (X-ray, CT, MRI, scintigraphy) and endoscopic methods (flexible or capsule enteroscopy) are used in the diagnosis and treatment. If, despite having used these methods, the source of bleeding is not found and the bleeding continues, or if the source is known but the bleeding cannot be stopped by radiologic or endoscopic intervention, surgical intervention is usually indicated. The article provides an overview of current diagnostic and treatment options, including instructions on how to proceed in these diagnostically difficult situations.

  14. Incidence and Clinical Features of Peptic Ulcer Disease In Acute Upper Gastrointestinal Bleeding: -Experience of Moroccan University Hospital Unit-

    Directory of Open Access Journals (Sweden)

    Y. Cherradi

    2015-12-01

    Full Text Available Introduction: Peptic ulcer disease (PUD has been recognized as the leading cause of acute upper gastrointestinal bleeding (AUGIB. This study aims to report general features of bleeding peptic ulcers in patients who benefit of urgent endoscopy in our department after an acute upper gastrointestinal hemorrhage. Results: A total of 1809 patients were explored for acute upper gastrointestinal bleeding in our unit since 2003 to 2008. Gastroduodenal peptic ulcers were the most frequent diagnosed etiology. They present 38% of all reported causes of bleeding (n=527 (table I. 25% were located at duodenal mucosa (n= 347 and 13% were gastric ulcers (n=180. No esophageal ulcers were reported. Incidence of both duodenal and gastric ulcers decreases during the last years. Conclusion: In our department, incidence of bleeding peptic ulcer disease is decreasing but they continue to be the first cause of AUGIB.

  15. Pros and cons of colonoscopy in management of acute lower gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Dekey Y Lhewa; Lisa L Strate

    2012-01-01

    Acute lower gastrointestinal bleeding (LGIB) is a frequent gastrointestinal cause of hospitalization,particularly in the elderly,and its incidence appears to be on the rise.Endoscopic and radiographic measures are available for the evaluation and treatment of LGIB including flexible sigmoidoscopy,colonoscopy,angiography,radionuclide scintigraphy and multi-detector row computed tomography.Although no modality has emerged as the gold standard in the management of LGIB,colonoscopy is the current preferred initial test for the majority of the patients presenting with hematochezia felt to be from a colon source.Colonoscopy has the ability to diagnose all sources of bleeding from the colon and,unlike the radiologic modalities,does not require active bleeding at the time of the examination.In addition,therapeutic interventions such as cautery and endoclips can be applied to achieve hemostasis and prevent recurrent bleeding.Studies suggest that colonoscopy,particularly when performed early in the hospitalization,can decrease hospital length of stay,rebleeding and the need for surgery.However,results from available small trials are conflicting and larger,multicenter studies are needed.Compared to other management options,colonoscopy is a safe procedure with complications reported in less than 2% of patients,including those undergoing urgent examinations.The requirement of bowel preparation (typically 4 or more liters of polyethylene glycol),the logistical complexity of coordinating after-hours colonoscopy,and the low prevalence of stigmata of hemorrhage complicate the use of colonoscopy for LGIB,particularly in urgent situations.This review discusses the above advantages and disadvantages of colonoscopy in the management of acute lower gastrointestinal bleeding in further detail.

  16. Lower gastrointestinal bleeding.

    Science.gov (United States)

    Feinman, Marcie; Haut, Elliott R

    2014-02-01

    This article examines causes of occult, moderate and severe lower gastrointestinal (GI) bleeding. The difference in the workup of stable vs unstable patients is stressed. Treatment options ranging from minimally invasive techniques to open surgery are explored.

  17. Gastrointestinal Bleeding in Athletes.

    Science.gov (United States)

    Eichner, Edward R.

    1989-01-01

    Describes the scope and importance of gastrointestinal bleeding in runners and other athletes, discussing causes, sites, and implications of exercise-related bleeding. Practical tips to mitigate the problem, potentially more troublesome in women because of lower iron stores, are presented (e.g., gradual conditioning and avoidance of prerace…

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

    DEFF Research Database (Denmark)

    Krag, Mette; Perner, Anders; Wetterslev, Jørn

    2015-01-01

    PURPOSE: To describe the prevalence of, risk factors for, and prognostic importance of gastrointestinal (GI) bleeding and use of acid suppressants in acutely ill adult intensive care patients. METHODS: We included adults without GI bleeding who were acutely admitted to the intensive care unit (ICU...... bleeding occurred in 2.6 % (95 % confidence interval 1.6-3.6 %) of patients. The following variables at ICU admission were independently associated with clinically important GI bleeding: three or more co-existing diseases (odds ratio 8.9, 2.7-28.8), co-existing liver disease (7.6, 3.3-17.6), use of renal...

  19. Investigation of acute lower gastrointestinal bleeding with 16- and 64-slice multidetector CT.

    Science.gov (United States)

    Lee, S; Welman, C J; Ramsay, D

    2009-02-01

    We evaluated the usefulness of 16- and 64-slice multidetector CT (MDCT) in the detection of a bleeding site in acute lower gastrointestinal tract (GIT) haemorrhage by conducting a retrospective study of cases of presumed acute lower GIT haemorrhage imaged with CT in two teaching hospitals in an 11-month period. The patients underwent contrast enhanced CT using either a 16 or 64 MDCT. No oral contrast was used. One hundred milliliters of non-ionic intravenous contrast agent was injected at 4.5 mL/s, followed by a 60 mL saline flush at 4 mL/s through a dual head injector. Images were acquired in arterial phase with or without non-contrast and portal phase imaging with 16 x 1.5 mm or 64 x 0.625 mm collimation. Active bleeding was diagnosed by the presence of iodinated contrast extravasation into the bowel lumen on arterial phase images with attenuation greater than and distinct from the normal mucosal enhancement or focal pooling of increased attenuation contrast material within a bowel segment on portal-venous images. Further management and final diagnosis was recorded. Fourteen patients and 15 studies were reviewed. CT detected and localized a presumed bleeding site or potential causative pathology in 12 (80%) of the patients. Seven of these were supported by other investigations or surgery, while five were not demonstrated by other modalities. Eight patients had mesenteric angiography, of which only four corroborated the site of bleeding. CT did not detect the bleeding site in three patients, of which two required further investigation and definitive treatment. We propose that MDCT serves a useful role as the initial rapid investigation to triage patients presenting with lower GIT bleeding for further investigation and management.

  20. Is urgent CT angiography necessary in cases of acute lower gastrointestinal bleeding?

    Science.gov (United States)

    Díaz, A Martín; Rodríguez, L Fernández; de Gracia, M Martí

    2017-01-06

    Acute lower gastrointestinal bleeding usually presents as hematochezia, rectal bleeding or melena and represents 1-2% of the medical appointments in the Emergency Services. Mortality reaches the 30-40% and it is highly related with the severity and associated comorbidity. Most clinical practice guidelines include colonoscopy at some point in the diagnostic and therapeutic process (urgent for severe cases and ambulatory for mild ones) and look for predictors of severity. In the last years, there have been numerous studies where is clear the relevance and complementarity of advanced diagnostic imaging techniques, gradually incorporated as an alternative or second step in severe cases. Therefore, we have made a review of current scientific evidence to establish a clinical prediction rule for optimal indication of CT angiography in these patients. However, future studies providing greater robustness and level of evidence are necessary.

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

    Directory of Open Access Journals (Sweden)

    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.

  2. Acute upper gastrointestinal bleeding in operated stomach: Outcome of 105 cases

    Institute of Scientific and Technical Information of China (English)

    Vassiliki N Nikolopoulou; Konstantinos C Thomopoulos; George I Theocharis; Vassiliki A Arvaniti; Constantine E Vagianos

    2005-01-01

    AIM: To compare the causes and clinical outcome of patients with acute upper gastrointestinal bleeding (AUGB) and a history of gastric surgery to those with AUGB but without a history of gastric surgery in the past.METHODS: The causes and clinical outcome were compared between 105 patients with AUGB and a history of gastric surgery, and 608 patients with AUGB but without a history of gastric surgery.RESULTS: Patients who underwent gastric surgery in the past were older (mean age: 68.1±11.7 years vs 62.8±17.8 years, P= 0.001), and the most common cause of bleeding was marginal ulcer in 63 patients (60%). No identifiable source of bleeding could be found in 22 patients (20.9%) compared to 42/608 (6.9%) in patients without a history of gastric surgery (P = 0.003). Endoscopic hemostasis was permanently successful in 26 out of 35 patients (74.3%) with peptic ulcers and active bleeding or non-bleeding visible vessel. Nine patients (8.6%) were operated due to continuing or recurrent bleeding,compared to 23/608 (3.8%) in the group of patients without gastric surgery in the past (P= 0.028). Especially in peptic ulcer bleeding patients, emergency surgery was more common in the group of patients with gastric surgery in the past [9/73 (12.3%) vs 19/360 (5.3%), P = 0.025].Moreover surgically treated patients in the past required more blood transfusion (3.3±4.0 vs 1.5±1.7, P = 0.0001) and longer hospitalization time (8.6±4.0 vs 6.9±4.9 d,P = 0.001) than patients without a history of gastric surgery. Mortality was not different between the two groups [4/105 (3.8%) vs 19/608 (3.1%)].CONCLUSION: Upper gastrointestinal bleeding seems to be more severe in surgically treated patients than in non-operated patients.

  3. Acute gastrointestinal bleeding following aortic valve replacement in a patient with Heyde's sindrome. Case report.

    Science.gov (United States)

    De Palma, G D; Salvatori, F; Masone, S; Simeoli, I; Rega, M; Celiento, M; Persico, G

    2007-09-01

    A 58-year old man was admitted to the hospital because of melena. He had a 1-year history of mechanical aortic valve replacement and coronary stent placement because of myocardial infarction and he was taking warfarin and clopidogrel. Esophagogastroduodenoscopy and colonoscopy were negative for bleeding. Capsule endoscopy showed bleeding diffuse angiodysplasia of the small bowel. The patient was treated with octreotide 20 mg, at monthly interval. After 25 months there had been no recurrence of gastrointestinal bleeding. The case suggests that mechanical valve replacement may not prevent gastrointestinal bleeding in Heyde syndrome and that octreotide treatment should be considered in these cases.

  4. Primary aortoesophageal fistula: a rare cause of acute upper gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Samira Ineida Morais Gomes

    2011-12-01

    Full Text Available Acute upper gastrointestinal bleeding is a potentially life-threateningemergency, especially in the elderly. This condition accounts for approximately1% of all emergency room admissions. Among the causes of such bleedingis aortoesophageal fistula, a dreaded but apparently rare condition, firstrecognized in 1818. The great majority of cases are of primary aortoesophagealfistula, caused by atheromatous aortic aneurysms or, less frequently, bypenetrating aortic ulcer. The clinical presentation of aortoesophageal fistulais typically characterized by the so-called Chiari’s triad, consisting of thoracicpain followed by herald bleeding, a variable, short symptom-free interval,and fatal exsanguinating hemorrhage. The prognosis is poor, the in-hospitalmortality rate being 60%. Conservative treatment does not prolong survival,and the in-hospital mortality rate is 40% for patients submitted to conventionalsurgical treatment. Here, we report the case of a 93-year-old woman whopresented to the emergency room with a history of hematemesis. The patientwas first submitted to upper gastrointestinal endoscopy, the findings of whichwere suggestive of aortoesophageal fistula. The diagnosis was confirmedby multidetector computed tomography of the chest. Surgery was indicated.However, on the way to the operating room, the patient presented with massivebleeding and went into cardiac arrest, which resulted in her death.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

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

    Science.gov (United States)

    Jaeckle, T; Stuber, G; Hoffmann, M H K; Jeltsch, M; Schmitz, B L; Aschoff, A J

    2008-07-01

    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.

  7. Prediction of esophageal varices and variceal hemorrhage in patients with acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Rockey, Don C; Elliott, Alan; Lyles, Thomas

    2016-03-01

    In patients with upper gastrointestinal bleeding (UGIB), identifying those with esophageal variceal hemorrhage prior to endoscopy would be clinically useful. This retrospective study of a large cohort of patients with UGIB used logistic regression analyses to evaluate the platelet count, aspartate aminotransferase (AST) to platelet ratio index (APRI), AST to alanine aminotransferase (ALT) ratio (AAR) and Lok index (all non-invasive blood markers) as predictors of variceal bleeding in (1) all patients with UGIB and (2) patients with cirrhosis and UGIB. 2233 patients admitted for UGIB were identified; 1034 patients had cirrhosis (46%) and of these, 555 patients (54%) had acute UGIB due to esophageal varices. In all patients with UGIB, the platelet count (cut-off 122,000/mm(3)), APRI (cut-off 5.1), AAR (cut-off 2.8) and Lok index (cut-off 0.9) had area under the curve (AUC)s of 0.80 0.82, 0.64, and 0.80, respectively, for predicting the presence of varices prior to endoscopy. To predict varices as the culprit of bleeding, the platelet count (cut-off 69,000), APRI (cut-off 2.6), AAR (cut-off 2.5) and Lok Index (0.90) had AUCs of 0.76, 0.77, 0.57 and 0.73, respectively. Finally, in patients with cirrhosis and UGIB, logistic regression was unable to identify optimal cut-off values useful for predicting varices as the culprit bleeding lesion for any of the non-invasive markers studied. For all patients with UGIB, non-invasive markers appear to differentiate patients with varices from those without varices and to identify those with a variceal culprit lesion. However, these markers could not distinguish between a variceal culprit and other lesions in patients with cirrhosis.

  8. Omeprazole versus ranitidine in the medical treatment of acute upper gastrointestinal bleeding: assessment by early repeat endoscopy.

    Science.gov (United States)

    Fasseas, P; Leybishkis, B; Rocca, G

    2001-12-01

    The purpose of this study was to assess the effects of acid suppression in patients with upper gastrointestinal bleeding using early repeat endoscopy. Ninety-two patients with the diagnosis of acute upper gastrointestinal bleeding (endoscopically verified), entered a single-blind, randomised study comparing two treatment groups: omeprazole (40 mg orally daily) to ranitidine (50 mg intravenously four times daily). The lesions considered were gastric ulcers, duodenal ulcers and erosive gastritis. All patients were candidates for medical treatment. The parameters assessed included: 1) stabilisation of the lesion by repeat endoscopy at 7.0 +/- 3.0 days, 2) bleeding recurrence, 3) duration of stay in the intermediate medical care unit. For erosive gastritis only parameters 2 and 3 were considered. The study was limited to the hospitalisation period. Endoscopic stabilisation rate at 7.0 +/- 3.0 days for duodenal lesions was higher in the omeprazole group (71% vs 37%, p=0.03), but there was no significant difference for gastric lesions (50% vs 54%, NS). The overall bleeding recurrence rate (0% vs 17%, p=0.013) and the duration of stay (3.9 vs 6.4 days, p<0.01) were significantly lower in the omeprazole group. Our study suggests that omeprazole is more effective than ranitidine in the pharmacological treatment of acute upper gastrointestinal bleeding.

  9. Acute upper gastrointestinal bleeding secondary to Kaposi sarcoma as initial presentation of HIV infection.

    Science.gov (United States)

    Mansfield, Sara A; Stawicki, Stanislaw P A; Forbes, Rachel C; Papadimos, Thomas J; Lindsey, David E

    2013-12-01

    Despite our decades of experience with Kaposi Sarcoma its true nature remains elusive. This angioproliferative disease of the vascular endothelium has a propensity to involve visceral organs in the immunocompromised population. There are four variants of the disease and each has its own pathogenesis and evolution. While the common sources of upper gastrointestinal bleeding are familiar to surgeons and critical care physicians, here we present the exceedingly rare report of upper gastrointestinal bleeding attributable to this malady, explore its successful management, and review the various forms of Kaposi Sarcoma including the strategies in regard to their management.

  10. Prediction scores or gastroenterologists' Gut Feeling for triaging patients that present with acute upper gastrointestinal bleeding

    NARCIS (Netherlands)

    Groot, N.; Oijen, M.G. van; Kessels, K.; Hemmink, M.; Weusten, B.; Timmer, R.; Hazen, W.; Lelyveld, N. van; Vermeijden, J.R.; Curvers, W.; Baak, L.; Verburg, R.; Bosman, J.; Wijkerslooth, L. de; Rooij, J van; Venneman, N.; Pennings, M.C.P.; Hee, K. van; Scheffer, R.; Eijk, R. van; Meiland, R.; Siersema, P.; Bredenoord, A.

    2014-01-01

    INTRODUCTION: Several prediction scores for triaging patients with upper gastrointestinal (GI) bleeding have been developed, yet these scores have never been compared to the current gold standard, which is the clinical evaluation by a gastroenterologist. The aim of this study was to assess the added

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

    Institute of Scientific and Technical Information of China (English)

    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.

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

    Science.gov (United States)

    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.

  13. Guidelines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding (2015, Nanchang, China).

    Science.gov (United States)

    Bai, Yu; Li, Zhao Shen

    2016-02-01

    Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is one of the most common medical emergencies in China and worldwide. In 2009, we published the "Guidelines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding" for the patients in China; however, during the past years numerous studies on the diagnosis and treatment of ANVUGIB have been conducted, and the management of ANVUGIB needs to be updated. The guidelines were updated after the databases including PubMed, Embase and CNKI were searched to retrieve the clinical trials on the management of ANVUGIB. The clinical trials were evaluated for high-quality evidence, and the advances in definitions, diagnosis, etiology, severity evaluation, treatment and prognosis of ANVUGIB were carefully reviewed, the recommendations were then proposed. After several rounds of discussions and revisions among the national experts of digestive endoscopy, gastroenterology, radiology and intensive care, the 2015 version of "Guidelines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding" was successfully developed by the Chinese Journal of Internal Medicine, National Medical Journal of China, Chinese Journal of Digestion and Chinese Journal of Digestive Endoscopy. It shall be noted that although much progress has been made, the clinical management of ANVUGIB still needs further improvement and refinement, and high-quality randomized trials are required in the future.

  14. Characteristics and outcomes of acute upper gastrointestinal bleeding after therapeutic endoscopy in the elderly

    Institute of Scientific and Technical Information of China (English)

    Phunchai Charatcharoenwitthaya; Nonthalee Pausawasdi; Nuttiya Laosanguaneak; Jakkrapan Bubthamala; Tawesak Tanwandee; Somchai Leelakusolvong

    2011-01-01

    AIM: To characterize the effects of age on clinical pre-sentations and endoscopic diagnoses and to determine outcomes after endoscopic therapy among patients aged ≥ 65 years admitted for acute upper gastrointestinal bleeding (UGIB) compared with those aged < 65 years.METHODS: Medical records and an endoscopy data-base of 526 consecutive patients with overt UGIB ad-mitted during 2007-2009 were reviewed. The initial presentations and clinical course within 30 d after en-doscopy were obtained.RESULTS: A total of 235 patients aged ≥ 65 years constituted the elderly population (mean age of 74.2 ± 6.7 years, 63% male). Compared to young patients, the elderly patients were more likely to present with melena (53% vs 30%, respectively; P < 0.001), have comor-bidities (69% vs 54%, respectively; P < 0.001), and receive antiplatelet agents (39% vs 10%, respectively; P < 0.001). Interestingly, hemodynamic instability was observed less in this group (49% vs 68%, respec-tively; P < 0.001). Peptic ulcer was the leading cause of UGIB in the elderly patients, followed by varices and gastropathy. The elderly and young patients had a similar clinical course with regard to the utilization of endoscopic therapy, requirement for transfusion, duration of hospital stay, need for surgery [relative risk (RR), 0.31; 95% confidence interval (CI), 0.03-2.75; P = 0.26], rebleeding (RR, 1.44; 95% CI, 0.92-2.25; P = 0.11), and mortality (RR, 1.10; 95% CI, 0.57-2.11; P = 0.77). In Cox's regression analysis, hemodynamic instability at presentation, background of liver cirrhosis or disseminated malignancy, transfusion requirement, and development of rebleeding were significantly as-sociated with 30-d mortality.CONCLUSION: Despite multiple comorbidities and the concomitant use of antiplatelets in the elderly patients, advanced age does not appear to influence adverse outcomes of acute UGIB after therapeutic endoscopy.

  15. Gastrointestinal bleeding under dabigatran

    Directory of Open Access Journals (Sweden)

    C Stöllberger

    2014-01-01

    Full Text Available Dabigatran-absorption is dependent on the intestinal P-glycoprotein (P-gp-system, and P-gp activity is modulated by several drugs. We report an 83-old female with atrial fibrillation who developed gastrointestinal bleeding. She was under a therapy with non-steroidal anti-inflammatory drugs (NSAID and P-gp-modulating drugs and renal function was impaired. We conclude that NSAID and P-gp-modulating drugs should be avoided in dabigatran-treated patients. If renal function deteriorates the dabigatran-dosage should be reduced or the therapy should be stopped. There is an urgent need to increase knowledge about drug interactions with dabigatran.

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

    Institute of Scientific and Technical Information of China (English)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Wei-Chou [Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Tsai, Shih-Hung [Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Chang, Wei-Kuo [Division of Gasteroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Liu, Chang-Hsien [Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Tung, Ho-Jui [Department of Healthcare Administration, Asia University, Taichung, Taiwan (China); Hsieh, Chung-Bao [Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Huang, Guo-Shu; Hsu, Hsian-He [Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Yu, Chih-Yung, E-mail: chougo2002@yahoo.com.tw [Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China)

    2011-11-15

    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.

  18. Overt gastrointestinal bleeding in patients with acute myocardial infarction:retrospective analysis of risks and outcomes

    Institute of Scientific and Technical Information of China (English)

    Xinhong Guo; Yusheng Zhao; Jiayue Li; Deshui Wang; Qiao Xue; Wei Gao

    2008-01-01

    Overt gastrointestinal bleeding (GIB) is one of the noncardiac complications in patients with acute myocardial infarction (AMI).Identification of patients at increased risk of overt GIB could aid in targeting more aggressive treatment,and lead to improved outcomes.The aim of this study is to determine the frequency,risk factors,and prognostic significance of overt GIB in patients with AMI.Methods A retrospective review of the medical records of 1443 patients admitted to the Chinese PLA General Hospital with AMI was conducted.Charts were reviewed for clinical characteristics,possible precipitating factors and complications.Patients were categorized as having or not having overt GIB(GIB associated with hemodynamic changes or the need for transfusions).Results Twenty nine (2.0%) patients developed overt GIB within 30 days after AMI.Patients with overt GIB had higher 30-day mortality rate than those without (44.8% vs.9.9%,P < 0.001).Multivariate logistic regression analysis showed major determinants of in-hospital overt GIB secondary to AMI were gender of female (odds ratio 2.41,95% confidence interval [CI] 1.08 to 5.37),age=75 years (odds ratio 1.58,95% CI 1.13 to 2.20),prior history of AMI (odds ratio 2.28,95% CI 1.17 to 4.88),pneumonia (odds ratio 3.47,95% CI 1.50 to 8.03) and anemia at admission (odds ratio 2.37,95% CI 1.04 to 5.37).Conclusions In patients with AMI,overt GIB is associated with higher in-hospital mortality,and female sex,older age,prior AMI,pneumonia and anemia at admission are predictors of overt GIB during hospitalization.(J Geriatr Cardiol 2008;5:195-198)

  19. Acute upper gastrointestinal bleeding in patients on long-term oral anticoagulation therapy: Endoscopic findings, clinical management and outcome

    Institute of Scientific and Technical Information of China (English)

    Konstantinos C Thomopoulos; Konstantinos P Mimidis; George J Theocharis; Anthie G Gatopoulou; Georgios N Kartalis; Vassiliki N Nikolopoulou

    2005-01-01

    AIM: Acute gastrointestinal bleeding is a severe complication in patients receiving long-term oral anticoagulant therapy.The purpose of this study was to describe the causes and clinical outcome of these patients.METHODS: From January 1999 to October 2003, 111patients with acute upper gastrointestinal bleeding (AUGIB)were hospitalized while on oral anticoagulants. The causes and clinical outcome of these patients were compared with those of 604 patients hospitalized during 2000-2001with AUGIB who were not taking warfarin.RESULTS: The most common cause of bleeding was peptic ulcer in 51 patients (45%) receiving anticoagulants compared to 359/604 (59.4%) patients not receiving warfarin (P<0.05). No identifiable source of bleeding could be found in 33 patients (29.7%) compared to 31/604(5.1%) patients not receiving anticoagulants (P= 0.0001).The majority of patients with concurrent use of non-steroidal anti-inflammatory drugs (NSATDs) (26/35, 74.3%) had a peptic ulcer as a cause of bleeding while 32/76 (40.8%)patients not taking a great dose of NSATDs had a negative upper and lower gastrointestinal endoscopy. Endoscopic hemostasis was applied and no complication was reported.Six patients (5.4%) were operated due to continuing or recurrent hemorrhage, compared to 23/604 (3.8%) patients not receiving anticoagulants. Four patients died, the overall mortality was 3.6% in patients with AUGIB due to anticoagulants, which was not different from that in patients not receiving anticoagulant therapy.CONCLUSION: Patients with AUGIB while on long-term anticoagulant therapy had a clinical outcome, which is not different from that of patients not taking anticoagulants.Early endoscopy is important for the management of these patients and endoscopic hemostasis can be safely applied.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  1. Hemospray treatment is effective for lower gastrointestinal bleeding

    NARCIS (Netherlands)

    Holster, I.L.; Brullet, E.; Kuipers, E.J.; Campo, R.; Fernandez-Atutxa, A.; Tjwa, E.T.

    2014-01-01

    Acute lower gastrointestinal bleeding (LGIB) is diverse in origin and can be substantial, requiring urgent hemostasis. Hemospray is a promising novel hemostatic agent for upper gastrointestinal bleeding (UGIB). It has been claimed in a small series that the use of Hemospray is also feasible in LGIB.

  2. Acute pancreatitis associated left-sided portal hypertension with severe gastrointestinal bleeding treated by transcatheter splenic artery embolization: a case report and literature review

    Institute of Scientific and Technical Information of China (English)

    Zhi-yu LI; Bin LI; Yu-lian WU; Qiu-ping XIE

    2013-01-01

    Left-sided portal hypertension (LSPH) followed by acute pancreatitis is a rare condition with most patients being asymptomatic.In cases where gastrointestinal (GI) bleeding is present,however,the condition is more complicated and the mortality is very high because of the difficulty in diagnosing and selecting optimal treatment.A successfully treated case with severe GI bleeding by transcatheter splenic artery embolization is reported in this article.The patient exhibited severe uncontrollable GI bleeding and was confirmed as gastric varices secondary to LSPH by enhanced computed tomography (CT) scan and CT-angiography.After embolization,the bleeding stopped and stabilized for the entire follow-up period without any severe complications.In conclusion,embolization of the splenic artery is a simple,safe,and effective method of controlling gastric variceal bleeding caused by LSPH in acute pancreatitis.

  3. Acute pancreatitis associated left-sided portal hypertension with severe gastrointestinal bleeding treated by transcatheter splenic artery embolization: a case report and literature review.

    Science.gov (United States)

    Li, Zhi-yu; Li, Bin; Wu, Yu-lian; Xie, Qiu-ping

    2013-06-01

    Left-sided portal hypertension (LSPH) followed by acute pancreatitis is a rare condition with most patients being asymptomatic. In cases where gastrointestinal (GI) bleeding is present, however, the condition is more complicated and the mortality is very high because of the difficulty in diagnosing and selecting optimal treatment. A successfully treated case with severe GI bleeding by transcatheter splenic artery embolization is reported in this article. The patient exhibited severe uncontrollable GI bleeding and was confirmed as gastric varices secondary to LSPH by enhanced computed tomography (CT) scan and CT-angiography. After embolization, the bleeding stopped and stabilized for the entire follow-up period without any severe complications. In conclusion, embolization of the splenic artery is a simple, safe, and effective method of controlling gastric variceal bleeding caused by LSPH in acute pancreatitis.

  4. Embolization of acute nonvariceal upper gastrointestinal hemorrhage resistant to endoscopic treatment: results and predictors of recurrent bleeding.

    Science.gov (United States)

    Loffroy, Romaric; Rao, Pramod; Ota, Shinichi; De Lin, Ming; Kwak, Byung-Kook; Geschwind, Jean-François

    2010-12-01

    Acute nonvariceal upper gastrointestinal (UGI) hemorrhage is a frequent complication associated with significant morbidity and mortality. The most common cause of UGI bleeding is peptic ulcer disease, but the differential diagnosis is diverse and includes tumors; ischemia; gastritis; arteriovenous malformations, such as Dieulafoy lesions; Mallory-Weiss tears; trauma; and iatrogenic causes. Aggressive treatment with early endoscopic hemostasis is essential for a favorable outcome. However, severe bleeding despite conservative medical treatment or endoscopic intervention occurs in 5-10% of patients, requiring surgery or transcatheter arterial embolization. Surgical intervention is usually an expeditious and gratifying endeavor, but it can be associated with high operative mortality rates. Endovascular management using superselective catheterization of the culprit vessel, «sandwich» occlusion, or blind embolization has emerged as an alternative to emergent operative intervention for high-risk patients and is now considered the first-line therapy for massive UGI bleeding refractory to endoscopic treatment. Indeed, many published studies have confirmed the feasibility of this approach and its high technical and clinical success rates, which range from 69 to 100% and from 63 to 97%, respectively, even if the choice of the best embolic agent among coils, cyanaocrylate glue, gelatin sponge, or calibrated particles remains a matter of debate. However, factors influencing clinical outcome, especially predictors of early rebleeding, are poorly understood, and few studies have addressed this issue. This review of the literature will attempt to define the role of embolotherapy for acute nonvariceal UGI hemorrhage that fails to respond to endoscopic hemostasis and to summarize data on factors predicting angiographic and embolization failure.

  5. Gastrointestinal Bleeding Secondary to Calciphylaxis.

    Science.gov (United States)

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

    2015-11-17

    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.

  6. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  7. 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

    Directory of Open Access Journals (Sweden)

    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

  8. Interventional management of lower gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Weldon, Derik T.; Burke, Stephen J.; Sun, Shiliang; Mimura, Hidefumi; Golzarian, Jafar [University of Iowa Hospitals and Clinics, Department of Radiology, Iowa, IA (United States)

    2008-05-15

    Lower gastrointestinal bleeding (LGIB) arises from a number of sources and is a significant cause of hospitalization and mortality in elderly patients. Whereas most episodes of acute LGIB resolve spontaneously with conservative management, an important subset of patients requires further diagnostic workup and therapeutic intervention. Endovascular techniques such as microcatheter embolization are now recognized as safe, effective methods for controlling LGIB that is refractory to endoscopic intervention. In addition, multidetector CT has shown the ability to identify areas of active bleeding in a non-invasive fashion, enabling more focused intervention. Given the relative strengths and weaknesses of various diagnostic and treatment modalities, a close working relationship between interventional radiologists, gastroenterologists and diagnostic radiologists is necessary for the optimal management of LGIB patients. (orig.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  10. 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

    Energy Technology Data Exchange (ETDEWEB)

    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

  11. Gastrointestinal bleeding in the pediatric patient.

    OpenAIRE

    Hillemeier, C.; Gryboski, J. D.

    1984-01-01

    Gastrointestinal hemorrhage in infants and children is a catastrophic event but is not associated with significant mortality except in those with a severe primary illness. Upper gastrointestinal bleeding in infants and young children is most often associated with stress ulcers or erosions, but in older children it may also be caused by duodenal ulcer, esophagitis, and esophageal varices. Lower gastrointestinal bleeding may be caused by a variety of lesions among which are infectious colitides...

  12. An unusual cause of gastrointestinal bleed

    Directory of Open Access Journals (Sweden)

    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.

  13. 老年急性上消化道出血临床特征观察%Observe clinical characteristics of elderly with acute upper gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    邱伟伟; 陈建荣

    2016-01-01

    Objective To explore the characteristics of elderly with acute upper gastrointestinal bleeding and treatment methods. Methods A retrospective analysis of 60 cases of elderly patients with acute upper gastrointestinal bleeding were made. The patients were diagnosised and treated in branch hospital of nantong university affiliated hospital from January 2012 to June 2015. Results 42 cases of patients were with epigastric pain and discomfort before bleeding, and 18 cases were without symptoms of digestive system;Before bleeding,15 cases had taken non-steroidal anti-inflammatory drugs like aspirin;38 cases were appear to Merge diseases such as heart,brain,kidney . 23 cases of acute upper gastrointestinal bleeding patients were melena ,17 cases hematemesis,10 cases hematemesis and melena,10 cases found during a medical or other inspection. 52 cases showed bleeding symptoms include fatigue,pale complexion, dizziness and other,8 cases of hemorrhage shock. In the course,12 cases were with onset. Cause of bleeding was 20 cases of gastric ulcer,acute gastric mucosal lesions in 15 cases,10 cases of gastric cancer and esophageal cancer,10 cases of duodenal bulb ulcers,stomach esophagus varicosity burst and other 5 cases;Treatment of bleeding stopped(9.23±4.34)days on average,4 cases died. Conclusion Clinical manifestation of Elderly patients with acute upper gastrointestinal bleeding is not typical with complex bleeding reason,much complications and poorer prognosis. The patients should be given timely effective treatment,and maintain vital organ function of the body at the same time.%目的:探讨老年急性上消化道出血特点及处理方法。方法回顾性分析2012年1月~2015年6月南通大学附属医院分院诊治的60例老年急性上消化道出血患者的临床资料。结果出血前有上腹疼痛及不适42例,无消化系统症状18例;出血前有服用非甾体抗炎药15例;合并心、脑、肾、肝等疾病38例。急性上

  14. Role of videocapsule endoscopy for gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    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.

  15. Do statins protect against upper gastrointestinal bleeding?

    DEFF Research Database (Denmark)

    Gulmez, Sinem Ezgi; Lassen, Annmarie Touborg; Aalykke, Claus;

    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...... of statins with UGB were 0.94 (0.78-1.12) for current use, 1.40 (0.89-2.20) for recent use and 1.42 (0.96-2.10) for past use. The lack of effect was consistent across most patient subgroups, different cumulative or current statin doses and different statin substances. In explorative analyses, a borderline...... significant protective effect was observed for concurrent users of low-dose aspirin [OR 0.43 (0.18-1.05)]. CONCLUSION: Statins do not prevent UGB, except possibly in users of low-dose aspirin....

  16. Upper gastrointestinal bleeding - state of the art.

    Science.gov (United States)

    Szura, Mirosław; Pasternak, Artur

    2014-01-01

    Upper gastrointestinal (GI) bleeding is a condition requiring immediate medical intervention, with high associated mortality exceeding 10%. The most common cause of upper GI bleeding is peptic ulcer disease, which largely corresponds to the intake of NSAIDs and Helicobacter pylori infection. Endoscopy is the essential tool for the diagnosis and treatment of active upper GI hemorrhage. Endoscopic therapy together with proton pump inhibitors and eradication of Helicobacter pylori significantly reduces rebleeding rates, mortality and number of emergency surgical interventions. This paper presents contemporary data on the diagnosis and treatment of upper gastrointestinal bleeding.

  17. Lower Gastrointestinal Bleeding in Chronic Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Fahad Saeed

    2011-01-01

    Full Text Available Gastrointestinal (GI bleeding is more common in patients with chronic kidney disease and is associated with higher mortality than in the general population. Blood losses in this patient population can be quite severe at times and it is important to differentiate anemia of chronic diseases from anemia due to GI bleeding. We review the literature on common causes of lower gastrointestinal bleeding (LGI in chronic kidney disease (CKD and end-stage renal disease (ESRD patients. We suggest an approach to diagnosis and management of this problem.

  18. The management of lower gastrointestinal bleeding.

    Science.gov (United States)

    Marion, Y; Lebreton, G; Le Pennec, V; Hourna, E; Viennot, S; Alves, A

    2014-06-01

    Lower gastrointestinal (LGI) bleeding is generally less severe than upper gastrointestinal (UGI) bleeding with spontaneous cessation of bleeding in 80% of cases and a mortality of 2-4%. However, unlike UGI bleeding, there is no consensual agreement about management. Once the patient has been stabilized, the main objective and greatest difficulty is to identify the location of bleeding in order to provide specific appropriate treatment. While upper endoscopy and colonoscopy remain the essential first-line examinations, the development and availability of angiography have made this an important imaging modality for cases of active bleeding; they allow diagnostic localization of bleeding and guide subsequent therapy, whether therapeutic embolization, interventional colonoscopy or, if other techniques fail or are unavailable, surgery directed at the precise site of bleeding. Furthermore, newly developed endoscopic techniques, particularly video capsule enteroscopy, now allow minimally invasive exploration of the small intestine; if this is positive, it will guide subsequent assisted enteroscopy or surgery. Other small bowel imaging techniques include enteroclysis by CT or magnetic resonance imaging. At the present time, exploratory surgery is no longer a first-line approach. In view of the lesser gravity of LGI bleeding, it is most reasonable to simply stabilize the patient initially for subsequent transfer to a specialized center, if minimally invasive techniques are not available at the local hospital. In all cases, the complexity and diversity of LGI bleeding require a multidisciplinary collaboration involving the gastroenterologist, radiologist, intensivist and surgeon to optimize diagnosis and treatment of the patient.

  19. Jejunal GIST causing acute massive gastrointestinal bleeding: role of multidetector row helical CT in the preoperative diagnosis and management.

    Science.gov (United States)

    Daldoul, Sami; Moussi, Amir; Triki, Wissem; Baraket, Rym Bennaceur; Zaouche, Abdeljelil

    2012-09-01

    In this report, we describe a 34-year-old man with a jejunal gastrointestinal stromal tumour (GIST) accompanied by an unusual severe haemorrhage. Because oesophagogastroduodenoscopy proved inconclusive in determining the source of the bleeding and also because of gradually dropping haemoglobin levels and persistence of the melena not allowing colonic preparation, colonoscopy was cancelled and a mesenteric angio-computed tomography (angio-CT) was deemed necessary. The results of this analysis showed a 5-cm heterogeneous mass located in the jejunal loop surrounded by abnormal arterial structures. This multidetector computed tomography (MDCT) appearance was highly suggestive of GIST. The patient then underwent an urgent laparotomy and, peroperative findings being compatible with angio-CT descriptions, a small-bowel resection was performed. The results of the histopathological examination confirmed the diagnosis of GIST. Angio-CT helps define the size of GIST as well as its range and location and can be used as the primary routine test for patients suffering from lower-GI bleeding.

  20. AN UNUSUAL CAUSE OF UPPER GASTROINTESTINAL BLEEDING.

    Science.gov (United States)

    Ali, Kishwar; Zarin, Muhammad; Latif, Humera

    2015-01-01

    Gastrointestinal haemorrhage (GI) is a serious condition that presents both diagnostic as well as therapeutic challenges. Resuscitation of the patient is the first and most important step in its management followed by measures to localize and treat the exact source and site of bleeding. These modalities are upper and lower GI endoscopies, radionuclide imaging and angiography. Surgery is the last resort to handle the situation, if the patient does not respond to resuscitative measures and the various interventional procedures fail to locate and stop the bleeding. We present a case of upper GI bleeding which presented with massive per rectal bleeding and the patient was not responding to resuscitation with multiple blood transfusions. Ultimately an exploratory laparotomy was done which revealed an extra-intestinal source of bleeding into the lumen of duodenum, presenting as upper GI bleeding.

  1. Management of lower gastrointestinal bleeding in older adults.

    Science.gov (United States)

    Triadafilopoulos, George

    2012-09-01

    Lower gastrointestinal bleeding, acute overt, occult or obscure in nature, causes significant morbidity and mortality in older adults. As the elderly population is expected to increase in the future, healthcare costs and the clinical burden of lower gastrointestinal bleeding will rise. Lower gastrointestinal bleeding, by definition, originates from a site distal to the ligament of Treitz and is usually suspected when patients present with haematochezia, or maroon stools per rectum. A thorough history is paramount in guiding the diagnostic steps and management but is frequently inadequate in elderly, poorly communicating, nursing home patients. The causes of lower gastrointestinal bleeding in older adults may be anatomic, vascular, inflammatory, neoplastic or iatrogenic. Comorbidity from cardiopulmonary disease, renal disease, diabetes or underlying cancer, all prevalent in older adults, may affect the incidence, severity, morbidity and mortality of lower gastrointestinal bleeding in the elderly. The use of multiple medications, particularly non-steroidal anti-inflammatory, antiplatelet and anticoagulant agents, needs to be always considered in elderly patients with lower gastrointestinal bleeding and anaemia. CT imaging and early colonoscopy are useful in determining the site of bleeding and allowing haemostasis. If unsuccessful, angiographic intervention and surgery need to be considered. Videocapsule endoscopy is useful in cases where the small bowel is suspected as the source, and its results guide the performance of double- or single-balloon enteroscopy. Optimal care should involve a coordinated effort among the primary physician, endoscopist, interventional radiologist and surgeon in order to improve prognosis and subsequent management and reduce morbidity, mortality, length of stay and overall healthcare costs.

  2. Bayesian network modelling of upper gastrointestinal bleeding

    Science.gov (United States)

    Aisha, Nazziwa; Shohaimi, Shamarina; Adam, Mohd Bakri

    2013-09-01

    Bayesian networks are graphical probabilistic models that represent causal and other relationships between domain variables. In the context of medical decision making, these models have been explored to help in medical diagnosis and prognosis. In this paper, we discuss the Bayesian network formalism in building medical support systems and we learn a tree augmented naive Bayes Network (TAN) from gastrointestinal bleeding data. The accuracy of the TAN in classifying the source of gastrointestinal bleeding into upper or lower source is obtained. The TAN achieves a high classification accuracy of 86% and an area under curve of 92%. A sensitivity analysis of the model shows relatively high levels of entropy reduction for color of the stool, history of gastrointestinal bleeding, consistency and the ratio of blood urea nitrogen to creatinine. The TAN facilitates the identification of the source of GIB and requires further validation.

  3. A STUDY ON UPPER GASTROINTESTINAL ENDOSCOPIC FINDINGS IN PATIENTS WITH UPPER GASTROINTESTINAL BLEEDING

    Directory of Open Access Journals (Sweden)

    Salla Surya Prakasa Rao

    2016-10-01

    Full Text Available BACKGROUND Vomiting of blood almost always proximal to the ligament of Treitz is the upper gastrointestinal haemorrhage. The incidence of acute upper gastrointestinal haemorrhage has been estimated to be 50-100 per 1,00,000 person per year, with an annual hospitalization rate of approximately 100 per 1, 00,000 hospital admission. This study is to find out the prevalence of nature of lesion on Upper Gastrointestinal Endoscopy in patients admitted for Gastrointestinal bleeding. (UGI Bleed. MATERIALS AND METHODS Place of Study- Department of General Medicine, Andhra Medical College, Visakhapatnam, India. Type of Study- Prospective study. Period of Study- July 2015 to August 2016. RESULTS The Results Study on Endoscopic Findings in Upper Gastro Intestinal Bleed are 1. The peptic ulcer disease was the most common lesion found on endoscopy with prevalence of 54%. 2. Varices contributes second common lesion, next to peptic ulcer disease in UGI bleed with prevalence of 16%. 3. Minor UGI bleed was the commonest presentation. Majority of lesions (60% presented with minor UGI bleed, 28% lesions presented as moderate UGI bleed. Only 8% presented as major UGI bleed. 4. Varices account for the most common cause for major UGI bleed contributing 50%. 5. Gastric ulcer was commonest lesions accounting for 37 cases (37% among 72 cases having single acid peptic lesions on endoscopy. The second most common is duodenal ulcer (31%. 6. Multiple lesions were found in 10% of cases. Peptic ulcer lesions were found in 20% of total number of varices cases. CONCLUSION Peptic ulcer disease was found to be most common lesion causing UGI bleed, with most common presentation as minor UGI bleed and variceal bleed being most common cause of major UGI bleed.

  4. Initial Assessment and Resuscitation in Nonvariceal Upper Gastrointestinal Bleeding.

    Science.gov (United States)

    Simon, Tracey G; Travis, Anne C; Saltzman, John R

    2015-07-01

    Acute nonvariceal upper gastrointestinal bleeding remains an important cause of hospital admission with an associated mortality of 2-14%. Initial patient evaluation includes rapid hemodynamic assessment, large-bore intravenous catheter insertion and volume resuscitation. A hemoglobin transfusion threshold of 7 g/dL is recommended, and packed red blood cell transfusion may be necessary to restore intravascular volume and improve tissue perfusion. Patients should be risk stratified into low- and high-risk categories, using validated prognostic scoring systems such as the Glasgow-Blatchford, AIMS65 or Rockall scores. Effective early management of acute, nonvariceal upper gastrointestinal hemorrhage is critical for improving patient outcomes.

  5. Incidental detection of a bleeding gastrointestinal stromal tumor on Tc-99m red blood cell scintigraphy.

    Science.gov (United States)

    Santhosh, Sampath; Bhattacharya, Anish; Gupta, Vikas; Singh, Rajinder; Radotra, Bishan Dass; Mittal, Bhagwant Rai

    2012-10-01

    The role of 99m-technetium labeled red blood cell (RBC) scintigraphy in acute gastro-intestinal bleed is well-established. The authors report a case of a bleeding gastrointestinal stromal tumor (GIST) incidentally discovered on Tc-99m RBC scintigraphy.

  6. Computed tomography angiography in patients with active gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    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)

  7. [Epidemiology of upper gastrointestinal bleeding in Gabon].

    Science.gov (United States)

    Gaudong Mbethe, G L; Mounguengui, D; Ondounda, M; Magne, C; Bignoumbra, R; Ntsoumou, S; Moussavou Kombila, J-B; Nzenze, J R

    2014-01-01

    The department of internal medicine of the military hospital of Gabon managed 92 cases of upper gastrointestinal bleeding from April 2009 to November 2011. The frequency of these hemorrhages in the department was 8.2%; they occurred most often in adults aged 30-40 years and 50-60 years, and mainly men (74%). Erosive-ulcerative lesions (65.2%) were the leading causes of hemorrhage, followed by esophageal varices (15.2%). These results underline the importance of preventive measures for the control of this bleeding.

  8. The Approach to Occult Gastrointestinal Bleed.

    Science.gov (United States)

    Naut, Edgar R

    2016-09-01

    Occult gastrointestinal bleeding is not visible and may present with a positive fecal occult blood test or iron deficiency anemia. Obscure bleeding can be overt or occult, with no source identified despite an appropriate diagnostic workup. A stepwise approach to this evaluation after negative upper and lower endoscopy has been shown to be cost effective. This includes repeat endoscopies if warranted, followed by video capsule endoscopy (VCE) if no obstruction is present. If the VCE is positive then specific endoscopic intervention may be possible. If negative, patients may undergo either repeat testing or watchful waiting with iron supplements.

  9. Jejunal diverticulosis as the obscure cause of overt gastrointestinal bleeding.

    Science.gov (United States)

    Nyin, L Y; Zainun, A R; Tee, H P

    2011-08-01

    Jejunal diverticulosis is a rare gastrointestinal condition manifested as benign outpouching from the jejunal wall. It is usually asymptomatic, but may present as obscure gastrointestinal bleeding. This condition is often found incidentally in the imaging work-up of patients with other gastrointestinal conditions. We present a case of jejunal diverticulosis in a 65-year-old gentleman with obscure overt gastrointestinal bleed.

  10. Angiographic diagnosis and treatment of gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jae Hyung; Sung, Kyu Bo; Koo, Kyung Hoi; Bae, Tae Young; Chung, Eun Chul; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1986-02-15

    Diagnostic angiographic evaluations were done in 33 patients with gastrointestinal bleeding for recent 5 years at Department of Radiology, Seoul National University Hospital. On 11 patients of them, therapeutic interventional procedures were made and the results were analysed. 1. In a total of 33 cases, there were 18 cases of upper GI bleeding and 15 cases of lower GI bleeding. The most frequent causes were peptic ulcer in the former and intestinal typhoid fever in the latter. 2. Bleeding sites were localized angiographically in 28 cases, so the detection rate was 85%. Four of the five angiographically negative cases were lower GI bleeding cases. 3. The most frequent bleeding site was left gastric artery (7/33). The next was ileocecal branch of superior mesenteric artery (6/33). 4. Among the 11 interventional procedures, Gelfoam embolization was done in 7 cases and Vasopressin infusion was tried in 4 cases. They were successful in 4 and 3 cases, suggesting 57% and 47% success rates respectively.

  11. 急性重症脑卒中患者并发上消化道出血临床分析%Clinical characteristics of severe acute stroke complicated with upper gastrointestinal bleeding:analysis of 180 cases

    Institute of Scientific and Technical Information of China (English)

    李丽霞; 李建国

    2012-01-01

    Objective To investigate the clinical characters of severe acute stroke complicated with upper gastrointestinal bleeding. Methods The clinical data of 180 patients with severe acute hemorrhagic or cerebral infarction were retrospectively analyzed. Results The incidence of severe acute stroke complicated with upper gastrointestinal bleeding was 28.3% (51/180). The upper gastrointestinal bleeding often occurred 2 to 7 days after acute stroke. The incidence of upper gastrointestinal bleeding in the patients with severe acute cerebral infarction was 31.3%, a little higher than that of the patients with severe cerebral hemorrhage (27.3%), but not significantly. Multivariate logistic regression analysis showed that senility, low GCS score and previous history of aspirin use were the important risk factors of upper gastrointestinal bleeding. The vast majority of patients with severe acute stroke complicated with upper gastrointestinal hemorrhage were treated with fasting and proton pump inhibitor. The mortality within 90 days of the patients complicated with upper gastrointestinal bleeding was 62.7% (32/52), significantly higher than that of the patients not complicated with upper gastrointestinal bleeding [32 45.7% (59/129), P<0.05]. Conclusion The patients with severe acute stroke are susceptible to upper gastrointestinal bleeding. The prognosis of acute stroke complicated with upper gastrointestinal bleeding is poor.%目的 探讨急性重症脑卒中患者并发上消化道出血的临床特点.方法 对180例符合入选标准 的急性重症脑出血或脑梗死患者的临床资料进行回顾性分析.结果 急性重症脑卒中患者上消化道出血 发生率为28.3%,上消化道出血多发生于卒中2~7 d之内.急性重症脑梗死患者上消化道出血的发生率 为31.3%,略高于重症脑出血患者(27.3%),但二者比较无显著差异.高龄、入院GCS评分低、发病前服用 小剂量阿司匹林是重症脑卒中患者并发上消化道

  12. Acute variceal bleeding: general management

    Institute of Scientific and Technical Information of China (English)

    David Patch; Lucy Dagher

    2001-01-01

    @@ TREATMENT STRATEGIES FOR ACUTE VARICEAL BLEEDING Backgound Acute variceal bleeding has a significant mortality which ranges form 5% to 50% in patients with cirrhosis[1].Overall survival is probably improving,because of new therapeutic approaches,and improved medical care.However,mortality is still closely related to failure to control hacmorrhage or carly rebleeding,which is a distinct characteristic of portal hypertensive bleeding and occures in as many as 50% of patients in the first days to 6 weeks after admission et al[2].

  13. [Bleeding non-epithelial gastrointestinal neoplasms].

    Science.gov (United States)

    Zak, V I; Galtsev, A P

    1993-01-01

    Inefficiency of x-ray and endoscopic examinations of a bleeding hollow organ of the gastrointestinal tract may be explained by the effection of its wall with nonepithelial tumor (lipoma, neurinoma, leiomyoma). In some cases only laparotomy and examination of the abdominal cavity succeed in localization of the tumor. Intraoperative cytodiagnosis of nonepithelial benign tumors is a method conducive to sparing surgery (partial resection, dissection).

  14. 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

    Institute of Scientific and Technical Information of China (English)

    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

  15. The role of endoscopy in pediatric gastrointestinal bleeding

    Science.gov (United States)

    Franke, Markus; Geiß, Andrea; Greiner, Peter; Wellner, Ulrich; Richter-Schrag, Hans-Jürgen; Bausch, Dirk; Fischer, Andreas

    2016-01-01

    Background and study aims: Gastrointestinal bleeding in children and adolescents accounts for up to 20 % of referrals to gastroenterologists. Detailed management guidelines exist for gastrointestinal bleeding in adults, but they do not encompass children and adolescents. The aim of this study was to assess gastrointestinal bleeding in pediatric patients and to determine an investigative management algorithm accounting for the specifics of children and adolescents. Patients and methods: Pediatric patients with gastrointestinal bleeding admitted to our endoscopy unit from 2001 to 2009 (n = 154) were identified. Retrospective statistical and neural network analysis was used to assess outcome and to determine an investigative management algorithm. Results: The source of bleeding could be identified in 81 % (n = 124/154). Gastrointestinal bleeding was predominantly lower gastrointestinal bleeding (66 %, n = 101); upper gastrointestinal bleeding was much less common (14 %, n = 21). Hematochezia was observed in 94 % of the patients with lower gastrointestinal bleeding (n = 95 of 101). Hematemesis (67 %, n = 14 of 21) and melena (48 %, n = 10 of 21) were associated with upper gastrointestinal bleeding. The sensitivity and specificity of a neural network to predict lower gastrointestinal bleeding were 98 % and 63.6 %, respectively and to predict upper gastrointestinal bleeding were 75 % and 96 % respectively. The sensitivity and specifity of hematochezia alone to predict lower gastrointestinal bleeding were 94.2 % and 85.7 %, respectively. The sensitivity and specificity for hematemesis and melena to predict upper gastrointestinal bleeding were 82.6 % and 94 %, respectively. We then developed an investigative management algorithm based on the presence of hematochezia and hematemesis or melena. Conclusions: Hematochezia should prompt colonoscopy and hematemesis or melena should prompt esophagogastroduodenoscopy. If no

  16. A STUDY ON ENDOSCOPIC EVALUATION OF UPPER GASTROINTESTINAL BLEEDING

    Directory of Open Access Journals (Sweden)

    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

  17. Clinical Analysis of 120 Cases of Elderly Patients with Acute Upper Gastrointestinal Bleeding%120例老年急性上消化道出血患者临床分析

    Institute of Scientific and Technical Information of China (English)

    伍煜伦; 赵青山; 陈素文

    2012-01-01

      目的:探讨老年急性上消化道出血的临床特点.方法:回顾性分析120例老年急性上消化道出血患者的临床资料,与同期收治的110例非老年急性上消化道出血患者进行比较.结果:与非老年人组比较,老年人组上消化道出血的病因中胃溃疡、急性胃黏膜病变、胃癌的患病率均较高(P<0.05),而十二指肠溃疡及食管静脉曲张破裂的患病率均较低(P<0.05).伴随疾病率、死亡率均较高(P<0.05).结论:掌握老年急性上消化道出血临床特点,有助于改善预后.%  Objective:To investigate the clinical features of elderly patients with acute upper gastrointestinal bleeding.Method:A retrospective analysis of 120 cases of elderly patients with acute upper gastrointestinal bleeding,110 cases of non-elderly patients with acute gastrointestinal bleeding at the same period were compared.Result:Compared with non-elderly group,the incidence rate of gastric ulcer,acute gastric mucosal lesions and gastric cancer in the elderly group were significant higher(P<0.05),duodenal ulcer and esophageal varices were significant lower(P<0.05).The rate of comorbidity and mortality were significant higher(P<0.05).Conclusion:Mastering the clinical characteristics of elderly patients with acute upper gastrointestinal bleeding can help to improve the prognosis.

  18. Diagnosis and therapy of non-variceal upper gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Erwin; Biecker

    2015-01-01

    Non-variceal upper gastrointestinal bleeding(UGIB) is defined as bleeding proximal to the ligament of Treitz in the absence of oesophageal, gastric or duodenal varices. The clinical presentation varies according to the intensity of bleeding from occult bleeding to melena or haematemesis and haemorrhagic shock. Causes of UGIB are peptic ulcers, Mallory-Weiss lesions,erosive gastritis, reflux oesophagitis, Dieulafoy lesions or angiodysplasia. After admission to the hospital a structured approach to the patient with acute UGIB that includes haemodynamic resuscitation and stabilization as well as pre-endoscopic risk stratification has to be done. Endoscopy offers not only the localisation of the bleeding site but also a variety of therapeutic measures like injection therapy, thermocoagulation or endoclips. Endoscopic therapy is facilitated by acid suppression with proton pump inhibitor(PPI) therapy. These drugs are highly effective but the best route of application(oral vs intravenous) and the adequate dosage are still subjects of discussion. Patients with ulcer disease are tested for Helicobacter pylori and eradication therapy should be given if it is present. Non-steroidal antiinflammatory drugs have to be discontinued if possible. If discontinuation is not possible, cyclooxygenase-2 inhibitors in combination with PPI have the lowest bleeding risk but the incidence of cardiovascular events is increased.

  19. An Unusual Case of Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Kristin N. Fiorino

    2011-01-01

    Full Text Available A 10-year-old boy presented with a 3-day history of worsening abdominal pain, fever, emesis and melena. Abdominal ultrasound revealed a right upper quadrant mass that was confirmed by computed tomography angiogram (CTA, which showed an 8 cm well-defined retroperitoneal vascular mass. 123Iodine metaiodobenzylguanidine (123MIBG scan indicated uptake only in the abdominal mass. Subsequent biopsy revealed a paraganglioma that was treated with chemotherapy. This case represents an unusual presentation of a paraganglioma associated with gastrointestinal (GI bleeding and highlights the utility of CTA and 123MIBG in evaluation and treatment.

  20. Capsule endoscopy: Current status in obscure gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    R Gupta; Nageshwar Duvvuru Reddy

    2007-01-01

    Capsule endoscopy (CE) is a safe, non invasive diagnostic modality for the evaluation of small bowel lesions. Obscure gastrointestinal bleeding (OGIB) is one of the most important indications of capsule endoscopy.Capsule endoscopy has a very high diagnostic yield especially if the bleeding is ongoing. This technique appears to be superior to other techniques for the detection of suspected lesions and the source of bleeding. Capsule endoscopy has been shown to change the outcome in patients with obscure gastrointestinal (GI)bleed.

  1. A rare cause of recurrent gastrointestinal bleeding: mesenteric hemangioma

    Directory of Open Access Journals (Sweden)

    Zeytunlu Murat

    2009-01-01

    Full Text Available Abstract Lower gastrointestinal hemorrhage accounts for approximately 20% of gastrointestinal hemorrhage. The most common causes of lower gastrointestinal hemorrhage in adults are diverticular disease, inflammatory bowel disease, benign anorectal diseases, intestinal neoplasias, coagulopathies and arterio-venous malformations. Hemangiomas of gastrointestinal tract are rare. Mesenteric hemangiomas are also extremely rare. We present a 25-year-old female who was admitted to the emergency room with recurrent lower gastrointestinal bleeding. An intraluminal bleeding mass inside the small intestinal segment was detected during explorative laparotomy as the cause of the recurrent lower gastrointestinal bleeding. After partial resection of small bowel segment, the histopathologic examination revealed a cavernous hemagioma of mesenteric origin. Although rare, gastrointestinal hemangioma should be thought in differential diagnosis as a cause of recurrent lower gastrointestinal bleeding.

  2. A rare cause of recurrent gastrointestinal bleeding: mesenteric hemangioma

    Science.gov (United States)

    Kazimi, Mircelal; Ulas, Murat; Ibis, Cem; Unver, Mutlu; Ozsan, Nazan; Yilmaz, Funda; Ersoz, Galip; Zeytunlu, Murat; Kilic, Murat; Coker, Ahmet

    2009-01-01

    Lower gastrointestinal hemorrhage accounts for approximately 20% of gastrointestinal hemorrhage. The most common causes of lower gastrointestinal hemorrhage in adults are diverticular disease, inflammatory bowel disease, benign anorectal diseases, intestinal neoplasias, coagulopathies and arterio-venous malformations. Hemangiomas of gastrointestinal tract are rare. Mesenteric hemangiomas are also extremely rare. We present a 25-year-old female who was admitted to the emergency room with recurrent lower gastrointestinal bleeding. An intraluminal bleeding mass inside the small intestinal segment was detected during explorative laparotomy as the cause of the recurrent lower gastrointestinal bleeding. After partial resection of small bowel segment, the histopathologic examination revealed a cavernous hemagioma of mesenteric origin. Although rare, gastrointestinal hemangioma should be thought in differential diagnosis as a cause of recurrent lower gastrointestinal bleeding. PMID:19178725

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

    Science.gov (United States)

    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.

  4. Endoscopic treatment of non-variceal gastrointestinal bleeding: hemoclips and other hemostatic techniques

    Institute of Scientific and Technical Information of China (English)

    Rossana M. Moura; Jamie S. Barkin

    2000-01-01

    @@ Although the number of hospitalizations for nonvariccal gastrointestinal bleeding has decreased in recent years, acute upper gastrointestinal hemorrhage continues to be a common reason for hospital admission, and peptic ulcers account for at least fifty percent of all cases. Despite the fact that bleeding from ulcers ceases spontaneously in approximately 80% of patients, it is still a diagnosis associated with substantial medical costs and significant morbidity and mortality, the latter ranging between 8 and 14%[1], especially in the elderly.

  5. Culprit for recurrent acute gastrointestinal massive bleeding: “Small bowel Dieulafoy’s lesions”-a case report and literature review

    Institute of Scientific and Technical Information of China (English)

    Anjana Sathyamurthy; Jessica N Winn; Jamal A Ibdah; Veysel Tahan

    2016-01-01

    A Dieulafoy’s lesion is a dilated,aberrant,submucosal vessel that erodes the overlying epithelium without evidence of a primary ulcer or erosion.It can be located anywhere in the gastrointestinal tract.We describe a case of massive gastrointestinal bleeding from Dieulafoy’s lesions in the duodenum.Etiology and precipitating events of a Dieulafoy’s lesion are not well known.Bleeding can range from being self-limited to massive life- threatening.Endoscopic hemostasis can be achieved with a combination of therapeutic modalities.The endoscopic management includes sclerosant injection,heater probe,laser therapy,electrocautery,cyanoacrylate glue,banding,and clipping.Endoscopic tattooing can be helpful to locate the lesion for further endoscopic re-treatment or intraoperative wedge resection.Therapeutic options for re-bleeding lesions comprise of repeated endoscopic hemostasis,angiographic embolization or surgical wedge resection of the lesions.We present a 63-yearold Caucasian male with active bleeding from the two small bowel Dieulafoy’s lesions,which was successfully controlled with epinephrine injection and clip applications.

  6. Gastrointestinal bleeding in patients with hereditary hemorrhagic telangiectasia

    DEFF Research Database (Denmark)

    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....

  7. Gastrointestinal Bleeding Scintigraphy in the Early 21st Century.

    Science.gov (United States)

    Grady, Erin

    2016-02-01

    Gastrointestinal bleeding scintigraphy performed with (99m)Tc-labeled autologous erythrocytes or historically with (99m)Tc-sulfur colloid has been a clinically useful tool since the 1970s. This article reviews the history of the techniques, the different methods of radiolabeling erythrocytes, the procedure, useful indications, diagnostic accuracy, the use of SPECT/CT and CT angiography to evaluate gastrointestinal bleeding, and Meckel diverticulum imaging. The causes of pediatric bleeding are discussed by age.

  8. ICU急性上消化道大出血床旁胃镜疗效及安全性的观察%Value and Safety of the Bedside Gastroscopes Treatment for Acute Upper Gastrointestinal Bleeding in ICU

    Institute of Scientific and Technical Information of China (English)

    桂培根; 张凯; 吴正茂; 莫黎; 罗勇; 张群峰

    2015-01-01

    目的:回顾性探讨危重症患者急性上消化道大出血床旁胃镜下检查和救治的疗效及安全性。方法对我院2006年3月至2014年3月间422例常规内科治疗难以控制的急性上消化道大出血患者临床资料进行回顾性分析,非静脉曲张性上消化道大出血354例,静脉曲张性上消化道大出血68例,观察止血出血情况,维持>72 h为止血成功,<72 h为暂时止血,仍有出血为无效。结果非静脉曲张性上消化道大出血止血成功率为86.01%,静脉曲张性上消化道大出血止血成功率为66.18%。结论 ICU医生床旁紧急胃镜下检查及胃镜下联合止血治疗是安全有效的,能显著提高患者的救治成功率。%Objective To retrospectively evaluate the therapeutic effect and security of the application of the bedside gastroscopes in the examination and therapy among these critical patients with acute upper gastrointestinal bleeding. Methods The clinic data for 422 patients who difficult to control acute upper gastrointestinal bleeding during Mrach 2006 to February 2014 were retrospectively,including 354cases non-varicose upper gastrointestinal bleeding in the bedside gastro-scopes group underwent the bedside gastroscopes therapy. 68 cases varicose upper gastrointestinal bleeding were treated by either surgery or gastroscopes in the control group. Hemostasis were observed in all the patients of the two groups. If main-tence time is over 72h,the therapy is effective,on the contrary,it is judged to be invalid. Results Hemostasis rate of non-varicose acute upper gastrointestinal bleeding and varicose acute upper gastrointestinal bleeding were respectively 86.01% and66.18% in the bedside gastroscopes group,which were higher than those of control group (P<0.05). Conclusion The bedside gastroscopes therapy is a safe and effective treatment for critical patients with acute upper gastro-intestinal bleeding and is worth to recommend.

  9. Acute Myocardial Infarction Patients with Upper Gastrointestinal Bleeding in Clinical Care%急性心肌梗死患者合并上消化道出血的临床护理

    Institute of Scientific and Technical Information of China (English)

    李莹莹

    2012-01-01

    Objective: To investigate acute myocardial infarction(AMI) patients with upper gastrointestinal bleeding in clinical care measures. Methods:Retrospective analysis of 233 cases of patients with AMI risk factors, observed and recorded drug use during hospitalization and invasive methods of treatment and clinical care. Results:233 cases of AMI patients, the occurrence of upper gastrointestinal bleeding in patients with 7.3% (17/233). Average decline in the level of hemoglobin (1.9 ± 0.8) g/dL, upper gastrointestinal bleeding admitted to an average of (6 ±2) days. Upper gastrointestinal bleeding associated factors were age ≥70 years of age, previous peptic ulcer history, previous history of upper gastrointestinal bleeding,creatinine>2mg/dL,anemia,history of cardiopulmonary resuscitation, rt-PA, IABP implantation. Conclusions:AMI patients with anti-clotting drugs and anti-platelet drugs and stent implantation, should strengthen the complications of upper gastrointestinal bleeding in this observation, care, health education and individualized care.%目的 探讨急性心肌梗死(AMI) 患者合并上消化道出血的临床护理措施.方法 回顾性分析233 例AMI 患者危险因素,观察和记录住院期间用药情况和有创治疗情况及临床护理方法.结果 233 例AMI 患者,发生上消化道出血的患者占7.3%(17/233).血红蛋白下降水平平均在(1.9±0.8)g/dL,入院到上消化道出血的平均时间为(6±2) 天.上消化道出血相关的因素有年龄≥70 岁,既往消化性溃疡病史,既往上消化道出血病史,肌酐>2mg/dL,贫血,心肺复苏术史,rt-PA,IABP 植入等.结论 AMI 患者应用抗凝血药物及抗血小板药物及支架植入术后,应加强对上消化道出血这一并发症的观察、护理、健康教育和个体化的护理.

  10. Management of Upper Gastrointestinal Bleeding in Children: Variceal and Nonvariceal.

    Science.gov (United States)

    Lirio, Richard A

    2016-01-01

    Upper gastrointestinal (UGI) bleeding is generally defined as bleeding proximal to the ligament of Treitz, which leads to hematemesis. There are several causes of UGI bleeding necessitating a detailed history to rule out comorbid conditions, medications, and possible exposures. In addition, the severity, timing, duration, and volume of the bleeding are important details to note for management purposes. Despite the source of the bleeding, acid suppression with a proton-pump inhibitor has been shown to be effective in minimizing rebleeding. Endoscopy remains the interventional modality of choice for both nonvariceal and variceal bleeds because it can be diagnostic and therapeutic.

  11. Diagnosis and management of upper gastrointestinal bleeding in children.

    Science.gov (United States)

    Owensby, Susan; Taylor, Kellee; Wilkins, Thad

    2015-01-01

    Upper gastrointestinal bleeding is an uncommon but potentially serious, life-threatening condition in children. Rapid assessment, stabilization, and resuscitation should precede all diagnostic modalities in unstable children. The diagnostic approach includes history, examination, laboratory evaluation, endoscopic procedures, and imaging studies. The clinician needs to determine carefully whether any blood or possible blood reported by a child or adult represents true upper gastrointestinal bleeding because most children with true upper gastrointestinal bleeding require admission to a pediatric intensive care unit. After the diagnosis is established, the physician should start a proton pump inhibitor or histamine 2 receptor antagonist in children with upper gastrointestinal bleeding. Consideration should also be given to the initiation of vasoactive drugs in all children in whom variceal bleeding is suspected. An endoscopy should be performed once the child is hemodynamically stable.

  12. Diagnosis and Therapy Guideline of Acute Nonvariceal Upper Gastrointestinal Bleeding%急性非静脉曲张性上消化道出血诊治指南(草案)

    Institute of Scientific and Technical Information of China (English)

    中华内科杂志编委会

    2007-01-01

    @@ 1 定义 急性非静脉曲张性上消化道出血(Acute Nonvariceal Upper Gastrointestinal Bleeding,ANVU GIB)系指屈氏韧带以上的消化道的非静脉曲张性疾患引起的出血,包括胰管或胆管的出血和胃空肠吻合术后吻合口附近疾患引起的出血,年发病率为50~150/10万,病死率为6%~10%.

  13. 急性非静脉曲张性上消化道出血诊治指南(2009,杭州)%Guideline on managements of acute non-variceal upper gastrointestinal bleeding(2009,Hangzhou)

    Institute of Scientific and Technical Information of China (English)

    《中华内科杂志》编委会; 《中华消化杂志》编委会; 《中华消化内镜杂志》编委会; 李兆申; 杜奕奇; 湛先保

    2009-01-01

    @@ 一、定义 急性非静脉曲张性上消化道出血(acute nonvariceal upper gastrointestinal bleeding,ANVUGIB)系指屈氏韧带以上消化道非静脉曲张性疾患引起的出血,包括胰管或胆管的出血和胃空肠吻合术后吻合口附近疾患引起的出血,年发病率为(50~150)/10万,病死率为6%~10%[2-3].

  14. 急性非静脉曲张性上消化道出血诊治指南(2009,杭州)%Guidelines for managing patients with acute nonvariceal upper gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    《中华内科杂志》编委会; 《中华消化杂志》编委会; 《中华消化内镜杂志》编委会

    2009-01-01

    @@ 一、定义 急性非静脉曲张性上消化道出血(acute nonvariceal upper gastrointestinal bleeding,ANVUGIB)系指屈氏韧带以上消化道非静脉曲张性疾患引起的出血,包括胰管或胆管的出血和胃空肠吻合术后吻合口附近疾患引起的出血,年发病率为50/10万~150/10万,病死率为6%~10%~([1-2]).

  15. Tranexamic acid for upper gastrointestinal bleeding.

    Science.gov (United States)

    Bennett, Cathy; Klingenberg, Sarah Louise; Langholz, Ebbe; Gluud, Lise Lotte

    2014-11-21

    Background Tranexamic acid reduces haemorrhage through its antifibrinolytic effects. In a previous version of the present review, we found that tranexamic acid may reduce mortality. This review includes updated searches and new trials.Objectives To assess the effects of tranexamic acid versus no intervention, placebo or other antiulcer drugs for upper gastrointestinal bleeding.Search methods We updated the review by performing electronic database searches (Cochrane Central Register of Controlled Trials (CENTRAL),MEDLINE, EMBASE, Science Citation Index) and manual searches in July 2014.Selection criteriaRandomised controlled trials, irrespective of language or publication status.Data collection and analysis We used the standard methodological procedures of the The Cochrane Collaboration. All-cause mortality, bleeding and adverse events were the primary outcome measures. We performed fixed-effect and random-effects model meta-analyses and presented results as risk ratios (RRs) with 95% confidence intervals (CIs) and used I² as a measure of between-trial heterogeneity. We analysed tranexamic acid versus placebo or no intervention and tranexamic acid versus antiulcer drugs separately. To analyse sources of heterogeneity and robustness of the overall results, we performed subgroup, sensitivity and sequential analyses.Main results We included eight randomised controlled trials on tranexamic acid for upper gastrointestinal bleeding. Additionally, we identified one large ongoing pragmatic randomised controlled trial from which data are not yet available. Control groups were randomly assigned to placebo (seven trials) or no intervention (one trial). Two trials also included a control group randomly assigned to antiulcer drugs(lansoprazole or cimetidine). The included studies were published from 1973 to 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

  16. Life-threatening gastrointestinal system bleeding in Hodgkin disease: multidetector CT findings and review of the literature.

    Science.gov (United States)

    Akpinar, Erhan; Türkbey, Bariş; Cil, Barbaros Erhan; Canyiğit, Murat; Dündar, Ziya; Balkanci, Ferhun

    2007-06-01

    Acute lower gastrointestinal system (GIS) bleeding is a life-threatening condition. Immediate determination of the origin of the bleeding is crucial, since hemostatic management must be initiated as rapidly as possible. Colonoscopy, radionuclide studies, and conventional angiography are considered the most important methods for assessing the origin of the bleeding. There are few published reports about the feasibility of computed tomography (CT) in acute GIS bleeding. We present multidetector CT (MDCT) findings in a case of Hodgkin disease status one month post-chemotherapy (CHOP protocol; cyclophosphamide, doxorubicin, vincristine, prednisone) that presented with acute lower GIS bleeding.

  17. Gastrointestinal Bleeding: MedlinePlus Health Topic

    Science.gov (United States)

    ... GI Bleeding in Children (North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition) - PDF Patient Handouts Bleeding esophageal varices (Medical Encyclopedia) Also in Spanish Bloody or tarry stools (Medical Encyclopedia) Also in ...

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

    Institute of Scientific and Technical Information of China (English)

    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.

  19. Endoscopic Management of Nonvariceal, Nonulcer Upper Gastrointestinal Bleeding

    NARCIS (Netherlands)

    Tjwa, E.T.; Holster, I.L.; Kuipers, E.J.

    2014-01-01

    Upper gastrointestinal bleeding (UGIB) is the most common emergency condition in gastroenterology. Although peptic ulcer and esophagogastric varices are the predominant causes, other conditions account for up to 50% of UGIBs. These conditions, among others, include angiodysplasia, Dieulafoy and Mall

  20. Description of Prescribing Practices in Patients with Upper Gastrointestinal Bleeding Receiving Intravenous Proton-Pump Inhibitors: A Multicentre Evaluation

    Directory of Open Access Journals (Sweden)

    Robert Enns

    2004-01-01

    Full Text Available BACKGROUND: Intravenous forms of proton pump inhibitors (IV PPI are routinely used for patients with acute upper gastrointestinal bleeding, but a significant concern for their inappropriate use has been suggested.

  1. New advances in lower gastrointestinal bleeding management with embolotherapy.

    Science.gov (United States)

    Ierardi, Anna Maria; Urbano, Josè; De Marchi, Giuseppe; Micieli, Camilla; Duka, Ejona; Iacobellis, Francesca; Fontana, Federico; Carrafiello, Gianpaolo

    2016-01-01

    Lower gastrointestinal bleeding (LGIB) is associated with high morbidity and mortality. Embolization is currently proposed as the first step in the treatment of acute, life-threatening LGIB, when endoscopic approach is not possible or is unsuccessful. Like most procedures performed in emergency setting, time represents a significant factor influencing outcome. Modern tools permit identifying and reaching the bleeding site faster than two-dimensional angiography. Non-selective cone-beam CT arteriography can identify a damaged vessel. Moreover, sophisticated software able to detect the vessel may facilitate direct placement of a microcatheter into the culprit vessel without the need for sequential angiography. A further important aspect is the use of an appropriate technique of embolization and a safe and effective embolic agent. Current evidence shows the use of detachable coils (with or without a triaxial system) and liquid embolics has proven advantages compared with other embolic agents. The present article analyses these modern tools, making embolization of acute LGIB safer and more effective.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  3. Gastrointestinal bleeding 30 years after a complicated cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Thorsten; Brechmann; Wolff; Schmiegel; Volkmar; Nicolas; Markus; Reiser

    2010-01-01

    Gastrointestinal bleeding from small-bowel varices is a rare and difficult to treat complication of portal hypertension. We describe the case of a 79-year-old female patient with recurrent severe hemorrhage from smallbowel varices 30 years after a complicated cholecystectomy. When double balloon enteroscopy was unsuccessful to reach the site of bleeding, a rendezvous approach was favored with intraoperative endoscopy. Active bleeding from varices within a biliodigestive anastomosis was found and controlled ...

  4. Outcomes of acute upper gastrointestinal bleeding in relation to timing of endoscopy and the experience of endoscopist: a tertiary center experience

    Science.gov (United States)

    Mohammed, Noor; Rehman, Amer; Swinscoe, Mark Thomas; Mundre, Pradeep; Rembacken, Bjorn

    2016-01-01

    Introduction: Patients with gastrointestinal bleeding admitted out of hours or at the weekends may have an excess mortality rate. The literature reports around this are conflicting. Aims and methods: We aimed to analyze the outcomes of emergency endoscopies performed out of hours and over the weekends in our center. We retrospectively analyzed data from April 2008 to June 2012. Results: A total of 507 ‘high risk’ emergency gastroscopies were carried out over the study period for various indications. Patients who died within 30 days of the index procedure [22 % (114 /510)] had a significantly higher Rockall score (7.6 vs. 6.0, P < 0.0001), a higher American Society of Anesthesiologists (ASA) status (3.5 vs. 2.7, P < 0.001), and a lower systolic blood pressure (BP) at the time of the examination (94.8 vs 103, P = 0.025). These patients were significantly older (77.7 vs. 67.5 years, P = 0.006), and required more blood transfusion (5.9 versus 3.8 units). Emergency out-of-hours endoscopy was not associated with an increased risk of death [relative risk (RR) 1.09, 95 % confidence interval (CI) 1.12 – 1.95]. Whether the examination was carried out by a senior specialist registrar (senior trainee) or a consultant made no difference to the survival of the patient (RR 0.98, CI 0.77 – 1.32). Conclusion: Higher pre-endoscopy Rockall score and ASA status contributed significantly to the 30-day mortality following upper gastrointestinal bleeding, whereas lower BP tended towards significance. Outcomes did not vary with the time of the endoscopy nor was there any difference between a consultant and a senior specialist registrar led service. PMID:27004244

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

    OpenAIRE

    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 quic...

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

    Institute of Scientific and Technical Information of China (English)

    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.

  7. Acute gastrointestinal complications after cardiac surgery.

    Science.gov (United States)

    Halm, M A

    1996-03-01

    Gastrointestinal problems, with an incidence of about 1%, may complicate the postoperative period after cardiovascular surgery, increasing morbidity, length of stay, and mortality. Several risk factors for the development of these complications, including preexisting conditions; advancing age; surgical procedure, especially valve, combined bypass/valve, emergency, reoperative, and aortic dissection repair; iatrogenic conditions; stress; ischemia; and postpump complications, have been identified in multiple research studies. Ischemia is the most significant of these risk factors after cardiovascular surgery. Mechanisms that have been implicated include longer cardiopulmonary bypass and aortic cross-clamp times and hypoperfusion states, especially if inotropic or intra-aortic balloon pump support is required. These risk factors have been linked to upper and lower gastrointestinal bleeding, paralytic ileus, intestinal ischemia, acute diverticulitis, acute cholecystitis, hepatic dysfunction, hyperamylasemia, and acute pancreatitis. Gastrointestinal bleeding accounts for almost half of all complications, followed by hepatic dysfunction, intestinal ischemia, and acute cholecystitis. Identification of these gastrointestinal complications may be difficult because manifestations may be masked by postoperative analgesia or not reported by patients because they are sedated or require prolonged mechanical ventilation. Furthermore, clinical manifestations may be nonspecific and not follow the "classic" clinical picture. Therefore, astute assessment skills are needed to recognize these problems in high-risk patients early in their clinical course. Such early recognition will prompt aggressive medical and/or surgical management and therefore improve patient outcomes for the cardiovascular surgical population.

  8. Recent Update of Embolization of Upper Gastrointestinal Tract Bleeding

    Energy Technology Data Exchange (ETDEWEB)

    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.

  9. A Jejunal Gastrointestinal Stromal Tumour: an unusual cause of massive acute gastrointestinal haemorrhage with emphasis on pre intervention MDCT

    OpenAIRE

    2009-01-01

    Gastrointestinal stromal tumors (GIST) most commonly arise from the stomach followed by the small intestine and are common cause for an occult gastrointestinal (GI) bleeding. We present an unusual case of a jejunal GIST, which presented as an acute gastrointestinal haemorrhage. This case highlights the importance of an intravenous contrast enhanced abdominal CT with neutral oral contrast for the assessment of gastrointestinal bleeding where non-obstructive enhancing tumour, active extravasati...

  10. Efficacy of intra-arterial treatment for massive gastrointestinal bleeding in hemodialysis patients.

    Science.gov (United States)

    Banshodani, Masataka; Kawanishi, Hideki; Moriishi, Misaki; Shintaku, Sadanori; Sato, Tomoyasu; Tsuchiya, Shinichiro

    2014-02-01

    The incidence of acute nonvariceal massive gastrointestinal bleeding (GIB) is higher in hemodialysis (HD) patients than in healthy individuals, and this is often a life-threatening event. We evaluated the efficacy of intra-arterial treatment for GIB in HD patients. Between January 2006 and June 2012, eight HD patients with GIB were treated with superselective transarterial embolization. Of the eight cases, one was duodenal bleeding, two were jejunal bleeding, one was ileocecum bleeding, two were ascending colonic bleeding, and two were sigmoid colonic bleeding. After examining the site of bleeding by endoscopy or contrast-enhanced computed tomography (CT), embolizations with microcoils, gelatin sponges, or N-butyl cyanoacrylate were performed through interventional radiology (IVR). In all cases, blood transfusions were frequently administered. Six of the eight patients with GIB were successfully salvaged by transarterial embolization. In one case, duodenal bleeding was refractory to endoscopic treatment. Embolization was performed twice in this case; however, the patient died of an aneurysm rupture at the embolization site 24 days after the embolizations. In another case, massive jejunal bleeding and disseminated intravascular coagulation were identified at the time of the first examination, and the patient died of multiorgan failure 26 days after the embolization. On the basis of our experience, we established an effective treatment strategy for HD patients with acute nonvariceal massive GIB, by immediately identifying the exact site and degree of bleeding using contrast-enhanced computed tomography and performing early treatment with transarterial embolization.

  11. [Mid-gastrointestinal bleeding - endoscopy sheds light in the darkness].

    Science.gov (United States)

    May, A

    2014-08-01

    Mid-gastrointestinal bleeding is defined as a bleeding of the small bowel and is the most common indication for small bowel endoscopy. Intraoperative enteroscopy has been regarded as gold standard for a long time. With the introduction of different endoscopy techniques, they play now the central role, whereas intraoperative enteroscopy has become a reserve method for selected patients. Actually, there are, beside capsule endoscopy, five non-surgical, flexible enteroscopy techniques available. In Germany and Europe balloon-assisted enteroscopy (double balloon and single balloon enteroscopy) is mainly used. Double balloon enteroscopy (DBE) is the "oldest" flexible enteroscopy technique and has become established throughout the world for diagnostic and therapeutic examinations of the small bowel. The majority of the studies have been performed with DBE and it provides the highest rate of complete enteroscopy. Nevertheless, technical improvements to make enteroscopy easier and faster are still required. In patients with chronic MGI or problematic situations capsule endoscopy is an ideal screening option. In case of acute MGI the flexible enteroscopy techniques should be preferred because of the high diagnostic yield combined with the possibility of endoscopic therapeutic interventions. In difficult cases with unsuccessful enteroscopy, CT angiography and conventional angiography with the option of embolisation had proved their value.

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

    Directory of Open Access Journals (Sweden)

    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

  13. 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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  14. Obscure Gastrointestinal Bleeding Due to a Small Intestinal Gastrointestinal Stromal Tumor in a Young Adult

    Directory of Open Access Journals (Sweden)

    Mami Yamamoto

    2016-11-01

    Full Text Available The source of most cases of gastrointestinal bleeding is the upper gastrointestinal tract. Since bleeding from the small intestine is very rare and difficult to diagnose, time is required to identify the source. Among small intestine bleeds, vascular abnormalities account for 70–80%, followed by small intestine tumors that account for 5–10%. The reported peak age of the onset of small intestinal tumors is about 50 years. Furthermore, rare small bowel tumors account for only 1–2% of all gastrointestinal tumors. We describe a 29-year-old man who presented with obscure anemia due to gastrointestinal bleeding and underwent laparotomy. Surgical findings revealed a well-circumscribed lesion measuring 45 × 40 mm in the jejunum that initially appeared similar to diverticulosis with an abscess. However, the postoperative pathological diagnosis was a gastrointestinal stromal tumor with extramural growth.

  15. Analysis of the Etiology of 135 Cases with Acute Upper Gastrointestinal Bleeding in Non Elderly Patients%135例非老年急性上消化道出血患者的病因分析

    Institute of Scientific and Technical Information of China (English)

    许田英; 葛彦成

    2014-01-01

    目的:分析探讨非老年患者上消化道出血的原因及相关因素。方法对我院2009年~2012年间收治的135例非老年上消化道出血患者的临床资料进行回顾性分析,并与同期住院86例老年患者的出血原因进行比较。结果在135例非老年上消化道出血病例中,饮酒、精神因素、不当饮食为主要相关诱发因素,老年组中以服用非甾体药物为主要诱因。而非老年组中最常见的出血病因为十二指肠溃疡占34.81%(47/135),第二位是食管胃底静脉曲张破裂占18.52%(25/135),其他常见的病因还有急性胃黏膜病变15.56%(21/135),胃溃疡11.58%(16/135),消化道肿瘤7.41%(10/135)等。其中十二指肠溃疡、食管胃底静脉曲张发病率明显高于老年组,而胃溃疡、消化道肿瘤发病率低于老年组患者(P<0.05)。结论与老年组有所不同,非老年上消化道出血诱因多与饮酒、精神因素、不当饮食有关,十二指肠溃疡、食管胃底黏膜曲张破裂是致出血的主要病因,且发病率男性多于女性。%Objective To investigate the cause of upper gastrointestinal bleeding and relevant factors in non elderly patients. Methods Clinical data of 135 non elderly patients with upper gastrointestinal bleeding during 2009 and 2012 in our hospital and 86 cases of elderly patients at the same period were retrospectively analyzed. The causes of acute gastrointestinal bleeding were compared. Results Drinking wines, mental factors and improper diets in non elderly patients were main inducements leading to gastrointestinal hemorrhage. The inducement of the elderly group was NSAID drug. The most common cause of gastrointestinal hemorrhage in the non elderly group was the duodenal ulcer accounted for 34.81%(47/135), the second was the esophageal gastric fundus varicosity burst accounted for 18.82%(25/135). Other causes were acute gastric mucosal lesion 15.56%(21/135), gastric ulcer 11.58%(16/135) and

  16. Application of endoscopic hemoclips for nonvariceal bleeding in the upper gastrointestinal tract

    Institute of Scientific and Technical Information of China (English)

    Shi-Bin Guo; Ai-Xia Gong; Jing Leng; Jing Ma; Lin-Mei Ge

    2009-01-01

    AIM: To investigate acute nonvariceal bleeding in the upper gastrointestinal (GI) tract and evaluate the effects of endoscopic hemoclipping. METHODS: Sixty-eight cases of acute nonvariceal bleeding in the upper GI tract were given endoscopic treatment with hemoclip application. Clinical data, endoscopic findings, and the effects of the therapy were evaluated. RESULTS: The 68 cases (male:female = 42:26, age from 9 to 70 years, average 54.4) presented with hematemesis in 26 cases (38.2%), melena in nine cases (13.3%), and both in 33 cases (48.5%). The causes of the bleeding included gastric ulcer (29 cases), duodenal ulcer (11 cases), Dieulafoy's lesion (11 cases), Mallory-Weiss syndrome (six cases), postoperative (three cases), post-polypectomy bleeding (five cases), and post-sphincterotomy bleeding (three cases); 42 cases had active bleeding. The mean number of hemoclips applied was four. Permanent hemostasis was obtained by hemoclip application in 59 cases; 6 cases required emergent surgery (three cases had peptic ulcers, one had Dieulafoy's lesion, and two were caused by sphincterotomy); three patients died (two had Dieulafoy's lesion and one was caused by sphincterotomy); and one had recurrent bleeding with Dieulafoy's lesion 10 mo later, but in a different location. CONCLUSION: Endoscopic hemoclip application was an effective and safe method for acute nonvariceal bleeding in the upper GI tract with satisfactory outcomes.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. Challenges in the management of acute peptic ulcer bleeding.

    Science.gov (United States)

    Lau, James Y W; Barkun, Alan; Fan, Dai-ming; Kuipers, Ernst J; Yang, Yun-sheng; Chan, Francis K L

    2013-06-08

    Acute upper gastrointestinal bleeding is a common medical emergency worldwide, a major cause of which are bleeding peptic ulcers. Endoscopic treatment and acid suppression with proton-pump inhibitors are cornerstones in the management of the disease, and both treatments have been shown to reduce mortality. The role of emergency surgery continues to diminish. In specialised centres, radiological intervention is increasingly used in patients with severe and recurrent bleeding who do not respond to endoscopic treatment. Despite these advances, mortality from the disorder has remained at around 10%. The disease often occurs in elderly patients with frequent comorbidities who use antiplatelet agents, non-steroidal anti-inflammatory drugs, and anticoagulants. The management of such patients, especially those at high cardiothrombotic risk who are on anticoagulants, is a challenge for clinicians. We summarise the published scientific literature about the management of patients with bleeding peptic ulcers, identify directions for future clinical research, and suggest how mortality can be reduced.

  19. Interventional therapy for acute hemorrhage in gastrointestinal tract

    Institute of Scientific and Technical Information of China (English)

    Hong-Hui Wang; Bin Bai; Kai-Bing Wang; Wei Xu; Yuan-Shu Ye; Wei-Feng Zhang

    2006-01-01

    AIM: To evaluate the diagnostic angiography and therapy for acute massive hemorrhage in gastrointestinal tract.METHODS: Twenty-five cases of acute hemorrhage in gastrointestinal tract admitted between April 2002and September 2004 were reviewed and analyzed by angiography and embolotherapy.RESULTS: Fifteen patients were men and ten patients were women. The Seldinger technique and method of coaxial duct were used to get access to the bleeding region. PVA particles, gelfoam, and coils were used for embolism. All bleeding sites could be confirmed and were successfully embolized. Hemostasis was achieved in all the patients without bleeding again. The cure rate was 100%.CONCLUSION: Interventional therapy can not only ascertain the bleeding site, but also stop the bleeding .The method is simple and the effect is certain.

  20. Transarterial embolization of acute intercostal artery bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Jae Ik; Park, Auh Whan; Lee, Seon Joo [Inje University College of Medicine, Busan (Korea, Republic of); Ko, Gi Young; Yoon, Hyun Ki [University of Ulsan College of Medicine, Seoul (Korea, Republic of); Yoon, Chang Jin [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Shin, Tae Beom [Donga University College of Medicine, Busan (Korea, Republic of); Kim, Young Hwan [Kyimyung University School of Medicine, Daegu (Korea, Republic of)

    2005-09-15

    To report our experiences of transarterial embolization for acute intercostal artery bleeding. A retrospectively analysis of the causes, clinical manifestations, angiographic findings and transarterial embolization technique in 8 patients with acute intercostal artery bleeding, with a review of the anatomical basis. The causes of intercostal artery bleeding were iatrogenic and traumatic in 88 and 12% of cases, respectively. Active bleeding from the collateral intercostal or posterior intercostal arteries was angiographically demonstrated in 75 and 25% of cases, respectively. Transarterial embolization successfully achieved hemostasis in all cases. However, two patient with hypovolemic shock expired due to a massive hemothorax, despite successful transarterial embolization. Intercostal access should be performed through the middle of the intercostal space to avoid injury to the collateral intercostal artery. Transarterial embolization is an effective method for the control of intercostal artery bleeding.

  1. Efficacy of endoscopic therapy for gastrointestinal bleeding from Dieulafoy's lesion

    Institute of Scientific and Technical Information of China (English)

    Jun Cui; Liu-Ye Huang; Yun-Xiang Liu; Bo Song; Long-Zhi Yi; Ning Xu; Bo Zhang; Cheng-Rong Wu

    2011-01-01

    AIM: To investigate the endoscopic hemostasis for gastrointestinal bleeding due to Dieulafoy's lesion. METHODS: One hundred and seven patients with gastrointestinal bleeding due to Dieulafoy's lesion were treated with three endoscopic hemostasis methods: aethoxysklerol injection (46 cases), endoscopic hemoclip hemostasis (31 cases), and a combination of hemoclip hemostasis with aethoxysklerol injection (30 cases). RESULTS: The rates of successful hemostasis using the three methods were 71.7% (33/46), 77.4% (24/31) and 96.7% (29/30), respectively, with significant differences between the methods (P < 0.05). Among those who had unsuccessful treatment with aethoxysklerol injection, 13 were treated with hemoclip hemostasis and 4 underwent surgical operation; 9 cases were successful in the injection therapy. Among the cases with unsuccessful treatment with hemoclip hemostasis, 7 were treated with injection of aethoxysklerol and 3 cases underwent surgical operation; 4 cases were successful in the treatment with hemoclip hemostasis. Only 1 case had unsuccessful treatment with a combined therapy of hemoclip hemostasis and aethoxysklerol injection, and surgery was then performed. No serious complications of perforation occurred in the patients whose bleeding was treated with the endoscopic hemostasis, and no re-bleeding was found during a 1-year follow-up. CONCLUSION: The combined therapy of hemoclip hemostasis with aethoxysklerol injection is the most effective method for gastrointestinal bleeding due to Dieulafoy's lesion.

  2. Risk stratification in upper gastrointestinal bleeding; prediction, prevention and prognosis

    NARCIS (Netherlands)

    de Groot, N.L.

    2013-01-01

    In the first part of this thesis we developed a novel prediction score for predicting upper gastrointestinal (GI) bleeding in both NSAID and low-dose aspirin users. Both for NSAIDs and low-dose aspirin use risk scores were developed by identifying the five most dominant predictors. The risk of upper

  3. Evaluation and outcomes of patients with obscure gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Cositha; Santhakumar; Ken; Liu

    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 previous techniques. Following a negative bidirectional endoscopy, capsule endoscopy and double balloon enteroscopy remain the cornerstone of investigation in OGIB given their high diagnostic yield. Longterm outcome data in patients with OGIB is limited, but is most promising for capsule endoscopy. This article reviews the current literature and provides an overview of the clinical evaluation of patients with OGIB, available diagnostic and therapeutic modalities and longterm clinical outcomes.

  4. New Endoscopic Techniques for Obscure Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Henk den Ouden

    2007-01-01

    Full Text Available The case of a postmenopausal woman with a congenital aortic stenosis is presented. She presented with severe iron deficiency anemia. After negative extensive gastrointestinal analysis, she was treated with octreotide for six months. After cessation of octreotide, anemia rapidly recurred. A second capsule endoscopy and a double balloon enteroscopy were performed, and an intestinal vascular malformation was found. After surgical segment resection, the patient had stable, normal levels of hemoglobin and no complaints after 14 months of follow-up.

  5. Hemosuccus pancreaticus as a rare cause of gastrointestinal bleeding: a report of two cases.

    Directory of Open Access Journals (Sweden)

    Ghodratollah Maddah

    2015-05-01

    Full Text Available Pancreatic diseases are known to be associated with complications such as pseudocyst and abscess. A pseudoaneurysm associated with pancreatitis may develop as well. The pseudoaneurysm may rupture into various parts of the gastrointestinal tract; the peritoneal cavity, or the retroperitoneum. We report two cases of Hemosuccus pancreaticus admitted to our center in the past five years. One case was associated with acute pancreatitis, and another case was associated with chronic pancreatitis. A pseudocyst was found in two cases. Both were successfully managed by emergency surgery. So, Hemosuccus pancreaticus is a rare cause of gastrointestinal bleeding with difficult diagnosis, and surgery is the effective treatment for the patient with severe bleeding. However in cases with no life-threatening bleeding angiography and embolization can be performed.

  6. Haemorrhagic cholecystitis: an unusual cause of upper gastrointestinal bleeding.

    Science.gov (United States)

    Hicks, Natalie

    2014-01-17

    Haemorrhagic cholecystitis is a rare cause of upper gastrointestinal bleeding and is a difficult diagnosis to make. This case report describes an orthopaedic patient, who developed deranged liver function tests and anaemia after a hemiarthroplasty of the hip. The patient had upper abdominal pain and black stools which clinically appeared to be melaena. An ultrasound scan of the abdomen was inconclusive, and therefore a CT was performed and the potential diagnosis of haemorrhagic cholecystitis was raised. An endoscopic evaluation of the upper gastrointestinal tract showed no evidence of other causes of upper gastrointestinal bleeding. Following an emergency laparotomy and cholecystectomy, she recovered well. This report aims to increase awareness about the uncommon condition of haemorrhagic cholecystitis, and to educate regarding clinical and radiological signs which lead to this diagnosis.

  7. The evaluation and management of obscure and occult gastrointestinal bleeding.

    Science.gov (United States)

    Singh, Vijay; Alexander, Jeffrey A

    2009-01-01

    Gastrointestinal (GI) bleeding is a common clinical presentation increasing in an aging population, frequently requiring hospitalization and emergent intervention, with significant morbidity, mortality, and costs. It may manifest overtly as hematemesis, melena, or hematochezia, or as an asymptomatic occult bleed. Management typically involves an esophagogastroduodenoscopy or a colonoscopy; these in combination sometimes do not identify a source of bleeding, with the source remaining obscure. Further work up to identify an obscure source frequently requires radiologically detecting the leakage of an intravascular tracer (using tagged red blood cells or angiography) with brisk bleeding or in other cases CT enterography (CTE) to detect bowel wall changes consistent with a bleeding source. Recent advances including capsule endoscopy, CTE, and double-balloon endoscopy have helped to identify bleeding sources beyond the reach of conventional endoscopy. Clinical decision-making about their use is complex and evolving. Knowing their relative merits and weaknesses including yield, contraindications, complications, and cost is essential in coming up with an appropriate management plan. This review covers the rationale for clinical management of obscure sources of GI bleeding, mentioning the approach to and the yield of conventional methods, with an emphasis on the recent advances mentioned above.

  8. Solitary tubercular caecal ulcer causing massive lower gastrointestinal bleed: a formidable diagnostic challenge.

    Science.gov (United States)

    Ram, Duvuru; Karthikeyan, Vilvapathy Senguttuvan; Sistla, Sarath Chandra; Ali, Sheik Manwar

    2014-03-06

    Gastrointestinal (GI) haemorrhage is a common surgical emergency accounting for approximately 1% of acute hospital admissions. Lower GI bleed is less common and less severe than upper GI bleed and is usually caused by diverticulosis, neoplasms, angiodysplasia and inflammatory bowel disease. A 51-year-old man presented with massive lower GI bleed. He had no history of tuberculosis. He underwent colonoscopy and an isolated caecal ulcer was noted. Segmental ileocaecal resection was performed and no specific cause was identifiable on histopathology. PCR was performed on this specimen and it was positive for Mycobacterium tuberculosis. This case reports the unusual presentation of tuberculosis as solitary caecal ulcer with massive lower GI bleed and highlights the role of PCR as an adjuvant diagnostic tool for its diagnosis when characteristic histopathological findings are absent.

  9. Treatment of acute variceal bleeding

    DEFF Research Database (Denmark)

    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...

  10. Amphetamine-related ischemic colitis causing gastrointestinal bleeding

    OpenAIRE

    Panikkath, Ragesh; Panikkath, Deepa

    2016-01-01

    A 43-year-old woman presented with acute lower intestinal bleeding requiring blood transfusion. Multiple initial investigations did not reveal the cause of the bleeding. Colonoscopy performed 2 days later showed features suggestive of ischemic colitis. On detailed history, the patient admitted to using amphetamines, and her urine drug screen was positive for them. She was managed conservatively and advised not to use amphetamines again. She did not have any recurrence on 2-year follow-up.

  11. Amphetamine-related ischemic colitis causing gastrointestinal bleeding

    Science.gov (United States)

    Panikkath, Deepa

    2016-01-01

    A 43-year-old woman presented with acute lower intestinal bleeding requiring blood transfusion. Multiple initial investigations did not reveal the cause of the bleeding. Colonoscopy performed 2 days later showed features suggestive of ischemic colitis. On detailed history, the patient admitted to using amphetamines, and her urine drug screen was positive for them. She was managed conservatively and advised not to use amphetamines again. She did not have any recurrence on 2-year follow-up. PMID:27365888

  12. [Gastric lipoma as an unusual cause of upper gastrointestinal bleeding].

    Science.gov (United States)

    Vogt, W; Allemann, J; Simeon, B; Fornaro, M; Rehli, V

    1995-04-18

    This is a case report of a gastric lipoma causing a severe upper gastrointestinal bleeding. About 200 cases of this very rare benign gastric tumor have been reported so far. Symptoms are not characteristic, but may also mimic malignancy when occurring with bleeding, obstruction or weight loss. Malignant transformation is possible, but extremely rare. Because the tumor is situated under the submucosal layer in 90%, preoperative diagnosis by endoscopic biopsy is almost never possible. The tumor has to be treated by resection. A diagnosis by frozen section during the operation is recommended.

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

    Institute of Scientific and Technical Information of China (English)

    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...

  14. Role of hemostatic powders in the endoscopic management of gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Marco; Bustamante-Balén; Gema; Plumé

    2014-01-01

    Acute gastrointestinal bleeding(AGIB) is a prevalent condition with significant influence on healthcare costs. Endoscopy is essential for the management of AGIB with a pivotal role in diagnosis, risk stratification and management. Recently, hemostatic powders have been added to our endoscopic armamentarium to treat gastrointestinal(GI) bleeding. These substances are intended to control active bleeding by delivering a powdered product over the bleeding site that forms a solid matrix with a tamponade function. Local activation of platelet aggregation and coagulation cascade may be also boosted. There are currently three powders commercially available: hemostatic agent TC-325(Hemospray), EndoClotTM polysaccharide hemostatic system, and Ankaferd Bloodstopper. Although the available evidence is based on short series of cases and there is no randomized controlled trial yet, these powders seem to be effective in controlling GI bleeding from a variety of origins with a very favorable side effects profile. They can be used either as a primary therapy or a secondline treatment, and they seem to be especially indi-cated in cases of cancer-related bleeding and lesions with difficult access. In this review, we will comment on the mechanism of action, efficacy, safety and technical challenges of the use of powders in several clinical scenarios and we will try to define the main current indications of use and propose new lines of research in this area.

  15. Acute Gastric Bleeding Due to Giant Hyperplastic Polyp

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  17. A rare upper gastrointestinal system bleeding case: Aortoesophageal fistula

    OpenAIRE

    AYYILDIZ, Talat; Nas, Ömer Fatih; YILDIRIM, Çınar; Dolar, Enver; Gurel, Selim

    2014-01-01

    Aortoesophageal fistula is a rare condition with fatal prognosis. It is one of the life-threatining causes of massive upper gastrointestinal bleeding. With this case report, we will discuss an instance of a fatal aortoesophageal fistula in a patient to whom was implanted a stent due to an aorta aneurysm. In endoscopic examination blood clot on the mouth of the fistula was visualized. J. Exp. Clin. Med., 2014; 31:51-53

  18. An Unusual Cause of Gastrointestinal Bleeding: Duodenal Lipoma

    Directory of Open Access Journals (Sweden)

    R. Kadaba

    2011-04-01

    Full Text Available Common causes of chronic upper gastrointestinal bleeding include oesophageal varices, gastroduodenal ulcers and malignancy, and patients mostly present with iron deficiency type anaemia. We present the case of a 60-year-old lady who presented with iron deficiency anaemia and on investigation was found to have a large duodenal polyp requiring surgical excision. On histological examination, the polyp was revealed to be a lipoma. We review the recent literature and formulate a management plan for this rare entity.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  20. Upper gastrointestinal bleeding in Kuala Lumpur Hospital, Malaysia.

    Science.gov (United States)

    Lakhwani, M N; Ismail, A R; Barras, C D; Tan, W J

    2000-12-01

    Despite advancements in endoscopy and pharmacology in the treatment of peptic ulcer disease the overall mortality has remained constant at 10% for the past four decades. The aim of this study was to determine the age, gender, racial distribution, incidence and causes of endoscopically diagnosed cases of upper gastrointestinal (UGI) bleeding to summarise treatments undertaken and to report their outcome. A prospective study of UGI bleeding in 128 patients was performed in two surgical wards of Kuala Lumpur Hospital, involving both elective and emergency admissions. The study group comprised of 113 (88.2%) males and 15 (11.7%) females. The mean age was 51.9 years (range 14 to 85 years) and 37.5% (48 of 128 patients) were older than 60 years. The Indian race was over-represented in all disease categories. Smoking (50.1%), alcohol consumption (37.5%), non-steroidal anti-inflammatory drugs (NSAIDs) (17.2%), traditional remedies (5.5%), anti-coagulants (2.3%) and steroids (0.8%) were among the risk factors reported. Common presenting symptoms and signs included malaena (68.8%), haematemesis (59.4%) and fresh per rectal bleeding (33.6%). The commonest causes of UGI bleeding were duodenal ulcer (32%), gastric ulcer (29.7%), erosions (duodenal and gastric) (21.9%), oesophageal varices (10.9%) and malignancy (3.9%). UGI bleeding was treated non-surgically in 90.6% of cases. Blood transfusions were required in 62.6% (67/107) of peptic ulcer disease patients. Surgical intervention for bleeding peptic ulcer occurred in around 10% of cases and involved under-running of the bleeding vessel in most high risk duodenal and gastric ulcer patients. The overall mortality from bleeding peptic ulcer disease was 4.7%. Six patients died from torrential UGI haemorrhage soon after presentation, without the establishment of a cause. Active resuscitative protocols, early endoscopy, more aggressive interventional therapy, early surgery by more senior surgeons, increasing intensive care unit

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

    OpenAIRE

    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 diagnos...

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

    Directory of Open Access Journals (Sweden)

    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.

  3. Strongyloides hyper-infection causing life-threatening gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Lajos Csermely; Hassan Jaafar; Jorgen Kristensen; Antonio Castella; Waldemar Gorka; Ahmed Ali Chebli; Fawaz Trab; Hussain Alizadeh; Béla Hunyady

    2006-01-01

    A 55-year old male patient was diagnosed with strongyloides hyper-infection with stool analysis and intestinal biopsy shortly after his chemotherapy for myeloma.He was commenced on albendazole anthelmintic therapy. After initiation of the treatment he suffered lifethreatening gastrointestinal (GI) bleeding. Repeated endoscopies showed diffuse multi-focal intestinal bleeding. The patient required huge amounts of red blood cells and plasma transfusions and correction of haemostasis with recombinant activated factor Ⅶ.Abdominal aorto-angiography showed numerous microinferior mesenteric arteries' territories. While the biopsy taken prior to the treatment with albendazole did not show evidence of vasculitis, the biopsy taken after initiation of therapy revealed leukoclastic aggregations around the vessels. These findings suggest that, in addition to direct destruction of the mucosa, vasculitis could be an important additive factor causing the massive GI bleeding during the anthelmintic treatment.This might result from substances released by the worms that have been killed with anthelmintic therapy.Current guidelines advise steroids to be tapered and stopped in case of systematic parasitic infections as they might reduce immunity and precipitate parasitic hyper-infection. In our opinion, steroid therapy might be of value in the management of strongyloides hyperinfection related vasculitis, in addition to the anthelmintic treatment. Indeed, steroid therapy of vasculitis with other means of supportive care resulted in cessation of the bleeding and recovery of the patient.

  4. Endoscopic difficulties in the diagnosis of upper gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    M. N. Appleyard; C.P. Swain

    2001-01-01

    @@ INTRODUCTION Bleeding from the upper gastrointestinal ( GI ) tract remains common ,with a reported annual incidence of up to 172 per 100 000 [1],which has of anything increased from earlier series. Case fatality was recently reported as 14%[2] ,which has probably not changed over several decades .These figures may reflect a rising proportion of elderly patients and increasing non 杝teroidal anti-inflammatory use ,but occur despite apparently better treatments and understanding of the underlying pathophysiology of peptic ulcer disease.

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

    Science.gov (United States)

    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.

  6. Evaluation of gastrointestinal bleeding: Update of current radiologic strategies

    Institute of Scientific and Technical Information of China (English)

    Parth; J; Parekh; Ross; C; Buerlein; Rouzbeh; Shams; Harlan; Vingan; David; A; Johnson

    2014-01-01

    Gastrointestinal bleeding(GIB) is a common presenta-tion with significant associated morbidity and mortality, the prevalence of which continues to rise with the ever-increasing aging population. Initial evaluation includes an esophagoduodeonscopy and/or colonoscopy, which may fail to reveal a source. Such cases prove to be a dilemma and require collaboration between gastroen-terology and radiology in deciding the most appropriate approach. Recently, there have been a number of ra-diologic advances in the approach to GIB. The purpose of this review is to provide an evidence-based update on the most current radiologic modalities available and an algorithmic approach to GIB.

  7. An Unusual Case of Obscure Gastrointestinal Bleeding in a Patient with Coeliac Disease

    OpenAIRE

    2011-01-01

    This paper describes the journey of a patient with coeliac disease who presented with overt obscure gastrointestinal bleeding. Upper and lower gastrointestinal endoscopy did not reveal a source of bleeding, but an abdominal CT scan detected abnormal lymphadenopathy and a wireless capsule endoscopy diagnosed a jejunal tumour, which was surgically removed. Gastrointestinal bleeding is rare in celiac disease. Malignant tumours of the small intestine are generally uncommon, but celiac disease rep...

  8. Assessment of multi-modality evaluations of obscure gastrointestinal bleeding

    Science.gov (United States)

    Law, Ryan; Varayil, Jithinraj E; WongKeeSong, Louis M; Fidler, Jeff; Fletcher, Joel G; Barlow, John; Alexander, Jeffrey; Rajan, Elizabeth; Hansel, Stephanie; Becker, Brenda; Larson, Joseph J; Enders, Felicity T; Bruining, David H; Coelho-Prabhu, Nayantara

    2017-01-01

    AIM To determine the frequency of bleeding source detection in patients with obscure gastrointestinal bleeding (OGIB) who underwent double balloon enteroscopy (DBE) after pre-procedure imaging [multiphase computed tomography enterography (MPCTE), video capsule endoscopy (VCE), or both] and assess the impact of imaging on DBE diagnostic yield. METHODS Retrospective cohort study using a prospectively maintained database of all adult patients presenting with OGIB who underwent DBE from September 1st, 2002 to June 30th, 2013 at a single tertiary center. RESULTS Four hundred and ninety five patients (52% females; median age 68 years) underwent DBE for OGIB. AVCE and/or MPCTE performed within 1 year prior to DBE (in 441 patients) increased the diagnostic yield of DBE (67.1% with preceding imaging vs 59.5% without). Using DBE as the gold standard, VCE and MPCTE had a diagnostic yield of 72.7% and 32.5% respectively. There were no increased odds of finding a bleeding site at DBE compared to VCE (OR = 1.3, P = 0.150). There were increased odds of finding a bleeding site at DBE compared to MPCTE (OR = 5.9, P < 0.001). In inpatients with overt OGIB, diagnostic yield of DBE was not affected by preceding imaging. CONCLUSION DBE is a safe and well-tolerated procedure for the diagnosis and treatment of OGIB, with a diagnostic yield that may be increased after obtaining a preceding VCE or MPCTE. However, inpatients with active ongoing bleeding may benefit from proceeding directly to antegrade DBE. PMID:28216967

  9. An Unusual Case of Obscure Gastrointestinal Bleeding in a Patient with Coeliac Disease

    Directory of Open Access Journals (Sweden)

    M. Gwiggner

    2011-01-01

    Full Text Available This paper describes the journey of a patient with coeliac disease who presented with overt obscure gastrointestinal bleeding. Upper and lower gastrointestinal endoscopy did not reveal a source of bleeding, but an abdominal CT scan detected abnormal lymphadenopathy and a wireless capsule endoscopy diagnosed a jejunal tumour, which was surgically removed. Gastrointestinal bleeding is rare in celiac disease. Malignant tumours of the small intestine are generally uncommon, but celiac disease represents a significant risk factor. Wireless capsule endoscopy has been a useful tool to investigate patients with obscure gastrointestinal bleeding.

  10. 急性上消化道出血的诊断与治疗新进展%New progress of the diagnosis and treatment of acute upper gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    靳秀花

    2015-01-01

    上消化道出血已经备受人们的关注,治疗不当很可能会导致患者的死亡,本文首先分析了上消化道出血的原因,对目前诊疗技术以及治疗手段的进展进行了分析,供相关的医疗人员参考。%Upper gastrointestinal bleeding is the attention of people, inappropriate treatment is likely to lead to the death of patients. This paper analyses the causes of upper gastrointestinal bleeding, analysis of the current progress of diagnosis and treatment means, provide the reference for the related medical staff.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    Institute of Scientific and Technical Information of China (English)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  14. Superior mesenteric arteriovenous fistula presenting as gastrointestinal bleeding: case report and literature review

    Directory of Open Access Journals (Sweden)

    Chong Wang

    Full Text Available Superior mesenteric arteriovenous fistula (SMAVF is a rare vascular disorder usually following penetrating abdominal trauma or gastrointestinal surgery. Percutaneous endovascular treatment such as embolization, has been widely used to treat this disease. We report a patient, who was presented with melena at the onset of his symptoms, then an acute hematemesis in shock. A SMAVF was diagnosed on an angiogram after a large mesenteric vein was seen on CT. The patient had a successful emergency endoscopic variceal ligation (EVL to stop bleeding. Then the patient received fistula embolization with covered stent.

  15. An upper gastrointestinal ulcer still bleeding after endoscopy : what comes next?

    NARCIS (Netherlands)

    Craenen, E. M. E.; Hofker, Hendrik; Peters, Frans; Kater, G. M.; Glatman, K. R.; Zijlstra, J. G.

    2013-01-01

    Introduction: Recurrent bleeding from an upper gastrointestinal ulcer when endoscopy fails is a reason for radiological or surgical treatment, both of which have their advantages and disadvantages. Case: Based on a patient with recurrent gastrointestinal bleeding, we reviewed the available evidence

  16. A predominant pelvic gastrointestinal stromal tumor (GIST) mass observed on Tc-99m red blood cell gastrointestinal bleeding scintigraphy.

    Science.gov (United States)

    Sood, Ravi; Tee, Shang Ian

    2011-08-01

    A 51-year-old woman presented with recurrent bleeding per rectum. Her earlier endoscopies were negative. Tc-99m RBC GI bleeding scintigraphy was performed. It demonstrated an apparent hypervascular pelvic mass, and active small bowel bleeding. Based on scintigraphic finding of a predominant pelvic mass indicating tumor, CT of the abdomen and pelvis was performed for further gastrointestinal bleeding localization work up instead of an invasive angiography or endoscopy, which detected a small bowel tumor in the pelvis. A small bowel gastrointestinal stromal tumor was resected subsequently.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  18. Endovascular management of acute bleeding arterioenteric fistulas

    DEFF Research Database (Denmark)

    Leonhardt, H.; Mellander, S.; Snygg, J.

    2008-01-01

    The objective of this study was to review the outcome of endovascular transcatheter repair of emergent arterioenteric fistulas. Cases of abdominal arterioenteric fistulas (defined as a fistula between a major artery and the small intestine or colon, thus not the esophagus or stomach), diagnosed...... arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered. Patients with cancer may only need treatment for the acute bleeding episode, and an endovascular approach has the advantage...

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

    Science.gov (United States)

    Stunell, H; Buckley, O; Lyburn, I D; McGann, G; Farrell, M; Torreggiani, W C

    2008-01-01

    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.

  20. Distribution of bleeding gastrointestinal angioectasias in a Western population

    Institute of Scientific and Technical Information of China (English)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  2. The Application of Hemospray in Gastrointestinal Bleeding during Emergency Endoscopy

    Directory of Open Access Journals (Sweden)

    Alexander F. Hagel

    2017-01-01

    Full Text Available Introduction. Gastrointestinal bleeding represents the main indication for emergency endoscopy (EE. Lately, several hemostatic powders have been released to facilitate EE. Methods. We evaluated all EE in which Hemospray was used as primary or salvage therapy, with regard to short- and long-term hemostasis and complications. Results. We conducted 677 EE in 474 patients (488 examinations in 344 patients were upper GI endoscopies. Hemospray was applied during 35 examinations in 27 patients (19 males, 33 during upper and 2 during lower endoscopy. It was used after previous treatment in 21 examinations (60% and in 14 (40% as salvage therapy. Short-term success was reached in 34 of 35 applications (97.1%, while long-term success occurred in 23 applications (65.7%. Similar long-term results were found after primary application (64,3% or salvage therapy (66,7%. Rebleeding was found in malignant and extended ulcers. One major adverse event (2.8% occurred with gastric perforation after Hemospray application. Discussion. Hemospray achieved short-term hemostasis in virtually all cases. The long-term effect is mainly determined by the type of bleeding source, but not whether it was applied as first line or salvage therapy. But, even in the failures, patients had benefit from hemodynamic stabilization and consecutive interventions in optimized conditions.

  3. The Application of Hemospray in Gastrointestinal Bleeding during Emergency Endoscopy

    Science.gov (United States)

    Albrecht, Heinz; Nägel, Andreas; Vitali, Francesco; Vetter, Marcel; Dauth, Christine; Neurath, Markus F.; Raithel, Martin

    2017-01-01

    Introduction. Gastrointestinal bleeding represents the main indication for emergency endoscopy (EE). Lately, several hemostatic powders have been released to facilitate EE. Methods. We evaluated all EE in which Hemospray was used as primary or salvage therapy, with regard to short- and long-term hemostasis and complications. Results. We conducted 677 EE in 474 patients (488 examinations in 344 patients were upper GI endoscopies). Hemospray was applied during 35 examinations in 27 patients (19 males), 33 during upper and 2 during lower endoscopy. It was used after previous treatment in 21 examinations (60%) and in 14 (40%) as salvage therapy. Short-term success was reached in 34 of 35 applications (97.1%), while long-term success occurred in 23 applications (65.7%). Similar long-term results were found after primary application (64,3%) or salvage therapy (66,7%). Rebleeding was found in malignant and extended ulcers. One major adverse event (2.8%) occurred with gastric perforation after Hemospray application. Discussion. Hemospray achieved short-term hemostasis in virtually all cases. The long-term effect is mainly determined by the type of bleeding source, but not whether it was applied as first line or salvage therapy. But, even in the failures, patients had benefit from hemodynamic stabilization and consecutive interventions in optimized conditions. PMID:28232848

  4. Angiographic evaluation and management of acute gastrointestinal hemorrhage

    Institute of Scientific and Technical Information of China (English)

    T Gregory Walker; Gloria M Salazar; Arthur C Waltman

    2012-01-01

    Although most cases of acute nonvariceal gastrointestinal hemorrhage either spontaneously resolve or respond to medical management or endoscopic treatment,there are still a significant number of patients who require emergency angiography and transcatheter treatment.Evaluation with noninvasive imaging such as nuclear scintigraphy or computed tomography may localize the bleeding source and/or confirm active hemorrhage prior to angiography.Any angiographic evaluation should begin with selective catheterization of the artery supplying the most likely site of bleeding,as determined by the available clinical,endoscopic and imaging data.If a hemorrhage source is identified,superselective catheterization followed by transcatheter microcoil embolization is usually the most effective means of successfully controlling hemorrhage while minimizing potential complications.This is now wellrecognized as a viable and safe alternative to emergency surgery.In selected situations transcatheter intra-arterial infusion of vasopressin may also be useful in controlling acute gastrointestinal bleeding.One must be aware of the various side effects and potential complications associated with this treatment,however,and recognize the high re-bleeding rate.In this article we review the current role of angiography,transcatheter arterial embolization and infusion therapy in the evaluation and management of nonvariceal gastrointestinal hemorrhage.

  5. Upper gastrointestinal bleeding from duodenal vascular ectasia in a patient with cirrhosis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    We report a cirrhotic patient with duodenal vascular ectasia and spontaneous bleeding. The bleeding was successfully controlled with argon plasma coagulation.Duodenal vascular ectasia may be a cause of upper gastrointestinal bleeding in patients with cirrhosis, and argon plasma coagulation may be effective and safe to achieve hemostasis of this lesion.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  7. Role of endoscopy in the management of acute diverticular bleeding

    Institute of Scientific and Technical Information of China (English)

    Charalampos Pilichos; Emmanouil Bobotis

    2008-01-01

    Colonic diverticulosis is one of the most common causes of lower gastrointestinal bleeding. Endoscopy is not only a useful diagnostic tool for localizing the bleeding site, but also a therapeutic modality for its management. To date, haemostatic methods have included adrenaline injection, mechanical clipping, thermal and electrical coagulation or combinations of them. The results of all published data are herein reviewed.

  8. The usefulness of MDCT in acute intestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kum Rae; Park, Won Kyu; Kim, Jae Woon; Chang, Jay Chun; Jang, Han Won [College of Medicine, Yeungnam University, Daegu (Korea, Republic of)

    2006-10-15

    We wanted to evaluate the usefulness of MDCT for localizing a bleeding site and for helping make a decision on further management for acute intestinal bleeding. We conducted a retrospective review of 17 consecutive patients who presented with acute intestinal bleeding and who also underwent MDCT before angiography or surgery. The sensitivity of MDCT for detecting acute intestinal bleeding was assessed and compared with that of conventional angiography. The sensitivity of MDCT for the detection of acute intestinal bleeding was 77% (13 or 17), whereas that of angiography was 46% (6 or 13). All the bleeding points that were subsequently detected on angiography were visualized on MDCT. In three cases, the bleeding focus was detected on MDCT and not on angiography. In four cases, both MDCT and angiography did not detect the bleeding focus; for one of these cases, CT during SMA angiography was performed and this detected the active bleeding site. In patients with acute intestinal bleeding, MDCT is a useful image modality to detect the bleeding site and to help decide on further management before performing angiography or surgery. When tumorous lesions are detected, invasive angiography can be omitted.

  9. Upper non-variceal gastrointestinal bleeding-review the effectiveness of endoscopic hemostasis methods

    Institute of Scientific and Technical Information of China (English)

    Miros?aw; Szura; Artur; Pasternak

    2015-01-01

    Upper non-variceal gastrointestinal bleeding is a conditionthat requires immediate medical intervention and has a high associated mortality rate(exceeding 10%). The vast majority of upper gastrointestinal bleeding cases are due to peptic ulcers. Helicobacter pylori infection, non-steroidal anti-inflammatory drugs and aspirin are the main risk factors for peptic ulcer disease. Endoscopic therapy has generally been recommended as the firstline treatment for upper gastrointestinal bleeding as it has been shown to reduce recurrent bleeding, the need for surgery and mortality. Early endoscopy(within 24 h of hospital admission) has a greater impact than delayed endoscopy on the length of hospital stay and requirement for blood transfusion. This paper aims to review and compare the efficacy of the types of endoscopic hemostasis most commonly used to control non-variceal gastrointestinal bleeding by pooling data from the literature.

  10. Cameron ulcers: An atypical source for a massive upper gastrointestinal bleed

    Institute of Scientific and Technical Information of China (English)

    Samir Kapadia; Sophia Jagroop; Atul Kumar

    2012-01-01

    Cameron lesions represent linear gastric erosions and ulcers on the crests of mucosal folds in the distal neck of a hiatal hernia (HH).Such lesions may be found in upto 50% of endoscopies performed for another indication.Though typically asymptomatic,these may rarely present as acute,severe upper gastrointestinal bleed (GIB).The aim is to report a case of a non-anemic 87-year-old female with history of HH and atrial fibrillation who presented with hematemesis and melena resulting in hypovolemic shock.Repeat esophagogastroduodenoscopy was required to identify multiple Cameron ulcers as the source.Endoscopy in a patient with HH should involve meticulous visualization of hernia neck and surrounding mucosa.Cameron ulcers should be considered in all patients with severe,acute GIB and especially in those with known HH with or without chronic anemia.

  11. 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

    Directory of Open Access Journals (Sweden)

    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

  12. Effect of Gastric Acid Suppressant Prophylaxis on Incidence of Gastrointestinal Bleeding in Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Tahoora Abdollahi

    2016-11-01

    Full Text Available Background: Critically ill children admitted to pediatric intensive care unit (PICU are at increased risk of gastrointestinal bleeding due to stress related mucosal injury. Reducing gastric acid by acid suppressant medication is the accepted prophylaxis treatment, but there is not any definitive guideline for using prophylaxis in PICU patients. The present study aimed to assess the effect of Proton Pump Inhibitor (PPI and H2 Blocker (H2B prophylaxis on gastrointestinal bleeding in admitted patients of PICU, Mashhad- Iran.Materials and Methods: In this study, 100 patients admitted in PICU divided into two equal groups on the first day of admission. They received ranitidine or pantoprazole as prophylaxis of stress ulcer. Those patients who had history of gastrointestinal bleeding or coagulation disorder were excluded. 100 PICU patients who had not received prophylaxis during last 6 months retrospectively evaluated as control of the study. Data were collected as demographic characteristics, admission reason, definitive diagnosis, receiving corticosteroid and mechanical ventilation in each patient. Gastrointestinal bleeding (hematemesis, coffee ground aspirate, and melena and clinically significant gastrointestinal bleeding were daily monitored. Data analyzed through descriptive statistical tests, Chi-square, logistic regression, t-test and using SPSS-16 software.Results: Among 204 patients (control group=105 and case group=99, incidence of gastrointestinal bleeding (GB was 13.2% in which 6.9% of cases presented with clinically significant gastrointestinal bleeding (CSGB. Loss of consciousness and respiratory distress were the main reason of admission. There was no significant differences between the incidence of (GB and (CSGB in experimental and control groups (P>0.05 as well as ranitidine and pantoprazole prophylaxis (P>0.05. Significant risk factors of (GB were mechanical ventilation and loss of consciousness and corticosteroid therapy

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

    Energy Technology Data Exchange (ETDEWEB)

    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

    Energy Technology Data Exchange (ETDEWEB)

    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. ArterioVenous Malformation within Jejunal Diverticulum: An Unusual Cause of Massive Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Jeffrey K. Lee

    2009-01-01

    Full Text Available Massive gastrointestinal (GI bleeding can occur with multiple jejunal diverticulosis. However, significant bleeding in the setting of few diverticulae is very unusual and rare. We report a case of massive gastrointestinal bleeding from an arteriovenous malformation (AVM within a jejunal diverticulum to underscore the significance of such coexisting pathologies. Mesenteric angiogram was chosen to help identify the source of bleeding and to offer an intervention. Despite endovascular coiling, emergent intestinal resection of the bleeding jejunal segment was warranted to ensure definitive treatment. However several reports have shown jejunal diverticulosis as a rare cause of massive GI bleeding. The coexistence of jejunal diverticulum and AVM is rare and massive bleeding from an acquired Dieulafoy-like AVM within a diverticulum has never previously been described. Awareness of Dieulafoy-like AVM within jejunoileal diverticulosis is useful in preventing delay in treatment.

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

    DEFF Research Database (Denmark)

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

  17. Recurrent gastrointestinal bleeding and hepatic infarction after liver biopsy.

    Science.gov (United States)

    Bishehsari, Faraz; Ting, Peng-Sheng; Green, Richard M

    2014-02-21

    Hepatic artery pseudoaneurysms (HAP) are rare events, particularly after liver biopsy, but can be associated with serious complications. Therefore a high suspicion is necessary for timely diagnosis and appropriate treatment. We report on a case of HAP that potentially formed after a liver biopsy in a patient with sarcoidosis. The HAP in our case was virtually undetectable initially by angiography but resulted in several complications including recurrent gastrointestinal bleeding, hemorrhagic cholecystitis and finally hepatic infarction with abscess formation until it became detectable at a size of 5-mm. The patient remains asymptomatic over a year after endovascular embolization of the HAP. In this report, we demonstrate that a small HAP can avoid detection by angiography at an early stage while being symptomatic for a prolonged course. A high clinical suspicion with a close clinical/radiological follow-up is needed in symptomatic patients with history of liver biopsy despite initial negative work up. Once diagnosed, HAP can be safely and effectively treated by endovascular embolization.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  19. Pancreatic Perivascular Epithelioid Cell Tumour Presenting with Upper Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Christos Petrides

    2015-01-01

    Full Text Available PEComa is a family of rare mesenchymal tumours which can occur in any part of the human body. Primary PEComas of the pancreas are extremely rare tumours with uncertain malignant potential. A 17-year-old female was admitted to the hospital due to melena. She required several transfusions. CT scan demonstrated a mass at the head of the pancreas measuring 4.2 cm in maximum diameter. An endoscopic ultrasound showed an ulcerating malignant looking mass infiltrating 50% of the wall of the second part of the duodenum in the region of the ampulla. Multiple biopsies taken showed extensive ulceration with granulation tissue formation and underlying large macrophages without being able to establish a definite diagnosis. We proceeded with pylorus-preserving pancreaticoduodenectomy. The postoperative course of the patient was unremarkable, and she was discharged on the 8th postoperative day. Histology examination of the specimen showed a PEComa of pancreas. Eighteen months after resection the patient is disease free. To the best of our knowledge this is the first time we describe a case of a pancreatic PEComa presenting with massive gastrointestinal bleeding.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  1. Pharmacologic options in the management of upper gastrointestinal bleeding: focus on the elderly.

    Science.gov (United States)

    Kyaw, Moe Htet; Chan, Francis Ka Leung

    2014-05-01

    Despite the major advances in the treatment of peptic ulcer disease, its complication in the elderly has increased. This is because of the increasing use of nonsteroidal anti-inflammatory drugs, and the high prevalence of Helicobacter pylori infection. The presentation of peptic ulcers in the elderly patients can be subtle, and late presentation with upper gastrointestinal bleeding of peptic ulcers is not uncommon in the elderly population. The aim of this article is to review the current treatment options for upper gastrointestinal bleeding, and to discuss the place of drug therapy in both the acute and ongoing management of individual patients. Its focus will be on the benefits and risks of each option in the elderly. There is significant evidence to suggest that anti-secretory medications are useful in the treatment of peptic ulcers and associated complications in the elderly. Although a large number of studies have reported potential adverse effects of proton pump inhibitors, this evidence comes from retrospective observational studies, and such reports should be regarded with caution, and randomized controlled studies are required to confirm or refute these results. Nonetheless, it will be important to practice the appropriate use of acid suppression therapy, and identify which patients will gain maximum benefit from proton pump inhibitor therapy.

  2. TREATMENT OF UPPER GASTROINTESTINAL BLEEDING%上消化道大量出血的临床处理

    Institute of Scientific and Technical Information of China (English)

    林玉

    2011-01-01

    [Objective] To investigate methods for the treatment of upper gastrointestinal bleeding. [Methods] We retrospectively evaluated 48 cases of upper gastrointestinal bleeding. [Results] Peptic ulcer accounted for 52.1% of upper gastrointestinal bleeding. The incidences of upper gastrointestinal bleeding were 18.8%, 12.5% , 8.3% , 4.2% and 2.1% in liver cirrhosis, acute gastric mucosal lesion, gastric cancer, hepatic cancer and bile duct disease. [Conclusion] Management of patients with upper gastrointestinal bleeding should focus on the principal cause of a disease.%[目的]探讨上消化道大出血的病因及临床处理方法.[方法]通过对确诊为上消化道大量出血的48例患者病因进行分析.[结果]消化性溃疡病发生率52.1% (25/48),肝硬化发生率18.8% (9/48),急性病胃黏膜出血发生率12.5% (6/48),胃癌发生率8.3% (4/48),肝癌发生率4.2% (2/48),胆道出血发生率2.1% (1/48),原因不明2.1% (1/48).[结论]对上消化道大量出血应根据不同的病因,采取相应的临床处理方法.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    NARCIS (Netherlands)

    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

  5. Reproducibility of Wireless Capsule Endoscopy in the Investigation of Chronic Obscure Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Dimitrios Christodoulou

    2007-01-01

    Full Text Available BACKGROUND: Capsule endoscopy (CE is a valuable tool in the diagnostic evaluation of obscure gastrointestinal bleeding, but limited information is available on the reproducibility of CE findings.

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

    DEFF Research Database (Denmark)

    Chavez-Tapia, N C; Barrientos-Gutierrez, T; Tellez-Avila, F;

    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....

  7. Obscure gastrointestinal bleeding: which factors are associated with positive capsule endoscopy findings?

    Directory of Open Access Journals (Sweden)

    Iolanda Ribeiro

    Full Text Available Background: Capsule endoscopy is a first line examination to evaluate obscure gastrointestinal bleeding. The identification of factors associated with the detection of lesions by capsule endoscopy could improve resource utilization and patient selection. Objectives: To identify factors associated with positive capsule endoscopy findings in patients with obscure gastrointestinal bleeding. Methods: Retrospective, single-center study, including 203 patients (214 capsule endoscopy procedures submitted to capsule endoscopy in the setting of obscure gastrointestinal bleeding. Type of obscure gastrointestinal bleeding, number of units of packed red blood cells transfused, type of positive finding, number of endoscopy studies performed prior to capsule endoscopy, comorbidities, medication and Charlson index were evaluated. Overt bleeding was subdivided into ongoing and previous gastrointestinal bleeding. Only lesions with high hemorrhagic potential (P2 were classified as positive findings. Results: The mean age was 62.2 years and 59.7% of patients were female. Most patients were referred for occult gastrointestinal bleeding (64.5%, while 35.5% were referred for overt gastrointestinal bleeding (63.2% previous-overt gastrointestinal bleeding. The most frequent positive findings included ulcers/erosions (34% and angioectasias (32%. In univariate analysis, the identification of positive findings was significantly higher in those with ongoing-overt bleeding (p < 0.001, advanced age (p = 0.003, increasing number of pre-capsule endoscopies (p < 0.001, increasing transfusion requirements (p < 0.001, moderate/severe renal disease (p = 0.009 and antiplatelet drugs (p = 0.021 and NSAID intake (p = 0.005. In multivariate analysis, positive findings were significantly higher only in those with ongoing-overt bleeding (odds ratio [OR] 18.68, 95% confidence interval [CI] 3.98-85.6, p < 0.001, higher transfusion requirements (OR 1.23, 95% CI 1.1-1.4, p < 0.001 and NSAID

  8. [Historical schedule of management of bleeding from the upper part of gastrointestinal tract].

    Science.gov (United States)

    Wójtowicz, Jacek; Wojtuń, Stanisław; Gil, Jerzy

    2009-05-01

    Treatment of bleeding from the upper part of gastrointestinal tract were changed many times. First there were waiting (Hipocrates, Sydenham, Stahl), next transfusion of the blood were initiated (Denis, Blundell, Dieffenbach, Bierkowski, Dungren, Hirszfeld). Big (Rydygier) and small (Dragstedt) operations procedures were attempted. Discovery of endoscopy of gastrointestinal tract (Mikulicz) and initiation of elastic scopes (Hirschowitz) and exploration inhibitor of histamine receptors (H2) and proton pump inhibitors with recognition of role Helicobacter pylori in bleeding were permitted elaborate actual schemas of proceedings.

  9. Gastrointestinal bleeding and iron absorption in the experimental blind loop syndrome.

    Science.gov (United States)

    Giannella, R A; Toskes, P P

    1976-07-01

    Rats with surgically created self-filling jejunal blind loops and the blind loop syndrome manifested gastrointestinal bleeding and hyperabsorption of iron. Although the mean hematocrit and serum iron levels of rats with self-filling blind loops became overtly anemic and manifested low-serum iron levels. It is suggested that the documented gastrointestinal bleeding in these rats with the experimental blind loop syndrome is another manifestation of damage to the intestinal epithelium in conditions of small intestinal bacterial overgrowth.

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

    Directory of Open Access Journals (Sweden)

    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

  11. Rare cause of upper gastrointestinal bleeding owing to hepatic cancer invasion: a case report.

    Science.gov (United States)

    Wu, Wei-Ding; Wu, Jia; Yang, Hong-Guo; Chen, Yuan; Zhang, Cheng-Wu; Zhao, Da-Jian; Hu, Zhi-Ming

    2014-09-21

    Upper gastrointestinal bleeding refers to bleeding that arises from the gastrointestinal tract proximal to the ligament of Treitz. The primary reason for gastrointestinal bleeding associated with hepatocellular carcinoma is rupture of a varicose vein owing to pericardial hypotension. We report a rare case of gastrointestinal bleeding with hepatocellular carcinoma in a patient who presented with recurrent gastrointestinal bleeding. The initial diagnosis was gastric cancer with metastasis to the multiple lymph nodes of the lesser curvature. The patient underwent exploratory laparotomy, which identified two lesions in the gastric wall. Total gastrectomy and hepatic local excision was then performed. Pathological results indicated that the hepatocellular carcinoma had invaded the stomach directly, which was confirmed immunohistochemically. The patient is alive with a disease-free survival of 1 year since the surgery. Hepatocellular carcinoma with gastric invasion should be considered as a rare cause of upper gastrointestinal bleeding in hepatocellular carcinoma patients, especially with lesions located in the left lateral hepatic lobe. Surgery is the best solution.

  12. Wireless Capsule Endoscopy for Obscure Gastrointestinal Bleeding: Single Center, One Year Experience

    Directory of Open Access Journals (Sweden)

    Shou-jiang Tang

    2004-01-01

    Full Text Available BACKGROUND: Wireless capsule endoscopy (CE is increasingly being used in the investigation of obscure gastrointestinal (GI bleeding, but some studies have found that many of the bleeding lesions recognized by this technique are within the reach of conventional endoscopy.

  13. Electrodermal screening of biologically active points for upper gastrointestinal bleeding.

    Science.gov (United States)

    Tseng, Ying-Jung; Hu, Wen-Long; Hung, I-Ling; Hsieh, Chia-Jung; Hung, Yu-Chiang

    2014-01-01

    The purpose of this case-control study was to investigate the relationship between the electrical resistance of the skin at biologically active points (BAPs) on the main meridians and upper gastrointestinal bleeding (UGIB). Electrical resistance to direct current at 20 BAPs on the fingers and toes of 100 patients with (38 men, 12 women; mean age [range], 58.20 ± 19.62 [18-83] years) and without (27 men, 23 women; 49.54 ± 12.12 [22-74] years) UGIB was measured through electrodermal screening (EDS), based on the theory of electroacupuncture according to Voll (EAV). Data were compared through analysis of variance (ANOVA), receiver operating characteristic (ROC) curve analysis, and logistic regression. The initial readings were lower in the UGIB group, indicating blood and energy deficiency due to UGIB. Significant differences in indicator drop values were observed at nine BAPs (p < 0.05) on the bilateral small intestine, bilateral stomach, bilateral circulation, bilateral fibroid degeneration, and right lymph meridians. The area under the ROC curve values of the BAPs on the bilateral small intestine and stomach meridians were larger than 0.5, suggesting the diagnostic accuracy of EDS for UGIB on the basis of the indicator drop of these BAPs. Logistic regression revealed that when the indicator drop of the BAP on the left stomach meridian increased by one score, the risk of UGIB increased by about 1.545-3.523 times. In conclusion, the change in the electrical resistance of the skin measured by EDS at the BAPs on the bilateral small intestine and stomach meridians provides specific information on UGIB.

  14. Gastrointestinal bleeding from Dieulafoy's lesion: Clinicalpresentation, endoscopic findings, and endoscopic therapy

    Institute of Scientific and Technical Information of China (English)

    Borko Nojkov; Mitchell S Cappell

    2015-01-01

    Although relatively uncommon, Dieulafoy's lesion is animportant cause of acute gastrointestinal bleeding dueto the frequent difficulty in its diagnosis; its tendency tocause severe, life-threatening, recurrent gastrointestinalbleeding; and its amenability to life-saving endoscopictherapy. Unlike normal vessels of the gastrointestinaltract which become progressively smaller in caliberperipherally, Dieulafoy's lesions maintain a large caliberdespite their peripheral, submucosal, location withingastrointestinal wall. Dieulafoy's lesions typicallypresent with severe, active, gastrointestinal bleeding,without prior symptoms; often cause hemodynamicinstability and often require transfusion of multipleunits of packed erythrocytes. About 75% of lesionsare located in the stomach, with a marked proclivity oflesions within 6 cm of the gastroesophageal junctionalong the gastric lesser curve, but lesions can alsooccur in the duodenum and esophagus. Lesions inthe jejunoileum or colorectum have been increasinglyreported. Endoscopy is the first diagnostic test, but hasonly a 70% diagnostic yield because the lesions arefrequently small and inconspicuous. Lesions typicallyappear at endoscopy as pigmented protuberances fromexposed vessel stumps, with minimal surrounding erosionand no ulceration (visible vessel sans ulcer). Endoscopictherapy, including clips, sclerotherapy, argon plasmacoagulation, thermocoagulation, or electrocoagulation,is the recommended initial therapy, with primary hemostasisachieved in nearly 90% of cases. Dual endoscopictherapy of epinephrine injection followed by ablative ormechanical therapy appears to be effective. Althoughbanding is reportedly highly successful, it entails asmall risk of gastrointestinal perforation from bandingdeep mural tissue. Therapeutic alternatives after failedendoscopic therapy include repeat endoscopic therapy,angiography, or surgical wedge resection. The mortalityhas declined from about 30% during the 1970's to9

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

    Science.gov (United States)

    Sadeghi, Peter; Lanzon-Miller, Sandro

    2015-11-02

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  17. Blue rubber bleb naevus syndrome: A rare cause of gastrointestinal bleeding in an African child

    Directory of Open Access Journals (Sweden)

    Walter C

    2010-01-01

    Full Text Available Blue rubber bleb naevus syndrome (BRBNS is characterised by vascular malformations of the skin and gastrointestinal tract. We present the rare case of BRBNS in an African child. She presented with large-volume gastrointestinal bleeding and was managed by on-table colonoscopic identification and surgical excision, of all her enteric, vascular malformations.

  18. Tranexamic Acid in the Management of Upper Gastrointestinal Bleeding: an Evidence-based Case Report

    Directory of Open Access Journals (Sweden)

    Nur Atikah

    2015-04-01

    Full Text Available Aim: to review the effectiveness of tranexamic acid therapy which has been proposed to reduce bleeding and in turn lower mortality rate. Methods: following literature searching based on our clinical question on Cochrane Library, PubMed, Clinical Key, EBSCO, Science Direct and Proquest, one systematic review that includes seven randomized controlled trials is obtained. The article meets validity and relevance criteria. Results: the systematic review found that there is no any clear evidence between intervention and control groups in term of mortality. Conclusion: the use of tranexamic acid to reduce mortality in patients with upper gastrointestinal bleeding is not recommended. Key words: tranexamic acid, mortality, upper gastrointestinal bleeding.

  19. Treatment of Rare Gastric Variceal Bleeding in Acute Pancreatitis Using Embolization of the Splenic Artery Combined with Short Gastric Vein

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    Lixin Li

    2012-12-01

    Full Text Available In the acute stage of pancreatitis, sinistral portal hypertension is a rare reason for gastric variceal bleeding. Here we report a 20-year-old female patient with massive upper gastrointestinal hemorrhage 7 days after an episode of severe acute pancreatitis. Computed tomography showed gastric varices caused by splenic venous thrombosis. Emergency endoscopic examination was performed, however tissue adhesive utilized to restrain the bleeding was not successful. Although interventional therapy was controversial to treat the gastric variceal hemorrhage resulting from sinistral portal hypertension, the bleeding was successfully treated by embolization of the splenic artery combined with short gastric vein. Two weeks after the interventional the patient was discharged from our hospital without recurrence of bleeding. Embolization of the splenic artery combined with short gastric vein proved to be an effective emergency therapeutic method for gastric variceal bleeding caused by sinistral portal hypertension in the acute stage of pancreatitis.

  20. [Massive small intestine bleeding: CT-angiography and surgical treatment - a case report].

    Science.gov (United States)

    Halamka, J; Chmátal, P

    2015-04-01

    Gastrointestinal bleeding is one of acute abdomen conditions that occur relatively frequently. Most cases can nowadays be managed endoscopically, surgery is rarely required. Approximately 5% of gastrointestinal bleeding cases are cases of so-called obscure gastrointestinal bleeding. The presented massive gastrointestinal bleed case report provides a current view on diagnostic and therapeutic modalities in the context of everyday clinical practice.

  1. Unusual cause of gastrointestinal bleeding in a cirrhotic patient:hepatocellular carcinoma with gastric invasion

    Institute of Scientific and Technical Information of China (English)

    Marcos Vinicius Perini; Paulo Herman; Rodrigo Pessoa; Willian Abraao Saad

    2009-01-01

    BACKGROUND: Upper gastrointestinal (GI) bleeding is a common complication of portal hypertension in cirrhotic patients, and hepatocellular carcinoma (HCC) is the most common tumor in cirrhotic livers. Bleeding from tumor erosion into the GI tract is very rare. A patient with HCC and gastric tumor invasion was described and the previously reported cases were reviewed. METHOD: A patient with upper GI bleeding was treated in a tertiary hospital. RESULTS: A cirrhotic patient with a HCC invading the stomach leading to upper GI bleeding was treated by left lateral segmentectomy and sub-total gastrectomy. The bleeding was controlled and a good surgical outcome was achieved. CONCLUSIONS: HCC with gastric invasion should be differentially diagnosed from upper GI bleeding in cirrhotic patients. Bleeding can be controlled and symptomatic relief marked in selected cases.

  2. Consensus on Control of Risky Nonvariceal Upper Gastrointestinal Bleeding in Taiwan with National Health Insurance

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    Bor-Shyang Sheu

    2014-01-01

    Full Text Available Background and Aims. To compose upper gastrointestinal bleeding (UGIB consensus from a nationwide scale to improve the control of UGIB, especially for the high-risk comorbidity group. Methods. The steering committee defined the consensus scope to cover preendoscopy, endoscopy, postendoscopy, and overview from Taiwan National Health Insurance Research Database (NHIRD assessments for UGIB. The expert group comprised thirty-two Taiwan experts of UGIB to conduct the consensus conference by a modified Delphi process through two separate iterations to modify the draft statements and to vote anonymously to reach consensus with an agreement ≥80% for each statement and to set the recommendation grade. Results. The consensus included 17 statements to highlight that patients with comorbidities, including liver cirrhosis, end-stage renal disease, probable chronic obstructive pulmonary disease, and diabetes, are at high risk of peptic ulcer bleeding and rebleeding. Special considerations are recommended for such risky patients, including raising hematocrit to 30% in uremia or acute myocardial infarction, aggressive acid secretory control in high Rockall scores, monitoring delayed rebleeding in uremia or cirrhosis, considering cycloxygenase-2 inhibitors plus PPI for pain control, and early resumption of antiplatelets plus PPI in coronary artery disease or stroke. Conclusions. The consensus comprises recommendations to improve care of UGIB, especially for high-risk comorbidities.

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

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    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.

  4. Rescue endoscopic bleeding control for nonvariceal upper gastrointestinal hemorrhage using clipping and detachable snaring.

    Science.gov (United States)

    Lee, J H; Kim, B K; Seol, D C; Byun, S J; Park, K H; Sung, I K; Park, H S; Shim, C S

    2013-06-01

    Nonvariceal upper gastrointestinal (UGI) bleeding recurs after appropriate endoscopic therapy in 10 % - 15 % of cases. The mortality rate can be as high as 25 % when bleeding recurs, but there is no consensus about the best modality for endoscopic re-treatment. The aim of this study was to evaluate clipping and detachable snaring (CDS) for rescue endoscopic control of nonvariceal UGI hemorrhage. We report a case series of seven patients from a Korean tertiary center who underwent endoscopic hemostasis using the combined method of detachable snares with hemoclips. The success rate of endoscopic hemostasis with CDS was 86 %: six of the seven patients who had experienced primary endoscopic treatment failure or recurrent bleeding after endoscopic hemostasis were treated successfully. In conclusion, rescue endoscopic bleeding control by means of CDS is an option for controlling nonvariceal UGI bleeding when no other method of endoscopic treatment for recurrent bleeding and primary hemostatic failure is possible.

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

    Science.gov (United States)

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

    2014-05-13

    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.

  6. Capsule endoscopy and push enteroscopy in the diagnosis of obscure gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    戈之铮; 胡运彪; 萧树东

    2004-01-01

    Background In obscure gastrointestinal (GI) bleeding, it is often difficult to detect the bleeding sites located in the small bowel with conventional radiological, scintigraphic or angiographic techniques. Push enteroscopy and capsule endoscopy are currently considered to be the most effective diagnostic procedures. The aim of this study was to compare the detection rates between capsule endoscopy and push enteroscopy. Methods From May 2002 through January 2003, we prospectively examined by capsule endoscopy 39 patients with suspected small bowel diseases, in particular GI bleeding of unknown origin in Renji Hospital. Among them, 32 complained of obscure recurrent GI bleeding. Between January 1993 and October 1996, we used push enteroscopy on 36 patients who suffered from unexplained GI bleeding. All patients had prior normal results on gastroscopy, colonoscopy, small bowel barium radiography, scintigraphy and/or angiography. Results M2A capsule endoscopy disclosed abnormal small bowel findings in 26 (82%) out of 32 patients. Twenty-one of them had significant pathological findings explaining their clinical disorders. Diagnostic yield was therefore 66% (21 of 32 patients). Definite bleeding sites diagnosed by capsule endoscopy in 21 patients included angiodysplasia (8), inflammatory small-bowel (5), small-bowel polyps (4), gastrointestinal stromal tumour (2), carcinoid tumour and lipoma (1), and hemorrhagic gastritis (1). Push enteroscopy detected the definite sources of bleeding in 9 (25%) of the 36 patients. Patients with definite bleeding sources included angiodysplasias (2), leiomyosarcoma (2), leiomyoma (1), lymphoma (1), Crohn's disease (1), small-bowel polyps (1) and adenocarcinoma of ampulla (1). Suspected bleeding sources were shown by push enteroscopy in two additional patients (6%), and in other five patients (16%) by capsule endoscopy.Conclusions The present study of patients with obscure GI bleeding showed that capsule endoscopy significantly superior

  7. Eosinophilic gastroenteritis with refractory ulcer disease and gastrointestinal bleeding as a rare manifestation of seronegative gastrointestinal food allergy.

    Science.gov (United States)

    Raithel, Martin; Hahn, Markus; Donhuijsen, Konrad; Hagel, Alexander F; Nägel, Andreas; Rieker, Ralf J; Neurath, Markus F; Reinshagen, Max

    2014-09-17

    Gastrointestinal bleeding and iron deficiency anaemia may cause severe symptoms and may require extensive diagnostics and substantial amounts of health resources.This case report focuses on the clinical presentation of a 22 year old patient with recurrent gastrointestinal bleeding from multilocular non-healing ulcers of the stomach, duodenum and jejunum over a period of four years. Extensive gastroenterological and allergological standard diagnostic procedures showed benign ulcerative lesions with tissue eosinophilia, but no conclusive diagnosis. Multiple diagnostic procedures were performed, until finally, endoscopically guided segmental gut lavage identified locally produced, intestinal IgE antibodies by fluoro-enzyme-immunoassay.IgE antibody concentrations at the intestinal level were found to be more-fold increased for total IgE and food-specific IgE against nuts, rye flour, wheat flour, pork, beef and egg yolk compared with healthy controls.Thus, a diet eliminating these allergens was introduced along with antihistamines and administration of a hypoallergenic formula, which resulted in complete healing of the multilocular ulcers with resolution of gastrointestinal bleeding. All gastrointestinal lesions disappeared and total serum IgE levels dropped to normal within 9 months. The patient has been in remission now for more than two years.Eosinophilic gastroenteritis (EG) is well known to induce refractory ulcer disease. In this case, the mechanisms for intestinal damage and gastrointestinal bleeding were identified as local gastrointestinal type I allergy. Therefore, future diagnostics in EG should also be focused on the intestinal level as identification of causative food-specific IgE antibodies proved to be effective to induce remission in this patient.

  8. Management of Antiplatelet Agents and Anticoagulants in Patients with Gastrointestinal Bleeding.

    Science.gov (United States)

    Abraham, Neena S

    2015-07-01

    Antithrombotic drugs (anticoagulants, aspirin, and other antiplatelet agents) are used to treat cardiovascular disease and to prevent secondary thromboembolic events. These drugs are independently associated with an increased risk of gastrointestinal bleeding (GIB), and, when prescribed in combination, further increase the risk of adverse bleeding events. Clinical evidence to inform the choice of endoscopic hemostatic procedure, safe temporary drug cessation, and use of reversal agents is reviewed to optimize management following clinically significant GIB.

  9. Non-small-bowel lesions encountered during double-balloon enteroscopy performed for obscure gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Hoi-Poh; Tee; Arthur; J; Kaffes

    2010-01-01

    AIM:To report the incidence of non-small-bowel bleeding pathologies encountered during double-balloon enteroscopy (DBE) procedures and to analyse their significance.METHODS: A retrospective study of a prospective DBE database conducted in a tertiary-referral center was conducted. A total of 179 patients with obscure gastrointestinal bleeding (OGIB) referred for DBE from June 2004 to November 2008 were analysed looking for the incidence of non-small-bowel lesions (NSBLs; all and newly diagnosed) encountered ...

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

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    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.

  11. Massive gastrointestinal bleeding:An unusual case of asymptomatic extrarenal,visceral,fibromuscular dysplasia

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Extrarenal fibromuscular dysplasia causing gastrointestinal bleeding without other manifestations and especially sparing renal vasculature is uncommon. The diagnosis of this entity is usually made by radiographic appearance and the treatment is controversial. To our knowledge only seven cases of visceral fibromuscular dysplasia as a primary manifestation of the disease have been described, symptoms range from abdominal pain to gangrene. This is the first case of visceral fibromuscular dysplasia presenting with otherwise asymptomatic gastrointestinal bleeding, without bowel necrosis or ischemic changes. We provide a review of the literature.

  12. Dieulafoy lesion: CT diagnosis of this lesser-known cause of gastrointestinal bleeding.

    Science.gov (United States)

    Batouli, A; Kazemi, A; Hartman, M S; Heller, M T; Midian, R; Lupetin, A R

    2015-06-01

    A Dieulafoy lesion describes a tortuous, submucosal artery in the gastrointestinal tract--most commonly the posterior stomach--that penetrates through the mucosa over time, eventually perforating to cause severe gastrointestinal bleeding. Due to its insidious onset, tendency to cause intermittent but severe bleeding, and difficulty of endoscopic diagnosis, Dieulafoy lesion has a very high mortality rate. Although originally thought not to be a radiologically diagnosable entity, Dieulafoy lesions can be seen at enhanced CT of the abdomen. The purpose of this review is to summarize the pathophysiology, epidemiology, diagnosis, and management of Dieulafoy lesions with a focus on diagnostic findings at enhanced CT imaging.

  13. Endoscopic Evaluation and Management of Gastrointestinal Bleeding in Patients with Ventricular Assist Devices

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    Marty M. Meyer

    2012-01-01

    Full Text Available The optimal diagnostic approach and yield for gastrointestinal bleeding (GIB in patients with ventricular assist devices (VAD are unknown. We explored the etiology of bleeding and yield of upper and lower endoscopy, balloon-assisted enteroscopy, and video capsule endoscopy in the evaluation of GIB in patients with VADs. Methods. All VAD patients with overt gastrointestinal bleeding and drop in hematocrit from April 1, 2000 to July 31, 2008 were retrospectively reviewed. The endoscopic evaluation of each episode was recorded. Overall yield of EGD, colonoscopy, balloon-assisted, and video capsule endoscopy were evaluated. Results. Thirty-six bleeding episodes occurred involving 20 patients. The site of GIB was identified in 32/36 episodes (88.9%, and the etiology of bleeding was determined in 30/36 cases (83.3%. Five VAD patients underwent VCE. The VCE exams demonstrated a high yield with 80% of exams identifying the etiology of GIB. Endoscopic intervention was successful in 8/9 attempts. No adverse events were recorded. Two patients required surgical intervention for GIB. Conclusion. Upper, lower, video capsule, and balloon-assisted enteroscopies are safe and demonstrate a high yield in the investigation of gastrointestinal bleeding in VAD patients. Medical centers caring for VAD patients should employ a standardized protocol to optimize endoscopic evaluation and intervention.

  14. The changing face of hospitalization due to gastrointestinal bleeding and perforation

    OpenAIRE

    Lanas, Angel; Garcia Rodriguez, Luis Alberto; Polo-Tomas, Monica; Ponce, Marta; Quintero, Enrique; Perez-Aisa, Maria Angeles; Gisbert, Javier P; Bujanda, Luis; Castro, Manuel; Muñoz, Maria; Del Pino, Maria Dolores; Garcia, Santiago; Calvet, Xavier

    2011-01-01

    Abstract Background: Temporal changes in the incidence of cause-specific gastrointestinal (GI) complications may be one of the factors underlying changing medical practice patterns. Aim: To report temporal changes in the incidence of five major causes of specific gastrointestinal (GI) complication events. Methodology: Population-based study of patients hospitalized due to GI bleeding and perforation from 1996?2005 in Spain. We report crude rates, and estimate regression coefficient...

  15. Klippel-Trenaunay syndrome with gastrointestinal bleeding,splenic hemangiomas and left inferior vena cava

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Klippel-Trenaunay syndrome is a congenital vascular anomaly characterized by a triad of varicose veins,cutaneous capillary malformation,and hypertrophy of bone and(or)soft tissue.Gastrointestinal vascular malformations in Klippel-Trenaunay syndrome may present with gastrointestinal bleeding.The majority of patients with spleenic hemangiomatosis and/or left inferior vena cava are asymptomatic.We herein report a case admitted to the gastroenterology clinic with life-threatening hematochezia and symptomatic ir...

  16. Recurrent Obscure Gastrointestinal Bleeding: Dilemmas and Success with Pharmacological Therapies. Case Series and Review

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    Majid Almadi

    2009-01-01

    Full Text Available The present article describes three difficult cases of recurrent bleeding from obscure causes, followed by a review of the pitfalls and pharmacological management of obscure gastrointestinal bleeding. All three patients underwent multiple investigations. An intervening complicating diagnosis or antiplatelet drugs may have compounded long-term bleeding in two of the cases. A bleeding angiodysplasia was confirmed in one case but was aggravated by the need for anticoagulation. After multiple transfusions and several attempts at endoscopic management in some cases, long-acting octreotide was associated with decreased transfusion requirements and increased hemoglobin levels in all three cases, although other factors may have contributed in some. In the third case, however, the addition of low-dose thalidomide stopped bleeding for a period of at least 23 months.

  17. T ranscatheter Arterial Embolization For Acute U pper Gastrointestinal Bleeding in Clinical Analysis of 3 0 Cases%经导管动脉栓塞治疗急性上消化道出血30例临床分析

    Institute of Scientific and Technical Information of China (English)

    刘云

    2015-01-01

    目的:探讨经导管栓塞治疗急性消化道出血的疗效和影响疗效的因素。方法回顾20例急性上消化道出血患者经导管栓塞治疗后的手术成功率,术后1个月内再次出血率及并发症等。结果手术成功率为93.3%(28/30),术后1个月再出血率为13.3%(4/30),其中1例患者给予保守治疗,1例患者动脉造影后再次栓塞,2例行外科手术治疗1例内镜止血治疗。结论经导管栓塞治疗急性消化道大出血是一种安全有效的方法,靶血管的正确选择、合适的栓塞剂和用量是成功的关键。%Objective To investigate the efficacy and factors affecting the efficacy of acute gastrointestinal hemorrhage transcatheter embolization .Methods A retrospective gastrointestinal surgery a success rate of pa-tients after transcatheter embolization ,within one month after re -bleeding rate and the 2 0 cases of acute com-plications .Results The surgical success rate was 9 3 .3% (2 8/3 0 ) ,after a month of rebleeding rate was 1 3 .3%(4/3 0 ) ,one patient given conservative treatment ,and 1 patient after arterial embolization again ,two cases un-derwent surgical treatment of an endoscopic hemostasis .Conclusion Transcatheter embolization for acute gas-trointestinal bleeding is a safe and effective way ,the correct choice of the target vessel ,the appropriate amount of embolic agents and is the key to success .

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

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    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

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

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    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.

  20. Lower gastrointestinal bleeding secondary to a rectal leiomyoma

    Institute of Scientific and Technical Information of China (English)

    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. Strongyloides stercoralis hyperinfection: an unusual cause of gastrointestinal bleeding

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    Juliana Trazzi Rios

    2015-08-01

    Full Text Available SummaryStrongyloidiasis is a parasitic disease that may progress to a disseminated form, called hyperinfection syndrome, in patients with immunosuppression. The hyperinfection syndrome is caused by the wide multiplication and migration of infective larvae, with characteristic gastrointestinal and/or pulmonary involvement. This disease may pose a diagnostic challenge, as it presents with nonspecific findings on endoscopy.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  4. Primary spinal extradural hydatid cyst associated with acute bleeding

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    Guohua Zhu

    2009-07-01

    Full Text Available Aims: To report a case of unilocular primary spinal extradural hydatid cyst which manifested as acute bleeding. Methods: The clinical presentation, diagnosis, and surgical treatment of this rare case are discussed. Published cases of primary extradural hydatid cysts are reviewed. Results: Complete recovery was achieved. Repeated clinical, radiological, and serological examinations did not show any evidence of local recurrence or systemic hydatidosis during the follow-up period of 50 months. Conclusions: Primary spinal extradural hydatid cyst may present as acute bleeding.

  5. Primary spinal extradural hydatid cyst associated with acute bleeding

    Directory of Open Access Journals (Sweden)

    Yongxin Wang

    2009-01-01

    Full Text Available Aims: The purpose of this article is to report a case of unilocular primary spinal extradural hydatid cyst which manifested as acute bleeding. Methods: The clinical presentation, diagnosis, and surgical treatment of this rare case are discussed and published cases of primary extradural hydatid cysts are reviewed. Results: Complete recovery was achieved. Repeated clinical, radiological, and serological examinations did not show any evidence of local recurrence or systemic hydatidosis during the follow-up period of 50 months. Conclusions: Primary spinal extradural hydatid cyst may present as acute bleeding. (Wang Y, Geng D, Zhu G, Du G.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    , 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...

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

    DEFF Research Database (Denmark)

    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...

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

    Institute of Scientific and Technical Information of China (English)

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

    Directory of Open Access Journals (Sweden)

    Pedro Monsanto

    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.

  10. Intractable Hematuria After Left Ventricular Assist Device Implantation: Can Lessons Learned from Gastrointestinal Bleeding Be Applied?

    Science.gov (United States)

    Son, Andre Y; Zhao, Lee; Reyentovich, Alex; Deanda, Abe; Balsam, Leora B

    2016-01-01

    Patients with continuous-flow left ventricular assist devices (CF-LVADs) are at increased risk of bleeding. We reviewed our institutional experience with bleeding in the urinary tract after CF-LVAD implantation and quantified the impact on hospital resource utilization in comparison with bleeding in the gastrointestinal (GI) tract, the most commonly reported mucosal site of bleeding after LVAD implantation. Records were retrospectively reviewed for patients undergoing CF-LVAD implantation at our institution between October 2011 and April 2015. Major adverse events of gross hematuria and GI bleeding were identified, and patient demographics and hospital course were reviewed. Gross hematuria occurred in 3 of the 35 patients (8.6%) and in 5.1% of all hospitalizations for CF-LVAD patients. Severe hematuria occurred after traumatic urethral catheterization, urinary retention, or urologic surgery. Hospitalization for hematuria was six times less likely than hospitalization for GI bleeding; however, hematuria hospitalizations lasted 3.2 times longer than GI bleeding hospitalizations (17.0 vs. 5.3 days). Late recurrent gross hematuria occurred in all cases, with rehospitalization occurring after 109 ± 53 days. In conclusion, gross hematuria is an infrequent but morbid bleeding complication in CF-LVAD patients. Strategies to avoid this complication include strict avoidance of traumatic urethral catheterization and urinary retention in high-risk patients.

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

    Institute of Scientific and Technical Information of China (English)

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

    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.

  12. Evaluation of /sup 99m/Tc labeled red blood cell scintigraphy for the detection and localization of gastrointestinal bleeding sites

    Energy Technology Data Exchange (ETDEWEB)

    Markisz, J.A.; Front, D.; Royal, H.D.; Sacks, B.; Parker, J.A.; Kolodny, G.M.

    1982-08-01

    /sup 99m/Tc labeled red blood cell scintigraphy was performed upon 39 patients with clinical evidence for acute lower gastrointestinal bleeding from an unknown source. Seventeen of 39 patients (44%) had a scan became positive 6 or more h after injection, consistent with intermittent bleeding, in 8 of 17 patients (47%). In the 11 patients in whom the bleeding site was definitely identified by arteriography, surgery, or colonoscopy, scintigraphy correctly localized the bleeding site in 10 of 11 patients (91%). Four of 11 patients (36%) had an active bleeding site identified by arteriography. Ten of 17 patients (58%) with a positive scan required either gelfoam embolization (4 patients) or surgery (6 patients) to control the bleeding, whereas only 1 of 22 patients (5%) required surgery when the scan was negative. Six deaths occurred in the scan-positive patients compared with no deaths in the scan-negative patients. None of the 8 patients who had arteriography and no active bleeding site by scintigraphy had arteriographically demonstrable active bleeding. Scintigraphy provides a reliable noninvasive test to screen patients in whom arteriography is being considered to localize active bleeding sites. If the arteriogram is negative, the scintigraphic findings alone may guide the surgical or arteriographic intervention. In addition, scintigraphy identifies two patient populations which have considerably different morbidity and mortality.

  13. Somatostatin analogues for acute bleeding oesophageal varices

    DEFF Research Database (Denmark)

    Gøtzsche, Peter C.; Hrobjartsson, A.

    2008-01-01

    or recent bleeding from oesophageal varices. DATA COLLECTION AND ANALYSIS: The outcome measures extracted were: mortality, blood transfusions, use of balloon tamponade, initial haemostasis and rebleeding. Intention-to-treat analyses including all randomised patients were conducted if possible; a random...... it was substantially reduced in the other trials, relative risk 0.36 (0.19 to 0.68). Use of balloon tamponade was rarely reported. AUTHORS' CONCLUSIONS: The need for blood transfusions corresponded to one half unit of blood saved per patient. It is doubtful whether this effect is worthwhile. The findings do...

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

    Directory of Open Access Journals (Sweden)

    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.

  15. Brunner's Gland Adenoma – A Rare Cause of Gastrointestinal Bleeding: Case Report and Systematic Review

    Science.gov (United States)

    Sorleto, Michele; Timmer-Stranghöner, Annette; Wuttig, Helge; Engelhard, Oliver; Gartung, Carsten

    2017-01-01

    Brunner's gland adenoma is an extremely rare benign small bowel neoplasm, often discovered incidentally during upper gastrointestinal endoscopy or radiological diagnostics. In few cases, it tends to cause gastrointestinal hemorrhage or intestinal obstruction. We report here our experience with a 47-year-old woman with a Brunner's gland adenoma of more than 6 cm in size, located in the first part of the duodenum and causing gastrointestinal bleeding. Initially, we performed a partial endoscopic resection using endoloop and snare alternatively to prevent severe bleeding. A rest endoscopic polypectomy with the submucosal dissection technique was planned. However, on request of the patient, an elective surgical duodenotomy with submucosal resection of the remaining small duodenal tumor was performed. To better define the patient's characteristics and treatment options of such lesions, we performed a systematic review of the available literature in PubMed. Recently, an endoscopic removal is being increasingly practiced and is considered as a safe treatment modality of such lesions. PMID:28203131

  16. Applying Classification Trees to Hospital Administrative Data to Identify Patients with Lower Gastrointestinal Bleeding.

    Directory of Open Access Journals (Sweden)

    Juned Siddique

    Full Text Available Lower gastrointestinal bleeding (LGIB is a common cause of acute hospitalization. Currently, there is no accepted standard for identifying patients with LGIB in hospital administrative data. The objective of this study was to develop and validate a set of classification algorithms that use hospital administrative data to identify LGIB.Our sample consists of patients admitted between July 1, 2001 and June 30, 2003 (derivation cohort and July 1, 2003 and June 30, 2005 (validation cohort to the general medicine inpatient service of the University of Chicago Hospital, a large urban academic medical center. Confirmed cases of LGIB in both cohorts were determined by reviewing the charts of those patients who had at least 1 of 36 principal or secondary International Classification of Diseases, Ninth revision, Clinical Modification (ICD-9-CM diagnosis codes associated with LGIB. Classification trees were used on the data of the derivation cohort to develop a set of decision rules for identifying patients with LGIB. These rules were then applied to the validation cohort to assess their performance.Three classification algorithms were identified and validated: a high specificity rule with 80.1% sensitivity and 95.8% specificity, a rule that balances sensitivity and specificity (87.8% sensitivity, 90.9% specificity, and a high sensitivity rule with 100% sensitivity and 91.0% specificity.These classification algorithms can be used in future studies to evaluate resource utilization and assess outcomes associated with LGIB without the use of chart review.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  18. A rare cause for severe recurrent lower gastrointestinal bleeding in a 12 year old patient

    Directory of Open Access Journals (Sweden)

    D. Belsha

    2015-09-01

    Full Text Available The cause for severe, recurrent lower gastrointestinal (LGI bleeding in children can usually be diagnosed readily by means of the commonly used investigative/diagnostic techniques such as colonoscopy, laparoscopy ± laparotomy. Occasionally less commonly used investigations may be necessary to look for more elusive causes of LGI bleeding such as capsule endoscopy, angiography, technetium-99m (99m Tc-labeled red blood cell (RBC scintigraphy, cross-sectional imaging such as CT/MRI (including angiography and laparotomy combined with on-table small bowel enteroscopy. We report a case of severe, recurrent LGI bleeding that had occurred over several years, where the cause remained elusive despite numerous investigations and interventions. The etiology of this was eventually found to be a gastric duplication cyst infiltrating into adjacent transverse colon and causing bleeding from peptic ulceration in the colon. The process by which this diagnosis was made and the lessons learned are discussed.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  1. Clinical analysis of acute severe lower gastrointestinal bleeding and risk factors for recurrence in Crohn's disease%克罗恩病合并急性下消化道大出血的临床特点及再出血危险因素分析

    Institute of Scientific and Technical Information of China (English)

    杨红; 罗涵清; 阮戈冲; 金梦; 王丽; 钱家鸣

    2015-01-01

    Objective To analyze the clinical characteristics and the recurrence factors of acute severe lower gastrointestinal bleeding (GIB) in Crohn's disease (CD). Methods The clinical data of 29 CD patients with acute severe lower GIB from Dec., 2002 to Dec., 2012 were retrospectively analyzed. Results Twenty-nine patients (7.0%) were identified as acute severe lower GIB in 417 CD patients, the average age at the time of the onset was 29.5 years old, and the average age at the time of the first bleeding episode was 32.9 years old. The mortality was 24.1% and the incidence of rebleeding was 60.0%.The propotion of localization of bleeding in the small intestine was 62.1%, in the colon was 37.9%. The positive rate of diagnosis was 20.0% in colonscopy, 56.3% in angiography, and 77.8% in MDCT. Steroid alone might increase 4.567 folds for the risk of rebleeding (P = 0.0155). Platelet count increased could predict the recurrence of bleeding (P=0.0661, HR=3.858). Conclusion The incidence of rebleeding and mortality is high in the patients with CD and acute severe lower GIB. MDCT may be helpful for the diagnosis of the location.The use of glucocorticoid and the promotion of platelet count are the independent risk factors for recurrence of bleeding.%目的:探讨克罗恩病合并急性下消化道大出血病例的临床特点,及再出血危险因素。方法回顾性分析2002年12月至2012年12月29例克罗恩病合并急性下消化道大出血患者的临床资料。结果417例确诊克罗恩病患者中,发生急性下消化道大出血者29例(7.0%),平均发病年龄29.5岁,平均第1次出血年龄32.9岁,复发出血率60.0%(15/25),病死率24.1%(7/24)。出血好发部位依次为小肠(62.1%),结肠(37.9%)。出血部位的诊断以多层螺旋CT诊断阳性率最高(77.8%),其次为血管造影(56.3%)、结肠镜阳性率最低(20.0%)。糖皮质激素治疗使出血复发的风险增加4.567倍(P=0.0155

  2. National variation in transfusion strategies in patients with upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Steinthorsdottir, Kristin J; Svenningsen, Peter; Fabricius, Rasmus;

    2016-01-01

    INTRODUCTION: An optimal transfusion strategy for patients with upper gastrointestinal bleeding (UGIB) has yet to be established. The national guidelines contain recommendations for patients with life-threating bleeding in general, but no specific recommendations for patients with UGIB. We...... in Denmark in order to discover regional differences. RESULTS: A total of 5,292 admissions with treatment for non-variceal UGIB were identified, and analysis was made for the total group and a massive transfusions group (330 admissions). In the Capital Region, transfusion of platelets was more likely than...

  3. Isolated Splenic Vein Thrombosis: 8-Year-Old Boy with Massive Upper Gastrointestinal Bleeding and Hypersplenism.

    Science.gov (United States)

    Kiani, Mohammad Ali; Forouzan, Arash; Masoumi, Kambiz; Mazdaee, Behnaz; Bahadoram, Mohammad; Kianifar, Hamid Reza; Ravari, Hassan

    2015-01-01

    We present an 8-year-old boy who was referred to our center with the complaint of upper gastrointestinal bleeding and was diagnosed with hypersplenism and progressive esophageal varices. Performing a computerized tomography (CT) scan, we discovered a suspicious finding in the venography phase in favor of thrombosis in the splenic vein. Once complementary examinations were done and due to recurrent bleeding and band ligation failure, the patient underwent splenectomy. And during the one-year follow-up obvious improvement of the esophageal varices was observed in endoscopy.

  4. Isolated Splenic Vein Thrombosis: 8-Year-Old Boy with Massive Upper Gastrointestinal Bleeding and Hypersplenism

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Kiani

    2015-01-01

    Full Text Available We present an 8-year-old boy who was referred to our center with the complaint of upper gastrointestinal bleeding and was diagnosed with hypersplenism and progressive esophageal varices. Performing a computerized tomography (CT scan, we discovered a suspicious finding in the venography phase in favor of thrombosis in the splenic vein. Once complementary examinations were done and due to recurrent bleeding and band ligation failure, the patient underwent splenectomy. And during the one-year follow-up obvious improvement of the esophageal varices was observed in endoscopy.

  5. 国产奥美拉唑治疗急性非静脉曲张性上消化道出血的Meta分析%Effectiveness and Safety of China-Made Omeprazole in Treating Acute Non-Variceal Upper Gastrointestinal Bleeding: A Meta-Analysis

    Institute of Scientific and Technical Information of China (English)

    刘文平; 黄彩云

    2013-01-01

    目的 系统评价国产奥美拉唑治疗急性非静脉曲张性上消化道出血的疗效和安全性.方法 计算机检索PubMed、MEDLINE、Springer、The Cochrane Library、CNKI、VIP、CBM、WanFang Data等数据库,收集国产奥美拉唑治疗急性非静脉曲张性上消化道出血的随机对照试验(RCT),检索时限均为建库至2012年12月,并追溯纳入研究的参考文献.由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.1软件进行Meta分析.结果 纳入11个RCT,共1 075例患者(试验组544例,对照组531例).Meta分析结果显示,国产奥美拉唑与进口奥美拉唑相比,在急性非静脉曲张性上消化道出血的总有效率[OR=0.68,95%CI (0.35,1.33),P=0.26]和不良反应发生率[RR=1.33,95%CI (0.45,3.91),P=0.60]方面,两组差异无统计学意义.结论 国产奥美拉唑治疗急性非静脉曲张性上消化道出血疗效与进口奥美拉相当,安全有效.%Objective To systematically evaluate the effectiveness and safety of China-made omeprazole in treating acute non-variceal upper gastrointestinal bleeding.Methods Such databases as PubMed,MEDLINE,Springer,The Cochrane Library,CNKI,VIP,CBM and WanFang data were searched to collect the randomized controlled trials (RCTs)about China-made omeprazole in treating acute non-variceal upper gastrointestinal bleeding,and the references of included studies were also retrieved.The retrieval time was from inception to December 2012.Two reviewers independently screened the literature according to the inclusion and exclusion criteria,extracted the data,and assessed the quality,and then the meta-analysis was conducted by using RevMan 5.1 software.Results A total of 11 RCTs were included.Among all 1 075 patients,544 were in the treatment group,while the other 531 were in the control group.The results of metaanalysis showed that,there were no significant differences in the total effective rate (OR=0.68,95

  6. Emergency single-balloon enteroscopy in overt obscure gastrointestinal bleeding: Efficacy and safety

    Science.gov (United States)

    Pinho, Rolando; Rodrigues, Adélia; Fernandes, Carlos; Ribeiro, Iolanda; Fraga, José; Carvalho, João

    2014-01-01

    We aimed to evaluate the impact of emergency single-balloon enteroscopy (SBE) on the diagnosis and treatment for active overt obscure gastrointestinal bleeding (OGIB). Methods SBE procedures for OGIB were retrospectively reviewed and sub-divided according to the bleeding types: active-overt and inactive-overt bleeding. The patient’s history, laboratory results, endoscopic findings and therapeutic interventions were registered. Emergency SBE was defined as an endoscopy that was performed for active-overt OGIB, within 24 hours of clinical presentation. Results Between January 2010 and February 2013, 53 SBEs were performed in 43 patients with overt OGIB. Seventeen emergency SBEs were performed in 15 patients with active overt-OGIB procedures (group A), which diagnosed the bleeding source in 14: angiodysplasia (n = 5), ulcers/erosions (n = 3), bleeding tumors (gastrointestinal stromal tumor (GIST), n = 3; neuroendocrine tumor, n = 1), and erosioned polyps (n = 2). Endoscopic treatment was performed in nine patients, with one or multiple hemostatic therapies: argon plasma coagulation (n = 5), epinephrine submucosal injection (n = 5), hemostatic clips (n = 3), and polypectomy (n = 2). Twenty-eight patients with inactive bleeding (group B) were submitted to 36 elective SBEs, which successfully diagnosed 18 cases. The diagnostic yield in group A (93.3%) was significantly higher than in group B (64.3%)—Fisher’s exact test, p = 0.038. Conclusion This study revealed an important role of emergency SBE in the diagnosis of bleeding etiology in active overt OGIB. PMID:25452844

  7. 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

    DEFF Research Database (Denmark)

    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: Recombinan...... for stabilizing the 99mTc(CO)3 1-ligand structure in FVIIa were identified. Conclusion: Radiolabelled rFVIIa derivatives may represent a novel tool for the diagnosis of acute gastrointestinal bleeding lesions....

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  9. The American Society for Gastrointestinal Endoscopy (ASGE) diagnostic algorithm for obscure gastrointestinal bleeding: eight burning questions from everyday clinical practice.

    Science.gov (United States)

    Rondonotti, Emanuele; Marmo, Riccardo; Petracchini, Massimo; de Franchis, Roberto; Pennazio, Marco

    2013-03-01

    The diagnosis and management of patients with obscure gastrointestinal bleeding are often long and challenging processes. Over the last 10 years the introduction in clinical practice of new diagnostic and therapeutic procedures (i.e. Capsule Endoscopy, Computed Tomographic Enterography, Magnetic Resonance Enterography, and Device Assisted Enteroscopy) has revolutionized the diagnostic/therapeutic work-up of these patients. Based on evidence published in the last 10 years, international scientific societies have proposed new practice guidelines for the management of obscure gastrointestinal bleeding, which include these techniques. However, although these algorithms (the most recent ones are endorsed by the American Society for Gastrointestinal Endoscopy - ASGE) allow the management of the large majority of patients, some issues still remain unsolved. The present paper reports the results of the discussion, based on the literature published up to September 2011, among a panel of experts and gastroenterologists, working with Capsule Endoscopy and with Device Assisted Enteroscopy, attending the 6th annual meeting of the Italian Club for Capsule Endoscopy and Enteroscopy. Eight unresolved issues were selected: each of them is presented as a "Burning question" and the "Answer" is the strategy proposed to manage it, according to both the available evidence and the discussion among participants.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Institute of Scientific and Technical Information of China (English)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  13. Gastric Metastasis of Hepatocellular Carcinoma With Gastrointestinal Bleeding After Liver Transplant: A Case Report.

    Science.gov (United States)

    Li, L; Zhang, W H; Meng, F P; Ma, X M; Shen, L J; Jin, B; Li, H W; Han, J; Zhou, G D; Liu, S H

    2015-10-01

    Gastrointestinal (GI) metastasis of hepatocellular carcinoma is very rare. This is the first report of post-transplantation gastric metastasis. A 43-year-old man with a history of hepatitis B-related hepatocellular carcinoma (HCC) in the right anterior segment of the liver received an orthotopic liver transplant. Three months after the transplantation, pulmonary metastasis was found by chest computed tomography, and he received 1 course of gamma knife treatment. He complained of melena with anemia 17 months post liver transplantation. Abdominal CT scan showed new occupying lesions in the liver and a mass in the stomach and around the spleen with embolus in the splenic vein. Endoscopy revealed a large irregular cauliflower-like mass in fundus with ulceration and bleeding on the surface. He received symptomatic treatment, but died of cancer-related bleeding 4 months later. GI bleeding may due to gastric metastasis after liver transplantation.

  14. Obscure gastrointestinal bleeding: preliminary comparison of 64-section CT enteroclysis with video capsule endoscopy

    Energy Technology Data Exchange (ETDEWEB)

    Khalife, Samer; Vahedi, Kouroche; Dray, Xavier; Marteau, Philippe [Hopital Lariboisiere-AP-HP, Universite Diderot-Paris 7, Department of Digestive Diseases, Paris Cedex 10 (France); Soyer, Philippe; Hamzi, Lounis; Place, Vinciane; Boudiaf, Mourad [Hopital Lariboisiere-AP-HP, Universite Diderot-Paris 7, Department of Abdominal Imaging, Paris Cedex 10 (France); Alatawi, Abdullah [Hopital Lariboisiere-AP-HP, Universite Diderot-Paris 7, Department of Digestive Diseases, Paris Cedex 10 (France); Hopital Lariboisiere-AP-HP, Universite Diderot-Paris 7, Department of Abdominal Imaging, Paris Cedex 10 (France)

    2011-01-15

    To retrospectively compare the diagnostic capabilities of 64-section CT enteroclysis with those of video capsule endoscopy (VCE) to elucidate the cause of obscure gastrointestinal bleeding. Thirty-two patients who had 64-section CT enteroclysis and VCE because of obscure gastrointestinal bleeding were included. Imaging findings were compared with those obtained at double balloon endoscopy, surgery and histopathological analysis, which were used as a standard of reference. Concordant findings were found in 22 patients (22/32; 69%), including normal findings (n = 13), tumours (n = 7), lymphangiectasia (n = 1) and inflammation (n = 1), and discrepancies in 10 patients (10/32; 31%), including ulcers (n = 3), angioectasias (n = 2), tumours (n = 2) and normal findings (n = 3). No statistical difference in the proportions of abnormal findings between 64-section CT enteroclysis (11/32; 34%) and VCE (17/32, 53%) (P = 0.207) was found. However, 64-section CT enteroclysis helped identify tumours not detected at VCE (n = 2) and definitely excluded suspected tumours (n = 3) because of bulges at VCE. Conversely, VCE showed ulcers (n = 3) and angioectasias (n = 2) which were not visible at 64-section CT enteroclysis. Our results suggest that 64-section CT enteroclysis and VCE have similar overall diagnostic yields in patients with obscure gastrointestinal bleeding. However, the two techniques are complementary in this specific population. (orig.)

  15. Angiogenesis and vascular malformations: Antiangiogenic drugs for treatment of gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Treatment of gastrointestinal bleeding in patients with angiodysplasias and Osler's disease (hereditary hemorrhagic teleangiectasia) is clinically challenging.Frequently, vascular malformations occur as multiple disseminated lesions, making local treatment an unfavorable choice or impossible. After local therapy,lesions often recur at other sites of the intestine.However, as there are few therapeutic alternatives,repeated endoscopic coagulations or surgical resections are still performed to prevent recurrent bleeding.Hormonal therapy has been employed for more than 50 years but has recently been shown to be ineffective.Therefore, new therapeutic strategies are required.Understanding of the pathophysiology of angiogenesis and vascular malformations has recently substantially increased. Currently, multiple inhibitors of angiogenesis are under development for treatment of malignant diseases. Experimental and clinical data suggest that antiangiogenic substances, which were originally developed for treatment of malignant diseases, may also represent long-awaited specific drugs for the treatment of vascular malformations. However, antiangiogenics display significantly different actions and side-effects.Although antiangiogenics like thalidomide seem to inhibit gastrointestinal bleeding, other substances like bevacizumab can cause mucosal bleeding. Therefore differential and cautious evaluation of this therapeutic strategy is necessary.

  16. Predictors of Early Rebleeding after Endoscopic Therapy in Patients with Nonvariceal Upper Gastrointestinal Bleeding Secondary to High-Risk Lesions

    Directory of Open Access Journals (Sweden)

    Davide Maggio

    2013-01-01

    Full Text Available BACKGROUND: In an era of increasingly shortened admissions, data regarding predictors of early rebleeding among patients with nonvariceal upper gastrointestinal bleeding (NVUGIB exhibiting high-risk stigmata (HRS having undergone endoscopic hemostasis are lacking.

  17. A Canadian Clinical Practice Algorithm for the Management of Patients with Non-Variceal Upper Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Alan Barkun

    2004-01-01

    Full Text Available AIM: To use current evidence-based recommendations to provide a user-friendly clinical algorithm for the management of upper gastrointestinal bleeding, adapted to the Canadian environment.

  18. Mortality associated with gastrointestinal bleeding in children: A retrospective cohort study

    Science.gov (United States)

    Attard, Thomas M; Miller, Mikaela; Pant, Chaitanya; Kumar, Ashwath; Thomson, Mike

    2017-01-01

    AIM To determine the clinical characteristics of children with gastrointestinal bleeding (GIB) who died during the course of their admission. METHODS We interrogated the Pediatric Hospital Information System database, including International Classification of Diseases, Current Procedural Terminology and Clinical Transaction Classification coding from 47 pediatric tertiary centers extracting the population of patients (1-21 years of age) admitted (inpatient or observation) with acute, upper or indeterminate GIB (1/2007-9/2015). Descriptive statistics, unadjusted univariate and adjusted multivariate analysis of the associations between patient characteristics and treatment course with mortality was performed with mortality as primary and endoscopy a secondary outcome of interest. All analyses were performed using the R statistical package, v.3.2.3. RESULTS The population with GIB was 19528; 54.6% were male, overall mortality was 2.07%; (0.37% in patients with the principal diagnosis of GIB). When considering only the mortalities in which GIB was the principal diagnosis, 48% (12 of 25 principal diagnosis GIB mortalities) died within the first 3 d of admission, whereas 19.8% of secondary diagnosis GIB patients died with 3 d of admission. Patients who died were more likely to have received octreotide (19.8% c.f. 4.04%) but tended to have not received proton pump inhibitor therapy in the first 48 h, and far less likely to have undergone endoscopy during their admission (OR = 0.489, P < 0.0001). Chronic liver disease associated with a greater likelihood of endoscopy. Mortalities were significantly more likely to have multiple complex chronic conditions. CONCLUSION GIB associated mortality in children is highest within 7 d of admission. Multiple comorbidities are a risk factor whereas early endoscopy during the admission is protective. PMID:28321162

  19. Antiplatelet agents and/or anticoagulants are not associated with worse outcome following nonvariceal upper gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Elvira Manuela Costa Moreira Teles-Sampaio

    Full Text Available Background: Nonvariceal upper gastrointestinal bleeding emerges as a major complication of using antiplatelet agents and/or anticoagulants and represents a clinical challenge in patients undergoing these therapies. Aim: To characterize patients with nonvariceal upper gastrointestinal bleeding related to antithrombotics and their management, and to determine clinical predictors of adverse outcomes. Methods: Retrospective cohort of adults who underwent upper gastrointestinal endoscopy after nonvariceal upper gastrointestinal bleeding from 2010 to 2012. The outcomes were compared between patients exposed and not exposed to antithrombotics. Results: Five hundred and forty-eight patients with nonvariceal upper gastrointestinal bleeding (67% men; mean age 66.5 ± 16.4 years were included, of which 43% received antithrombotics. Most patients had comorbidities. Peptic ulcer was the main diagnosis and endoscopic therapy was performed in 46% of cases. The 30-day mortality rate was 7.7% (n = 42, and 36% were bleeding-related. The recurrence rate was 9% and 14% of patients with initial endoscopic treatment needed endoscopic retreatment. There were no significant differences between the exposed and non-exposed groups in most outcomes. Co-morbidities, hemodynamic instability, high Rockall score, low hemoglobin (7.76 ± 2.72 g/dL and higher international normalized ratio (1.63 ± 1.13 were associated significantly with mortality in a univariate analysis. Conclusions: Adverse outcomes were not associated with antithrombotic use. The management of nonvariceal upper gastrointestinal bleeding constitutes a challenge to clinical performance optimization and clinical cooperation.

  20. Technological value of SPECT/CT fusion imaging for the diagnosis of lower gastrointestinal bleeding.

    Science.gov (United States)

    Wang, Z G; Zhang, G X; Hao, S H; Zhang, W W; Zhang, T; Zhang, Z P; Wu, R X

    2015-11-24

    The aim of this study was to assess the clinical value of diagnosing and locating lower gastrointestinal (GI) bleeding using single photon emission computed tomography (SPECT)/computed tomography (CT) fusion imaging with 99mTc labeled red blood cells ((99m)Tc-RBC). Fifty-six patients with suspected lower GI bleeding received a preoperative intravenous injection of (99m)Tc-RBC and each underwent planar, SPECT/CT imaging of the lower abdominal region. The location and path of lower GI bleeding were diagnosed by contrastive analysis of planar and SPECT/CT fusion imaging. Among the 56 patients selected, there were abnormalities in concentrated radionuclide activity with planar imaging in 50 patients and in SPECT/CT fusion imaging in 52 patients. Moreover, bleeding points that were coincident with the surgical results were evident with planar imaging in 31 patients and with SPECT/CT fusion imaging in 48 patients. The diagnostic sensitivity of planar imaging and SPECT/CT fusion imaging were 89.3% (50/56) and 92.9% (52/56), respectively, and the difference was not statistically significant (χ(2) = 0.11, P > 0.05). The corresponding positional accuracy values were 73.8% (31/42) and 92.3% (48/52), and the difference was statistically significant (χ(2) = 4.63, P CT fusion imaging is an effective, simple, and accurate method that can be used for diagnosing and locating lower GI bleeding.

  1. Upper Gastrointestinal System Bleeding Associated with Mallory-Weiss Syndrome in a Patient with Prosthetic Mitral Valve Using Warfarin Sodium

    Directory of Open Access Journals (Sweden)

    Banu Şahin Yıldız

    2013-08-01

    Full Text Available Mallory-Weiss syndrome refers to bleeding from tears in the mucosa at the junction of the stomach and esophagus. Bleeding has been recognised as the major treatment-limiting complication in patients with prosthetic mitral valve using anticoagulant treatment. We report that upper gastrointestinal system bleeding associated with Mallory-Weiss syndrome in patient with prosthetic mitral valve using warfarin sodium.

  2. The critical role of CT angiography in the detection and management of lower gastro-intestinal bleeding

    OpenAIRE

    2013-01-01

    Lower gastro-intestinal bleeding (LGIB) is defined as a bleeding site localised in the colon or anorectum. (1) In the past, the diagnosis of LGIB has been a serious challenge for the radiology department because of its possible intermittent character, making it difficult to pinpoint the bleeding site. Patients with a LGIB will typically have undergone a long diagnostic work-up before they end up on the interventional radiology department.The development of multi-detector computed tomography (...

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

    Science.gov (United States)

    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.

  4. Evaluation of stress hormones in traumatic brain injury patients with gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Biteghe-Bi-Nzeng Alain-Pascal; WEI Hui-jie; CHEN Xin; ZHANG Jian-ning

    2010-01-01

    Objective:To evaluate the local risk factors of traumatic brain injury(TBI)patients developing gastrointestinal(GI)bleeding during the early hospitalization in neurosurgery intensive care unit(NICU).Method:From September 2005 to February 2006,41 patients admitted to NICU and 13 healthy volunteers were involved in our study.Blood samples at 24 hours,2-3 days and 5-7 days were obtained from each patient via arterial line at 8 a.m.to measure the concentrations of serum adrenocorticotropic hormone(ACTH),total cortisol and gastrin.The collected serum was immersed in an ice bath and tested by the Immulite 1000 systems.Data were analyzed by SPSS 11.5.Results:Within 24 hours following TBI,the concentrations of total cortisol,ACTH and gastrin increased proportionally to the severity of injury,especially significant in the experimental group(P<0.05).The concentrations of ACTH and gastrin were higher in the GI bleeding positive group than in the GI bleeding negative group,(F=1.413,P=0.253)for ACTH and(F=9.371,P=0.006)for gastrin.GI bleeding had a positive correlation with gastrin concentration(r=0.312,P<0.05)and a negative correlation with serum hemoglobin(Hb)(r=-0.420,P<0.01).The clinical incidence of GI bleeding was 24.39%(10/41)in the experimental group.Within 24 hours,GI bleeding had a strong correlation with gastrin concentration(OR=26.643,P<0.05)and hematocrit(Hct)(OR=5.385,P<0.05).High ACTH concentration(>100 pg/ml)increased the frequency of GI bleeding.For patients with severe TBI and treated with routine antacids,the incidence of GI bleeding was 40.91%(9/22)and the mortality rate was 20%(2/10).Conclusions:Low Glasgow coma scale scores,low Hb,high concentrations of gastrin and ACTH(>100 pg/ml)are risk factors and can be predictive values for post-traumatic GI bleeding.Severe TBI patients have high risks of GI bleeding with high mortality.

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

    Institute of Scientific and Technical Information of China (English)

    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

  6. Acute gastrointestinal emergencies requiring surgery in children

    Directory of Open Access Journals (Sweden)

    Pujari Amit

    2008-01-01

    Full Text Available Background: Although abdominal pain is common in the paediatric age group, problems of misdiagnosis and serious consequences are more particular in an emergency setting. This study examined the aetiologies of acute abdominal emergencies in children. Materials and Methods: This was a retrospective study of 100 children below the age of 12 years presenting with acute abdominal emergencies (gastrointestinal requiring operative interventions. All patients were operated on an emergency basis and the intraoperative findings were correlated with the clinical findings. Results: Acute abdominal emergencies in the paediatric age group were heterogenous, with a myriad of aetiological factors. Overall, 73% of patients were greater than 3 years of age. Early neonatal period formed the second most common group (12%. Acute appendicitis was the most common cause except in the infancy period where congenital abnormalities predominated. Conclusion: The correct diagnosis of acute abdomen in children requires attention to clinical details and a high degree of suspicion. Early surgical intervention in doubtful cases may be necessary to solve diagnostic problems.

  7. Sarcomatoid carcinoma of the jejunum presenting as obscure gastrointestinal bleeding in a patient with a history of gliosarcoma

    Science.gov (United States)

    Alfonso Puentes, Nidia; Jimenez-Alfaro Larrazabal, Carmen; García Higuera, Maria Isabel

    2014-01-01

    Small bowel malignant tumors are rare and sarcomatoid carcinomas have rarely been reported at this site. We report a 56-year-old woman, with history of an excised gliosarcoma, who presented with recurrent obscure gastrointestinal bleeding. She underwent endoscopy and colonoscopy, which failed to identify the cause of the bleeding. The abdominal computed tomography scan located a tumor in the small bowel. Pathology revealed a jejunal sarcomatoid carcinoma. She developed tumor recurrence and multiple liver metastases shortly after surgery. Immunohistochemistry is required for accurate diagnosis. Sarcomatoid carcinoma is a rare cause of obscure gastrointestinal bleeding, which is associated with a poor prognosis. PMID:24759341

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    agent (0.76, 0.68 to 0.86), and oral anticoagulation plus an antiplatelet agent (0.41, 0.32 to 0.52), and a reduced risk of thromboembolism was found in association with restart of oral anticoagulation (0.41, 0.31 to 0.54), an antiplatelet agent (0.76, 0.61 to 0.95), and oral anticoagulation plus...... an antiplatelet agent (0.54, 0.36 to 0.82). Restarting oral anticoagulation alone was the only regimen with an increased risk of major bleeding (1.37, 1.06 to 1.77) compared with non-resumption of treatment; however, the difference in risk of recurrent gastrointestinal bleeding was not significant between......-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...

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

    Institute of Scientific and Technical Information of China (English)

    Liz; Toapanta-Yanchapaxi; Norberto; Chavez-Tapia; Félix; Téllez-ávila

    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 though adequate use of the available resources is made. Reasons for these failures can be associated with the lesion features, such as extent or location. The use of long-standing techniques in nontraditional scenarios, such as with cyanoacrylate for gastric varices sclerosis, has been reported with favorable results. Although new products such as TC-325 or Ankaferd Blood Stopper hemosprays may be useful, their formulations are not available worldwide. Here we present two clinical cases with very different scenarios of gastrointestinal bleeding, where the use of cyanoac-rylate in spray had favorable results in uncommon indications. Cyanoacrylate used as a spray is a technique that can be used as an alternative method in emergent settings.

  10. Analysis of etiology in gastrointestinal bleeding%消化道出血的病因分析及临床研究

    Institute of Scientific and Technical Information of China (English)

    朱才雄

    2014-01-01

    ObjectiveTo analyze and discuss the etiology of gastrointestinal bleeding and provide a theoretical reference for the clinical diagnosis of gastrointestinal bleeding.Methods Selected 120 cases of gastrointestinal bleeding patients between 2010.03 to 2013.03 under treatment at our hospital,collected all the clinical data, and then analyzed with a view to explore the possible causes of morbidity.Results 75 cases'positions of bleeding located in upper gastrointestinal,62.5%(75/120)and 45 cases in lower gastrointestinal, 37.5%(45/120). Viewed causes of bleeding in the upper gastrointestinal tract,the most common one is peptic ulcer disease,a total of 36 cases,accounting for 48.0% (36/75), and acute gastric mucosal lesion of esophageal and gastric varices were followed,a total of 13 cases of the former,17.3% (13/75), a total of 10 cases of the later,accounting for 13.3%(10/75);Viewed causes of bleeding in the lower gastrointestinal,the main were tumor and inflammatory lesions,25 cases of the former, accounting for 55.6% (25/45),7 cases of the later,accounting for 15.6%(7/45).Conclusion The most common site of gastrointestinal bleeding located in upper gastrointestinal. The first causation of bleeding was peptic ulcer in upper gastrointestinal and tumor in lower gastrointestinal respectively.%目的:通过对消化道出血患者的发病原因的分析探讨,为消化道出血的临床诊断提供理论参考依据。方法选取120例2010年3月~2013年3月间于我院就诊的消化道出血患者,收集所有的病例资料,然后整理分析,探讨可能的发病原因。结果120例患者中,上消化道出血为75例,占62.5%(75/120);下消化道出血为45例,占37.5%(45/120);上消化道的出血原因中,消化性溃疡是最常见的,共36例,占48.0%(36/75),急性的胃黏膜病变以及食管胃底的静脉曲张破裂为其次,前者共13例,占17.3%(13/75),后者共10例,占13.3%(10/75);下消化

  11. Is Endoscopic Therapy Safe for Upper Gastrointestinal Bleeding in Anticoagulated Patients With Supratherapeutic International Normalized Ratios?

    Science.gov (United States)

    Shim, Choong Nam; Chung, Hyun Soo; Park, Jun Chul; Shin, Sung Kwan; Lee, Sang Kil; Lee, Yong Chan; Kim, Ha Yan; Kim, Dong Wook; Lee, Hyuk

    2016-01-01

    The management of upper gastrointestinal bleeding (UGIB) in anticoagulated patients with supratherapeutic international normalized ratios (INRs) presents a challenge. The purpose of the study was to evaluate the safety of endoscopic therapy for UGIB in anticoagulated patients with supratherapeutic INR in terms of rebleeding and therapeutic outcomes. One hundred ninety-two anticoagulated patients who underwent endoscopic treatment for UGIB were enrolled in the study. Patients were divided into 2 groups based on the occurrence of rebleeding within 30 days of the initial therapeutic endoscopy: no-rebleeding group (n = 168) and rebleeding group (n = 24). The overall rebleeding rate was 12.5%. Bleeding from gastric cancer and bleeding at the duodenum were significantly related to rebleeding in a univariate analysis. Multivariate analysis determined that presenting symptoms other than melena (hematemesis, hematochezia, or others) (odds ratio, 3.93; 95% confidence interval, 1.44-10.76) and bleeding from gastric cancer (odds ratio, 6.10; 95% confidence interval, 1.27-29.25) were significant factors predictive of rebleeding. Supratherapeutic INR at the time of endoscopic therapy was not significantly associated with rebleeding in either univariate or multivariate analysis. Significant differences in bleeding-related mortality, additional intervention to control bleeding, length of hospital stay, and transfusion requirements were revealed between the rebleeding and no-rebleeding groups. There were no significant differences in therapeutic outcomes between patients with INR within the therapeutic range and those with supratherapeutic INR. Supratherapeutic INR at the time of endoscopic therapy did not change rebleeding and therapeutic outcomes. Thus, we should consider endoscopic therapy for UGIB in anticoagulated patients, irrespective of INR at the time of endoscopic therapy.

  12. Predictors of positive endoscopic findings in hospitalized patients with occult gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Neil Sengupta

    2015-12-01

    Full Text Available Anemia with occult gastrointestinal bleeding (OGIB is a common reason for inpatient gastroenterology consultation and endoscopy. However, the utility of inpatient endoscopy in this setting is unclear. The aim of this paper is to determine variables that predict positive endoscopic examinations for inpatients presenting with anemia and OGIB. We performed a prospective observational study of consecutive hospitalized patients between March 2013 and April 2014 with anemia and OGIB. For patients undergoing inpatient endoscopic evaluation, logistic regression was used to determine which variables were associated with detecting etiology of OGIB. An occult bleeding score (OBS was created using receiver operating characteristics and area under the curve (AUC analysis to predict detection of bleeding source and need for endoscopic intervention. Of the 74 patients identified, 55 (74% underwent endoscopic evaluation, of whom 28 patients had a source of OGIB identified. Patients with malignancy (OR 7.25, 95%CI 1.06-144 were more likely to have a bleeding source identified on endoscopy, whereas patients with higher admission hemoglobin levels were less likely to have a detected source (OR 0.62, 95%CI 0.41-0.86. The OBS was constructed by assigning a point each for malignancy and admission hemoglobin <8.2 g/dL. The OBS predicted detection of etiology of bleeding and endoscopic intervention with an AUC of 0.79 and 0.75. The yield of endoscopy in determining a bleeding source in patients with OGIB is significant particularly in patients with malignancy or a low hemoglobin level. A simple score can assist in determining whether inpatient endoscopy is warranted in this population.

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

    Science.gov (United States)

    Foley, P T; Ganeshan, A; Anthony, S; Uberoi, R

    2010-02-01

    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.

  14. Initial assessment and management of patients with nonvariceal upper gastrointestinal bleeding.

    Science.gov (United States)

    Bethea, Emily D; Travis, Anne C; Saltzman, John R

    2014-01-01

    Upper gastrointestinal bleeding (UGIB) is a substantial clinical and economic burden, with an estimated mortality rate between 3% and 15%. The initial management starts with hemodynamic assessment and resuscitation. Blood transfusions may be needed in patients with low hemoglobin levels or massive bleeding, and patients who are anticoagulated may require administration of fresh frozen plasma. Patients with significant bleeding should be started on a proton-pump inhibitor infusion, and if there is concern for variceal bleeding, an octreotide infusion. Patients with UGIB should be stratified into low-risk and high-risk categories using validated risk scores. The use of these risk scores can aid in separating low-risk patients who are suitable for outpatient management or early discharge following endoscopy from patients who are at increased risk for needing endoscopic intervention, rebleeding, and death. Upper endoscopy after adequate resuscitation is required for most patients and should be performed within 24 hours of presentation. Key to improving outcomes is appropriate initial management of patients presenting with UGIB.

  15. Colonoscopic findings and management of patients with outbreak typhoid fever presenting with lower gastrointestinal bleeding.

    Science.gov (United States)

    Shaikhani, Mohammad A R; Husein, Hiwa A B; Karbuli, Taha A; Mohamed, Mohamed Abdulrahman

    2013-09-01

    Lower gastrointestinal bleeding (LGIB) along with intestinal perforation is a well-known complication of typhoid fever. Reports of colonoscopic appearance and intervention of typhoid perforation involve only few cases. This series reports the colonoscopic findings and the role of colonoscopic hemostatic interventions in controlling the bleeding ileocolonic lesions. During the typhoid fever outbreak in Sulaymaniyah City in Iraqi Kurdistan Region, we received 52 patients with LGIB manifesting as fresh bleeding per rectum or melena. We performed total colonoscopy with ileal intubation for all cases. The findings were recorded and endoscopic hemostatic intervention with adrenaline-saline injection and argon plasma coagulation was applied to actively bleeding lesion. These patients were young, 11-30 years of age, with female preponderance. Blood culture was positive in 50 %. Colonoscopic findings were mostly located in the ileocecal region, although other areas of the colon were involved in many cases. Twenty-four percent of the cases required endoscopic hemostatic intervention by adrenaline injection with argon plasma coagulation which was effective in all patients except one who died in spite of surgical intervention in addition of endoscopic hemostasis. Dual endoscopic hemostatic intervention can be a safe and effective management option for patients with LGIB due to typhoid fever.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  18. UPPER GASTRO-INTESTINAL BLEEDING IN THE YOUNG - GASTRIC GIST TUMOR OR PEPTIC ULCER DISEASE?

    Directory of Open Access Journals (Sweden)

    Ayodele Atolagbe

    2015-09-01

    Full Text Available GIST tumors is very unusual in the young and middle aged and a high index of suspicion is needed for the diagnosis in young patients who present with upper gastrointestinal bleeding. Appropriate imaging such as a Computed tomographic scan (CT scan may identify this tumor which may easily be misdiagnosed as a bleeding Peptic Ulcer Disease in the young. We present a case of a healthy 38 year old man with no alcohol use who presented with epigastric pain and melena and subsequent torrential bleeding uncontrolled during endoscopy necessitating an emergency exploratory laparotomy by the general surgery team. The bleeding intraluminal component of the tumor with gross splenic and pancreatic involvement was identified and surgical management consisted of a wedge resection of the greater curvature of the stomach incorporating the tumor and the spleen with successful dissection of the tumor off the tail of the pancreas. Histology was positive for C-KIT and DOG-1 markers. Postoperative course was uneventful and he is presently on Imatinib Mesylate.

  19. Retroperitoneal Leiomyosarcoma Presenting as Lower Gastrointestinal Bleeding: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Dominic G. Ventura

    2011-01-01

    Full Text Available We report the first known case of a retroperitoneal leiomyosarcoma that presented with an endoscopically defined source of gastrointestinal bleeding in the colon. A 68-year-old male with a history of diverticulosis, hypertension, and hypercholesterolemia who complained of a 3-month history of abdominal pain, nausea, and intermittent hematochezia presented for evaluation of large volume hematochezia and lightheadedness. Colonoscopy revealed left-sided diverticulosis and rectal varices without stigmata of recent bleed. CT scan showed a 26 × 20 × 13 cm heterogeneous retroperitoneal mass and multiple hypodense hepatic lesions. Liver biopsy revealed leiomyosarcoma. In summary, although surgery is the mainstay of treatment, resectability has not improved significantly. Early recognition and aggressive surgery are keys to long-term survival.

  20. Gastrointestinal bleeding secondary to trimethoprim-sulfamethoxazole-induced vitamin K deficiency.

    Science.gov (United States)

    Fotouhie, Azadeh; Desai, Hem; King, Skye; Parsa, Nour Alhoda

    2016-06-06

    There is a well-known association between vitamin K deficiency and haemorrhagic events including gastrointestinal bleeding. There is also a well-known association between both poor dietary intake of vitamin K and chronic antibiotic use and the development of vitamin K deficiency. Although the medical literature notes that cephalosporin antibiotics have a propensity to cause vitamin K deficiency due to the molecular structure of the medications and their ability to suppress the synthesis of clotting factors, there are other antibiotics that have also been implicated in the development of vitamin K deficiency. There are very few reports of trimethoprim/sulfamethoxazole causing vitamin K deficiency and further leading to bleeding episodes. We present such a case and discuss the risk factors leading to such complications.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  2. New insights on an old medical emergency: non-portal hypertension related upper gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Tiago Cúrdia-Gonçalves

    Full Text Available Upper gastrointestinal bleeding (UGIB is a potentially life-threatening condition and the most common medical emergency managed by gastroenterologists. Despite being one of the most antique medical problems, recent studies have been slowly changing the management of these patients, which should nowadays include not only initial resuscitation, but also risk stratification, pre-endoscopic therapy, endoscopy treatment, and post-procedure care. The aim of this paper is to review the extended approach to the patient with non-portal hypertension related UGIB.

  3. Use of CT enterography for the diagnosis of lower gastrointestinal bleeding in pediatric patients.

    Science.gov (United States)

    Davis, James S; Ryan, Mark L; Fields, Jonathan M; Neville, Holly L; Perez, Eduardo A; Sola, Juan E

    2013-03-01

    Diagnosis of lower gastrointestinal bleeding (LGIB) represents a significant diagnostic and therapeutic challenge for any physician. While CT enterography (CTE) has been applied in adults with occult LGIB, its use in children has been limited to evaluation of Crohn's disease. We reviewed 6 patients ages 4-15 who underwent CTE for LGIB at a tertiary pediatric institution. In sum, CTE appears to be a valuable tool for localizing the source of LGIB prior to surgical or endoscopic intervention. However, rapid lesion identification must be weighed against the increased radiation exposure and patient discomfort due to bowel distention associated with this diagnostic technique.

  4. Ileal angiodysplasia causing chronic, occult gastrointestinal bleeding in a 14-year-old boy

    Directory of Open Access Journals (Sweden)

    Andrew Jackson Murphy

    2017-01-01

    Diagnostic laparoscopy revealed intra-abdominal adhesions and no clear vascular malformation. Initial careful visual and manual examination of the bowel after conversion to laparotomy failed to identify the lesion. On-table retrograde enteroscopy demonstrated a small, pulsatile lesion without ulceration or adherent clot in the mucosa of the proximal ileum. With endoscopic transillumination, a cluster of serpiginous vessels could be seen within the wall of the small bowel. The lesion was resected and pathology was consistent with angiodysplasia. Angiodysplasia is a rare cause of occult, chronic gastrointestinal bleeding in children. A multidisciplinary approach optimizes the likelihood of therapeutic success.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    OpenAIRE

    2008-01-01

    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 negativ...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Institute of Scientific and Technical Information of China (English)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  10. A novel approach to assess the spontaneous gastrointestinal bleeding risk of antithrombotic agents using Apc(min/+) mice.

    Science.gov (United States)

    Wei, Huijun; Shang, Jin; Keohane, CarolAnn; Wang, Min; Li, Qiu; Ni, Weihua; O'Neill, Kim; Chintala, Madhu

    2014-06-01

    Assessment of the bleeding risk of antithrombotic agents is usually performed in healthy animals with some form of vascular injury to peripheral organs to induce bleeding. However, bleeding observed in patients with currently marketed antithrombotic drugs is typically spontaneous in nature such as intracranial haemorrhage (ICH) and gastrointestinal (GI) bleeding, which happens most frequently on top of preexisting pathologies such as GI ulcerations and polyps. Apc(min/+) mice are reported to develop multiple adenomas through the entire intestinal tract and display progressive anaemia.In this study, we evaluated the potential utility of Apc(min/+) mice as a model for assessing spontaneous GI bleeding with antithrombotic agents. Apc(min/+) mice exhibited progressive blood loss starting at the age of nine weeks. Despite the increase in bleeding, Apc(min/+) mice were in a hypercoagulable state and displayed an age-dependent increase in thrombin generation and circulating fibrinogen as well as a significant decrease in clotting times. We evaluated the effect of warfarin, dabigatran etexilate, apixaban and clopidogrel in this model by administering them in diet or in the drinking water to mice for 1-4 weeks. All of these marketed drugs significantly increased GI bleeding in Apc(min/+) mice, but not in wild-type mice. Although different exposure profiles of these antithrombotic agents make it challenging to compare the bleeding risk of compounds, our results indicate that the Apc(min/+) mouse may be a sensitive preclinical model for assessing the spontaneous GI bleeding risk of novel antithrombotic agents.

  11. Hypovolemic shock due to severe gastrointestinal bleeding in a child taking an herbal syrup

    Directory of Open Access Journals (Sweden)

    Paola Angela Moro

    2011-01-01

    Full Text Available We report the case of a 4-years-old boy who was admitted with hypovolemic shock due to a severe gastrointestinal bleeding. The esophagogastroduodenoscopy (EGDS showed hiatus hernia, erosions and ulcerations of the lower esophagus, possibly due to a gastroesophageal reflux, and a small duodenal erosion. The child was previously healthy and he had never shown any symptoms related to this condition. The only product taken by the child in the previous days was a syrup containing several herbs, among which Filipendula ulmaria (L. Maxim. and Salix spp. (known to contain salicylates, marketed as food and prescribed by his paediatrician to treat a mild cold accompanied by fever. Quali-quantitative analysis confirmed the presence of salicylates in the syrup. Naranjo algorithm showed a probable correlation between the onset of symptoms and the consumption of the herbal remedy. The child recovered after receiving intensive care. The product was withdrawn from Italian market.

  12. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Stanley, Adrian J; Laine, Loren; Dalton, Harry R

    2017-01-01

    OBJECTIVE: To compare the predictive accuracy and clinical utility of five risk scoring systems in the assessment of patients with upper gastrointestinal bleeding. DESIGN: International multicentre prospective study. SETTING: Six large hospitals in Europe, North America, Asia, and Oceania....... RESULTS: The Glasgow Blatchford score was best (area under the receiver operating characteristic curve (AUROC) 0.86) at predicting intervention or death compared with the full Rockall score (0.70), PNED score (0.69), admission Rockall score (0.66, and AIMS65 score (0.68) (all P... thresholds of ≥4 for PNED, ≥2 for AIMS65, ≥4 for admission Rockall, and ≥5 for full Rockall were optimal at predicting death, with sensitivities of 65.8-78.6% and specificities of 65.0-65.3%. No score was helpful at predicting rebleeding or length of stay. CONCLUSIONS: The Glasgow Blatchford score has high...

  13. Latent vitellointestinal duct sinus presenting with massive lower gastrointestinal bleeding in an adolescent.

    Science.gov (United States)

    Patel, Ramnik V; Evans, Kathryn; Sau, Indranil; Huddart, Simon

    2014-09-16

    A 12-year-old boy with a history, at birth, of a weeping pink fleshy lesion after his umbilical cord detached, requiring repeated chemical cauterisation, presented with massive lower gastrointestinal bleeding and required resuscitation and blood transfusion. Augmented Tc99m nuclear medicine scan confirmed ectopic gastric mucosa. The lateral view suggested its attachment behind the umbilicus. At exploration, a latent vitellointestinal duct sinus with ectopic gastric mucosal mass was found. Segmental resection of the sinus and mass excision with primary anastomosis and incidental appendicectomy was curative. Pink fleshy mass discharging coloured fluid at the umbilicus following detachment of umbilical cord should be considered a remnant of vitellointestinal duct unless proved otherwise. A pink lesion with yellowish discharge resistant to chemical cauterisation should raise the suspicion of embryonic structures. Latent vitellointestinal sinus is a new lesion in the spectrum of umbilical anomalies. Lateral view of the nuclear medicine scan is helpful in locating the site.

  14. [A Case of Resected Giant Gastrointestinal Stromal Tumor Associated with Intraperitoneal Bleeding Following Imatinib Administration].

    Science.gov (United States)

    Ide, Ryuta; Suzuki, Takahisa; Takakura, Yuji; Oshita, Akihiko; Ikeda, Satoshi; Matsugu, Yasuhiro; Nakahara, Hideki; Urushihara, Takashi; Itamoto, Toshiyuki; Shinozaki, Katsunori

    2016-09-01

    A 76-year-old woman with tarry stool was referred to our hospital for further examination. Contrast-enhanced computed tomography(CT)revealed a heterogeneous 15 cm tumor located in the left upper abdominal cavity. The tumor had a rich vascularity and was associated with intra-abdominal bleeding. Gastroscopy showed a large submucosal tumor in the gastric body. A biopsy was performed, and the patient was diagnosed with a c-kit-positive gastrointestinal stromal tumor(GIST)of the stomach. Imatinib mesylate(400mg/day)was administered for 6 months. Vascularity in the tumor was diminished and no new lesion had emerged, although there was no remarkable reduction in tumor size. The patient underwent partial gastrectomy and splenectomy with curative intent. She is currently alive 1 year and 4 months after surgery with no evidence of recurrence.

  15. Aspirin use for primary prophylaxis: Adverse outcomes in non-variceal upper gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Karina M Souk; Hani M Tamim; Hussein A Abu Daya; Don C Rockey; Kassem A Barada

    2016-01-01

    AIM: To compare outcomes of patients with nonvariceal upper gastrointestinal bleeding(NVUGIB) taking aspirin for primary prophylaxis to those not taking it.METHODS: Patients not known to have any vascular disease(coronary artery or cerebrovascular disease) who were admitted to the American University of Beirut Medical Center between 1993 and 2010 with NVUGIB were included. The frequencies of in-hospital mortality, re-bleeding, severe bleeding, need for surgery or embolization, and of a composite outcome defined as the occurrence of any of the 4 bleeding related adverse outcomes were compared between patients receiving aspirin and those on no antithrombotics. We also compared frequency of in hospital complications and length of hospital stay between the two groups.RESULTS: Of 357 eligible patients, 94 were on aspirin and 263 patients were on no antithrombotics(controlgroup). Patients in the aspirin group were older, the mean age was 58 years in controls and 67 years in the aspirin group(P < 0.001). Patients in the aspirin group had significantly more co-morbidities, including diabetes mellitus and hypertension [25(27%) vs 31(112%) and44(47%) vs 74(28%) respectively,(P = 0.001)], as well as dyslipidemia [21(22%) vs 16(6%), P < 0.0001).Smoking was more frequent in the aspirin group [34(41%) vs 60(27%), P = 0.02)]. The frequencies of endoscopic therapy and surgery were similar in both groups. Patients who were on aspirin had lower inhospital mortality rates(2.1% vs 13.7%, P = 0.002),shorter hospital stay(4.9 d vs 7 d, P = 0.01), and fewer composite outcomes(10.6% vs 24%, P = 0.01). The frequencies of in-hospital complications and re-bleeding were similar in the two groups.CONCLUSION: Patients who present with NVUGIB while receiving aspirin for primary prophylaxis had fewer adverse outcomes. Thus aspirin may have a protective effect beyond its cardiovascular benefits.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. Burden of Self-reported Acute Gastrointestinal Illness in Cuba

    OpenAIRE

    Prieto, Pablo Aguiar; Finley, Rita L; Muchaal, P.K.; Guerin, Michele T; Isaacs, Sandy; Domínguez, Arnaldo Castro; Marie, Gisele Coutín; Perez, Enrique

    2009-01-01

    Acute gastrointestinal illness is an important public-health issue worldwide. Burden-of-illness studies have not previously been conducted in Cuba. The objective of the study was to determine the magnitude, distribution, and burden of self-reported acute gastrointestinal illness in Cuba. A retrospective, cross-sectional survey was conducted in three sentinel sites during June-July 2005 (rainy season) and during November 2005–January 2006 (dry season). Households were randomly selected from a ...

  19. Do NSAIDs and ASA Cause More Upper Gastrointestinal Bleeding in Elderly than Adults?

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    Hakan Kocoglu

    2016-01-01

    Full Text Available Purpose. NSAIDs and ASA may cause upper gastrointestinal bleeding (UGIB both in adults and in elderly. There is no study that compares this increased bleeding risk between adult and elderly subjects. Methods. A total of 524 patients with UGIB were included in this study. The data of patients were, respectively, analyzed. Results. NSAIDs and ASA-associated UGIB rates were similar between <65 years (345 patients (group 1 and ≥65 years (179 patients (group 2 (28.4% versus 23.5%, p=0.225 and 13% versus 19%, p=0.071, resp.. Warfarin-associated UGIB was found significantly higher in group 2 than group 1. Elderly patients with NSAID-associated UGIB had significantly higher length of stay (LoS and CoH than adult patients with NSAID-associated UGIB (p=0.002 and 0.001, resp.. Elderly patients with ASA-associated UGIB had significantly higher CoH than adult patients with NSAID-associated UGIB. Conclusions. Using NSAIDs without gastroprotective drugs or using ASA with gastroprotective drugs in elderly patients is as safe as in adult patients. Not only should adding gastroprotective drugs to ASA or NSAID be based on their risk of UGIB, but the cost of hospitalization of ASA or NSAID-associated UGIB should be considered.

  20. Do NSAIDs and ASA Cause More Upper Gastrointestinal Bleeding in Elderly than Adults?

    Science.gov (United States)

    Kocoglu, Hakan; Oguz, Basak; Dogan, Hakan; Okuturlar, Yildiz; Hursitoglu, Mehmet; Harmankaya, Ozlem; Altuntas, Yuksel; Kumbasar, Abdulbaki

    2016-01-01

    Purpose. NSAIDs and ASA may cause upper gastrointestinal bleeding (UGIB) both in adults and in elderly. There is no study that compares this increased bleeding risk between adult and elderly subjects. Methods. A total of 524 patients with UGIB were included in this study. The data of patients were, respectively, analyzed. Results. NSAIDs and ASA-associated UGIB rates were similar between <65 years (345 patients) (group 1) and ≥65 years (179 patients) (group 2) (28.4% versus 23.5%, p = 0.225 and 13% versus 19%, p = 0.071, resp.). Warfarin-associated UGIB was found significantly higher in group 2 than group 1. Elderly patients with NSAID-associated UGIB had significantly higher length of stay (LoS) and CoH than adult patients with NSAID-associated UGIB (p = 0.002 and 0.001, resp.). Elderly patients with ASA-associated UGIB had significantly higher CoH than adult patients with NSAID-associated UGIB. Conclusions. Using NSAIDs without gastroprotective drugs or using ASA with gastroprotective drugs in elderly patients is as safe as in adult patients. Not only should adding gastroprotective drugs to ASA or NSAID be based on their risk of UGIB, but the cost of hospitalization of ASA or NSAID-associated UGIB should be considered. PMID:26880898

  1. Obscure gastrointestinal bleeding: evaluation with 64-section multiphase CT enterography--initial experience.

    Science.gov (United States)

    Huprich, James E; Fletcher, Joel G; Alexander, Jeffrey A; Fidler, Jeff L; Burton, Sharon S; McCullough, Cynthia H

    2008-02-01

    This retrospective HIPAA-compliant study was approved by the institutional review board and institutional conflict of interest committee. Patients gave informed consent for use of medical records. The purpose of the study was to retrospectively evaluate the findings depicted at computed tomographic (CT) enterography performed with a 64-section CT system and by using neutral enteric contrast material and a three-phase acquisition in patients with obscure gastrointestinal bleeding (OGIB). Twenty-two outpatients (11 men, 11 women; age range, 37-83 years) with OGIB underwent CT enterography. Findings were compared with capsule and traditional endoscopic, surgical, and angiographic findings. CT enterographic findings were positive for a bleeding source in 10 (45%) of 22 patients. Eight of 10 positive findings at CT enterography were also positive at capsule endoscopy or subsequent clinical diagnosis. CT enterography helped correctly identify three lesions undetected at capsule endoscopy. Study results suggest that multiphase, multiplanar CT enterography may have a role in the evaluation of OGIB.

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

    Directory of Open Access Journals (Sweden)

    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.

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

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    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.

  4. Double-Balloon Enteroscopy following Capsule Endoscopy in the Management of Obscure Gastrointestinal Bleeding: Outcome of a Combined Approach

    Directory of Open Access Journals (Sweden)

    Patarapong Kamalaporn

    2008-01-01

    Full Text Available BACKGROUND: There is no consensus on the relative accuracy of capsule endoscopy (CE versus double-balloon enteroscopy (DBE to investigate obscure gastrointestinal bleeding (GIB. CE is less invasive, but DBE more directly examines the small bowel, and allows tissue sampling plus therapeutic intervention.

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

    DEFF Research Database (Denmark)

    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...

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

    Institute of Scientific and Technical Information of China (English)

    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.

  7. Evaluation of nasogastric tubes to enable differentiation between upper and lower gastrointestinal bleeding in unselected patients with melena.

    Science.gov (United States)

    Kessel, Boris; Olsha, Oded; Younis, Aurwa; Daskal, Yaakov; Granovsky, Emil; Alfici, Ricardo

    2016-02-01

    Gastrointestinal (GI) bleeding is a common surgical problem. The aim of this study was to evaluate how insertion of the nasogastric tube may enable differentiation between upper and lower GI bleeding in patients with melena. A retrospective study involving patients admitted to our surgery division with a melena was carried out between the years 2010 and 2012. A total of 386 patients were included in the study. Of these, 279 (72.2%) patients had negative nasogastric aspirate. The sensitivity of examination of nasogastric aspirate to establish the upper GI as the source of bleeding was only 28% and the negative predictive value of a negative nasogastric aspirate was less than 1%. Most patients who initially presented with melena and were found to have upper GI bleeding had a negative nasogastric aspirate. Insertion of a nasogastric tube does not affect the clinical decision to perform upper endoscopy and should not be routinely carried out.

  8. 麒麟心痛舒对非ST段抬高型急性冠脉综合征合并消化道出血患者的疗效观察%An observation on therapeutic effect of Qilin Xintongshu pill for treatment of patients with non-ST segment elevation acute coronary syndromes accompanied by gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    李景君; 孙红娟; 陶愈婷; 王国蕾; 黄积存; 李亮; 苏会钦

    2014-01-01

    Objective To observe the therapeutic effect of Qilin Xintongshu pill for treatment of patients with non-ST segment elevation acute coronary syndromes(NSTE-ACS)accompanied by gastrointestinal bleeding (GIB). Methods A prospective randomized controlled trial was conducted. A total of 67 hospitalized patients in Cardiovascular Department of Qionghai City Hospital of Traditional Chinese Medicine were divided into therapy group(35 cases)and control group(32 cases). Both groups were given conventional medical treatment(except anti-coagulative agent). In the therapy group,the patients received Qilin Xintongshu pill(the ingredients consisting of panax pseudo-ginsen,dragon's blood,immature orange fruit,etc.)oral administration,once 5 mg and 3 times a day,while in the control group,the patients accepted clopidogrel orally,once 75 g and once a day,the therapeutic course in both groups being 30 days. The major cardiovascular events(such as death,a newly-happened myocardial infarction(MI),MI secondary,obstinately ischemia)and incidence of massive hemorrhage of gastrointestinal tract were compared between the two groups,and the adverse events were observed. Results After treatment,the incidence of cardiovascular events and massive hemorrhage of gastrointestinal tract in the therapy group were decreased significantly compared to those in the control group 〔incidence of cardiovascular events:8.57%(3/35)vs. 28.13%(9/32), incidence of massive hemorrhage of gastrointestinal tract:2.86%(1/35)vs. 21.88%(7/32),both P<0.05〕. Adverse events were not observed in both groups,and the examinations of blood,urine,liver and renal functions were of no abnormalities before and after treatment. Conclusion Qilin Xintongshu pill can effectively reduce the incidences of cardiovascular events and massive hemorrhage of gastrointestinal tract in patients with NSTE-ACS accompanied by GIB in the therapeutic course of 30 days,therefore this traditional Chinese herbal medicine is an ideal agent for

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

    Directory of Open Access Journals (Sweden)

    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

  10. Transcatheter arterial embolization in gastric cancer patients with acute bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun Joo; Shin, Ji Hoon; Yoon, Hyun-Ki; Ko, Gi-Young; Gwon, Dong-Il; Song, Ho-Young; Sung, Kyu-Bo [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Seoul (Korea)

    2009-04-15

    The safety and clinical effectiveness of transcatheter arterial embolization for bleeding associated with unresectable gastric cancer was evaluated. Twenty-three patients with bleeding from unresectable gastric cancer underwent transcatheter arterial embolization. Of the 23 patients, eight showed signs of active bleeding, such as contrast extravasation or pseudoaneurysm, seven showed only tumor staining, and the remaining eight patients showed negative angiographic findings. All embolization procedures were successful without procedure-related complications. In all eight active bleeding patients, immediate hemostasis was achieved. The overall clinical success rate was 52% (12/23). Recurrent bleeding within 1 month occurred in one (8%) in 12 patients with initial clinical success. One patient showed partial splenic infarction after embolization of the splenic artery for active bleeding from the short gastric artery. Overall 30-day mortality rate was 43% (10/23). The median overall survival period was 38 days. In patients with bleeding from unresectable gastric cancer, transcatheter arterial embolization was found to be safe and effective for achieving immediate hemostasis for active bleeding. Although the clinical success rate was not high, the recurrent bleeding rate was low at 1 month post procedure. (orig.)

  11. Pancreatitis-associated pseudoaneurysm of the splenic artery presenting as lower gastrointestinal bleeding: treatment with transcatheter embolisation.

    Science.gov (United States)

    Taslakian, Bedros; Khalife, Mohammad; Faraj, Walid; Mukherji, Deborah; Haydar, Ali

    2012-12-03

    Pancreatitis is a known cause of pseudoaneurysms of the peripancreatic arteries, which can rarely rupture into various adjacent structures and become a source of life-threatening bleeding. The management is challenging and requires an individualised approach and multidisciplinary care. Herein, we present the case of a 24-year-old man in whom a splenic pseudoaneurysm ruptured into the adjacent infected pseudocyst, communicating with the colon by a fistulous tract, causing massive lower gastrointestinal bleeding. This was successfully managed by transcatheter arterial embolisation (TAE).

  12. Under-diagnosing and under-treating iron deficiency in hospitalized patients with gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Mustapha M El-Halabi; Michael S Green; Christopher Jones; William J Salyers Jr

    2016-01-01

    AIM: To determine whether patients hospitalized with gastrointestinal(GI) blood loss anemia are being checked and treated for iron deficiency. METHODS: Retrospective chart review was conducted for all patients admitted to a single tertiary care hospital between 11/1/2011 and 1/31/2012 for any type of GI bleeding. The primary endpoint was the percentage of patients who had their iron studies checked during a hospitalization for GI blood loss anemia. Secondary outcomes included percentage of anemic GI bleeders who had adequate documentation of anemia and iron deficiency, and those who were treated for their iron deficiency. Then we tried to identify possible predictors of checking iron studies in an attempt to understand the thought process that physicians go through when managing these patients. Iron deficiency was defined as Iron saturation less than 15% or ferritin level less than 45 μg/L. Anemia was defined as hemoglobin level less than 13 g/dL for males and 12 g/dL for females.RESULTS: Three hundred and seven GI bleeders were hospitalized during the study period, and 282 of those(91.9%) had anemia during their hospital stay. Ninetyfive patients(30.9%) had iron studies performed during hospitalization, and 45 of those(47.4%) were actually found to be iron deficient. Only 29 of those 45 iron deficient patients were discharged home on iron supplements. Of the 282 patients that had anemia during hospitalization, 50(17.7%) had no documentation of the anemia in their hospital chart. Of the 45 patients that had lab proven iron deficiency anemia(IDA), only 22(48.5%) had documentation of IDA in at least one note in their chart. Predictors of checking iron studies in anemic GI bleeders were lower mean corpuscular volume, documentation of anemia, having fecal occult blood testing, not having hematemesis or past history of GI bleeding. There were no significant differences between the teaching and non-teaching services in any patient characteristics or outcomes. CONCLUSION

  13. Recurrent severe gastrointestinal bleeding and malabsorption due to extensive habitual megacolon

    Institute of Scientific and Technical Information of China (English)

    Ingo Mecklenburg; Markus Leibig; Christof Weber; Stefan Schmidbauer; Christian Folwaczny

    2005-01-01

    Dilatation of the colon and the rectum, which is not attributable to aganglionosis, is a rare finding and can be the result of intractable chronic constipation. We report a rare case of a 29-year-old male patient with impressive megacolon, in whom Hirschsprung's or Chagas disease was ruled out. In the present case, dilatation of the colon was most likely due to a behavioral disorder with habitual failure of defecation. Chronic stool retention led to a bizarre bulging of the large bowel with displacement of the other abdominal organs and severe occult blood loss. Because of two episodes of life-threatening gastrointestinal bleeding despite conventional treatment of constipation, a surgical approach for bowel restoration was necessary. Temporary loop ileostomy had to be performed for depressurization of the large bowel and the subsequent possibility for effective antegrade colonic lavage to remove impacted stools. Shortly after the operation, the patient was healthy and could easily manage the handling of the ileostomy. However, the course of the megacolon in this young adult cannot be predicted and the follow-up will have to reveal if regression of this extreme colonic distension with reestablishment of regular rectal perception will occur.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  15. Feasibility of capsule endoscopy in elderly patients with obscure gastrointestinal bleeding. An up-to-date report

    Directory of Open Access Journals (Sweden)

    Orlando G

    2012-11-01

    Full Text Available Abstract Background Anemia is the most common hematologic abnormality in older populations. Furthermore, iron deficiency anemia is common and merits investigation and treatment, as it usually results from chronic occult bleeding from the gastrointestinal tract. In view of a wide use of capsule endoscopy as a diagnostic procedure for occult gastrointestinal bleeding and of the growth of aging population, we performed a literature review about the feasibility of capsule endoscopy in the elderly. Methods We conducted a literature search in the PubMed database in July 2012, and all English-language publications on capsule endoscopy in elderly patients since 2005 were retrieved. The potential original articles mainly focused on obscure gastrointestinal bleeding were all identified and full texts were obtained and reviewed for further hand data retrieving. Results We retrieved only six papers based on different primary end-points. Four were retrospective non randomized studies and two were prospective non randomized studies. In the end 65, 70, 80 and 85 years were used as an age cut-off. All studies evaluate the diagnostic yield of capsule endoscopy in iron deficiency anemia. Only three studies assess the feasibility of capsule examination of the elderly. Conclusions Iron deficiency anemia in the elderly with or without obscure gastrointestinal bleeding is the major indication for capsule endoscopy after a negative esophago-gastro-duodenoscopy and colonoscopy. It is safe and effective to identify a small bowel pathology without a great discomfort for the elderly. Inability to swallow the capsule, battery failure before capsule reaches the cecum, and capsule retention are some of the important problems associated with capsule endoscopy in elderly as well as in younger patients.

  16. An Unusual Case of Gastrointestinal Bleeding from Isolated Gallbladder Varices in a Patient with Pancreatic Cancer Complicated by Portal Biliopathy

    Directory of Open Access Journals (Sweden)

    Mahir Gachabayov

    2016-01-01

    Full Text Available Portal biliopathy is the complex of abnormalities of extrahepatic and intrahepatic bile ducts, cystic duct, and gallbladder, arising as a result of extrahepatic portal vein obstruction and noncirrhotic portal fibrosis, which can be caused by coagulopathies, tumors, inflammation, postoperative complications, dehydration, and neonatal umbilical vein catheterization. We report a case of a 55-year-old male patient with the history of pancreatic cancer and cholecystoenteric anastomosis presenting with gastrointestinal bleeding from gallbladder varices via the anastomosis.

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

    OpenAIRE

    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 s...

  18. [Diagnosis, treatment and prophylaxis of acute ulcero-erosive gastroduodenal bleedings at cardiosurgical patients].

    Science.gov (United States)

    Kazymov, I L; Kirilenko, A S; Faĭbushevic h, A G; Kurbanov, F S; Tarichko, Iu V

    2007-01-01

    Results of treatment of 495 patients who has undergone various cardiac operations with artificial circulation are analyzed. The complex program "Blood-free surgery" was used at 388 (78.4%) of them. Among the patients treated traditionally the acute gastroduodenal erosions and ulcers were diagnosed at 25.7% patients, the rate of gastroduodenal bleedings was 3.0%. Complex of prophylactic measures permits to reduce the rate of acute erosions and ulcers in 1.5 times (18.4%) and the rate of postoperative gastroduodenal bleedings--to 0.7%. Control of risk factors, timely diagnosis, complex prophylaxis and treatment of acute gastroduodenal erosions and ulcers are effective way to improvement of operations results at cardiosurgical patients. "Blood-free" program doesn't lead to increase of acute postoperative gastroduodenal erosions and ulcers rate. Endoscopic (including repeated) hemostasis at acute ulcero-erosive gastroduodenal bleedings is available method and permits to achieve the stable hemostasis.

  19. 老年人上消化道出血病因分析%Analysis of Gastrointestinal Bleeding in the Elderly

    Institute of Scientific and Technical Information of China (English)

    杨韬

    2013-01-01

      目的:探讨老年性上消化道出血的病因.方法:回顾性分析本院2007-2011年间收治的220例上消化道出血患者的临床资料,其中老年性(60岁以上患者)上消化道出血患者110例,非老年性(小于60岁)出血患者110例,对两组患者的上消化道出血病因进行对比分析.结果:110例老年性上消化道出血患者中胃溃疡所致出血最多23例,占20.91%,其次为胃癌18例,占16.35%,其他常见的病因还有复合型溃疡、十二指肠溃疡、门脉高压出血,老年组患者肿瘤发生率、胃溃疡发生率明显高于非老年组,而十二指肠溃疡及肝硬化发生率明显低于非老年组.结论:胃及十二指肠溃疡是老年性上消化道出血最常见的病因,其次是胃癌.%Objective:To investigate the cause of upper gastrointestinal bleeding senile. Method:A retrospective analysis of clinical data of upper gastrointestinal bleeding in patients admitted to 220 cases in our hospital between 2007-2011 years,110 cases of upper gastrointestinal bleeding in patients with senile patients(above 60 years),the non-elderly(less than 60 years old)the bleeding 110 patients,a comparative analysis of the two groups of patients with upper gastrointestinal bleeding causes. Result:110 patients with senile upper gastrointestinal bleeding in patients with stomach ulcers caused by bleeding accounted for 20.91%,followed by up to 23 cases of 18 cases of gastric cancer accounting for 16.35%,and other common causes compound ulcer,duodenal ulcer,the door The clock high pressure bleeding,old age group,the incidence of tumors in patients with gastric ulcer incidence was significantly higher than the non-elderly group and duodenal ulcer and cirrhosis of the liver was significantly lower than the non-elderly group. Conclusion:Gastric and duodenal ulcers are senile,the most common cause of gastrointestinal bleeding,followed by stomach cancer.

  20. Evaluation of Results in Patients with Acute Upper Gis Bleeding: A Goverment Hospital Experience

    Directory of Open Access Journals (Sweden)

    Bilge Bas

    2016-01-01

    Full Text Available Aim: The aim was to assess the characteristics of patients with upper gastrointestinal system (GIS bleeding in our clinic. Material and Method: The patients who admitted to Usak State Hospital Gastroenterology Department with upper gastrointestinal system bleeding were retrospectively evaluated between May 2009 and March 2012. The patients were assessed for age, sex, complaints, history of medication, management, history of bleeding, laboratory findings, endoscopic findings, need for transfusion, hospitalization duration and mortality. Results: 392 patients admitted to our department with upper gastrointestinal system bleeding. 263 (67.1% of the patient were male and 129 (32.9% were female. It was presented only melena in 120 (%30.6 patients, hematemesis in 140 (%35.7 patients and both hematemesis and melena in 132 (%33.7 patients at admission. The mean hemoglobin level was 7.8±1.5 g/dl, and the mean hematocrit level was 27.4±4%. It was established coronary artery disease in 50 (12.8% patients, diabetes mellitus in 20 (5.1% patients, cerebrovascular disease in 8 (2% patients and peripheral arterial disease in 4 (1% patients. We presented 194 (49.5% bulbus ulcer, 117 (29.8% erosive gastritis, 35 (8.9% gastric ulcer in patients at upper gastrointestinal system endoscopy. We established Helicobacter pylori infection in 264 (67.3 % patients. Discussion: Duodenal ulcer and eritematous gastritis are the most common causes of upper GIS bleedings. In addition, Helicobacter pylori infection is keep in mind as a important bleeding cause in that patients. It is useful to give stomach acid suppressor therapy to the patients who have coronary heart disease, cerebrovascular disease and diabetes mellitus, especially if they have gastric complaints.

  1. A pedunculated polyp-shaped small-bowel lymphangioma causing gastrointestinal bleeding and treated by double-balloon enteroscopy

    Institute of Scientific and Technical Information of China (English)

    Akihiko Kida; Koichiro Matsuda; Satoshi Hirai; Akiyoshi Shimatani; Yousuke Horita; Katsushi Hiramatsu; Mitsuru Matsuda

    2012-01-01

    We report a rare case of a small-bowel lymphangioma causing massive gastrointestinal (GI) bleeding that we successfully diagnosed and treated using double-balloon enteroscopy (DBE).An 81-year-old woman suffering from repeated GI bleeding of unknown origin underwent a capsule endoscopy at a previous hospital.She was suspected of having bleeding from the jejunum,and was referred to our department for diagnosis and treatment.An oral DBE revealed a 20 mmx 10 mm,regularly surfaced,white to yellowish,elongated,pedunculated jejunal polyp with small erosions at 10 cm distal to the ligament of Treiz.Since no other source of bleeding was identified by endoscopy in the deep jejunum,an endoscopic polypectomy (EP) was performed for this lesion.A subsequent histopathological examination of the resected polyp showed clusters of lymphatic vessels with marked cystic dilatation in the submucosa and the deep layer of the lamina propria mucosae.These characteristics are consistent with the typical features of small-bowel lymphangioma with erosions.Although clipping hemostasis was performed during EP,re-bleeding occurred.Finally,a complete hemostasis was achieved by performing an additional argon plasma coagulation.

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

    Energy Technology Data Exchange (ETDEWEB)

    Owunwanne, A.; Al-Wafai, I.; Vallgren, S.; Sadek, S.; Abdel-Dayem, H.M.; Yacoub, T.

    1988-01-01

    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.

  3. SKP2 high expression, KIT exon 11 deletions, and gastrointestinal bleeding as predictors of poor prognosis in primary gastrointestinal stromal tumors.

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    Ang Lv

    Full Text Available BACKGROUND AND AIMS: Considering the indication of adjuvant therapy, the recurrence risk for primary gastrointestinal stromal tumor (GIST after surgery needs to be accurately estimated. However, current risk stratification schemes may still have room for improvement. This study seeks to analyze prognostic factors for primary GISTs from 3 aspects, including clinicopathological parameters, immunohistochemical biomarkers, and gene mutational status, and attempts to find novel valuable factors predicting the malignancy potential of GISTs. METHODS: Retrospective data from 114 primary GIST patients after R0 resection were collected. Clinicopathological data was obtained from medical records and re-evaluated. Immunohistochemical analysis was performed using the Tissue Microarray method for Ki67, p16, p27, p53, SKP2, CD133, and actin. KIT gene exons 9, 11, 13, and 17 and PDGFRα gene exons 12 and 18 were tested for mutations using PCR. RESULTS: Univariate analysis revealed the following factors as poor prognostic indicators for relapse-free survival with a median follow-up of 50 months: male gender, gastrointestinal bleeding, mitotic index >5/50HPFs, tumor size >5 cm, non-gastric site, necrosis, epithelioid or mixed cell type, surrounding tissue invasion, Ki67>5%, p16>20%, p53 index >10, SKP2>10%, and KIT exon 11 deletion. Besides mitotic index, tumor size and site, SKP2 high expression (RR = 2.91, 95% CI: 1.41-5.99, P = 0.004 and KIT exon 11 deletion (RR = 2.73, 95% CI: 1.04-7.16, P = 0.041 were also independent risk factors in multivariate analysis, with gastrointestinal bleeding also showing a trend towards significance (RR = 1.88, 95% CI: 0.98-3.64, P = 0.059. In addition, gastrointestinal bleeding and SKP2 high expression showed a good ability to stratify high-risk patients further. CONCLUSION: Our results show that gastrointestinal bleeding, SKP2 high expression, and KIT exon 11 deletions may be useful indicators of high recurrence risk for

  4. Thalidomide for treatment of gastrointestinal bleedings due to angiodysplasia : a case report in acquired von Willebrand syndrome and review of the literature

    NARCIS (Netherlands)

    Engelen, E T; van Galen, K P M; Schutgens, R E G

    2015-01-01

    INTRODUCTION: Acquired von Willebrand syndrome is a rare bleeding disorder and treatment of the associated gastrointestinal (GI) bleeding due to angiodysplasia is challenging. AIM: The aim of this study was to present a new case on the successful use of thalidomide in a patient with acquired von Wil

  5. Prevalence of upper gastrointestinal bleeding risk factors among the general population and osteoarthritis patients

    Science.gov (United States)

    Kim, Sang Hyuck; Yun, Jae Moon; Chang, Chong Bum; Piao, Heng; Yu, Su Jong; Shin, Dong Wook

    2016-01-01

    AIM To assess the prevalence of possible risk factors of upper gastrointestinal bleeding (UGIB) and their age-group specific trend among the general population and osteoarthritis patients. METHODS We utilized data from the National Health Insurance Service that included claims data and results of the national health check-up program. Comorbid conditions (peptic ulcer, diabetes, liver disease, chronic renal failure, and gastroesophageal reflux disease), concomitant drugs (aspirin, clopidogrel, cilostazol, non-steroidal anti-inflammatory drugs, steroid, anticoagulants, and SSRI), personal habits (smoking, and alcohol consumption) were considered as possible UGIB risk factors. We randomly imputed the prevalence of infection in the data considering the age-specific prevalence of Helicobacter pylori (H. pylori) infection in Korea. The prevalence of various UGIB risk factors and the age-group specific trend of the prevalence were identified. Prevalence was compared between osteoarthritis patients and others. RESULTS A total of 801926 subjects (93855 osteoarthritis patients) aged 20 and above were included. The prevalence of individual and concurrent multiple risk factors became higher as the age increased. The prevalence of each comorbid condition and concomitant drug were higher in osteoarthritis patients. Thirty-five point zero two percent of the overall population and 68.50% of osteoarthritis patients had at least one or more risk factors of UGIB. The prevalence of individual and concurrent multiple risk factors in younger age groups were also substantial. Furthermore, when personal habits (smoking, and alcohol consumption) and H. pylori infection were included, the prevalence of concurrent multiple risk factors increased greatly even in younger age groups. CONCLUSION Prevalence of UGIB risk factors was high in elderly population, but was also considerable in younger population. Patient with osteoarthritis was at higher UGIB risk than those without osteoarthritis

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

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    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.

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

    Science.gov (United States)

    Wang, Zhen; Chen, Jun-qiang; Liu, Jin-lu; Qin, Xin-gan; Huang, Yuan

    2013-06-01

    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.

  8. Acute Management and Secondary Prophylaxis of Esophageal Variceal Bleeding: A Western Canadian Survey

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    Justin Cheung

    2006-01-01

    Full Text Available BACKGROUND: Acute esophageal variceal bleeding (EVB is a major cause of morbidity and mortality in patients with liver cirrhosis. Guidelines have been published in 1997; however, variability in the acute management and prevention of EVB rebleeding may occur.

  9. [Digestive bleeding and acute abdomen caused by jejunal diverticulosis. Case report].

    Science.gov (United States)

    Nari, Gustavo A; Azar, Ricardo; Feliu, Luis; Moreno, Eduardo; Bonaparte, Fernando

    2012-03-01

    We present a patient with acute abdomen and digestive bleeding caused by jejunal diverticulosis. Jejunal diverticulosis, mainly asymptomatic, when is symptomatic have a wide clinical spectrum, ranging from chronic anemic syndrome to acute abdomen. In this communication, we reviewed the clinical presentation, the pathogenesis and the treatment this infrequent pathology.

  10. 冰冻紫地合剂胃内灌注救治急性上消化道出血的临床研究%Therapeutic effect evaluation on the treatment of acute upper gastrointestinal bleeding with freezing Zidi mixture lavage

    Institute of Scientific and Technical Information of China (English)

    郭佳莹; 欧秀娟; 王俏芝

    2014-01-01

    目的:观察冰冻紫地合剂灌胃救治急性上消化道出血的临床疗效。方法收集2011年1月至2013年8月广州中医药大学第一附属医院急诊科普内病区急性上消化道出血(upper gastrointestinal bleeding,UGIB)患者183例,按随机数字表法将患者随机分为两组,治疗组92例采用冰冻紫地合剂胃内灌注治疗;对照组91例采用冰盐水配合去甲肾上腺素胃内灌注治疗。分别于治疗前后观察两组患者的血压、血红蛋白、血尿素氮、脉搏及黑便等主要症状体征的变化,并评价治疗前后焦虑、抑郁、恐惧等不良情绪。结果①临床疗效比较:治疗后治疗组总有效率为96.7%(89/92)、对照组为85.7%(78/91),两组总有效率比较,差异有统计学意义(χ2=2.943,P<0.05)。②症状消失时间比较:治疗后治疗组呕血、黑便及隐血试验阴转时间均明显短于对照组(t值分别为6.628、14.052、21.706,P<0.05或0.01)。③症状体征比较:治疗后治疗组收缩压、心率、血红蛋白、血尿素氮[(114.3±12.1)mmHg、(78.6±11.4)次/min、(98.1±10.5)g/L、(5.9±1.1)mmol/L]均较对照组治疗后[(106.3±11.2)mmHg、(88.7±12.1)次/min、(88.2±11.7)g/L、(6.9±1.4)mmol/L]明显改善(P<0.05)。治疗后两组体温均升至正常,但组内组间比较差异均无统计学意义(P>0.05)。④焦虑、抑郁及正负性情绪变化比较:治疗后治疗组焦虑、抑郁及正负性情绪[分别为(42.5±9.4)分、(41.6±9.7)分、(26.3±5.4)分]均较对照组治疗后[分别为(51.2±10.1)分、(50.4±11.5)分、(30.4±6.9)分]明显改善(P<0.05)。结论冰冻紫地合剂胃内灌注治疗 UGIB,可升高患者收缩压、降低心率、升高血红蛋白,降低血尿素氮水平,缓解机体应激反应,减轻相关症状。%Objective To observe the clinical effects of treating acute upper gastrointestinal bleeding(AUGIB) with freezing Zidi

  11. 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

    Institute of Scientific and Technical Information of China (English)

    梁彩虹

    2014-01-01

    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。%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.

  12. Brunner’s Gland Adenoma – A Rare Cause of Gastrointestinal Bleeding: Case Report and Systematic Review

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    Michele Sorleto

    2017-01-01

    Full Text Available Brunner’s gland adenoma is an extremely rare benign small bowel neoplasm, often discovered incidentally during upper gastrointestinal endoscopy or radiological diagnostics. In few cases, it tends to cause gastrointestinal hemorrhage or intestinal obstruction. We report here our experience with a 47-year-old woman with a Brunner’s gland adenoma of more than 6 cm in size, located in the first part of the duodenum and causing gastrointestinal bleeding. Initially, we performed a partial endoscopic resection using endoloop and snare alternatively to prevent severe bleeding. A rest endoscopic polypectomy with the submucosal dissection technique was planned. However, on request of the patient, an elective surgical duodenotomy with submucosal resection of the remaining small duodenal tumor was performed. To better define the patient’s characteristics and treatment options of such lesions, we performed a systematic review of the available literature in PubMed. Recently, an endoscopic removal is being increasingly practiced and is considered as a safe treatment modality of such lesions.

  13. Endoscopic injection sclerotherapy in non-variceal upper gastrointestinal bleeding. A comparative study of polidocanol and thrombin.

    Science.gov (United States)

    Benedetti, G; Sablich, R; Lacchin, T

    1991-01-01

    To date several agents have been used to achieve haemostasis in patients with non-variceal upper gastrointestinal bleeding using endoscopic sclerotherapy techniques. Polidocanol has been widely used but local complications have been reported after treatment. We have compared the efficacy and safety of thrombin and polidocanol in 82 consecutive patients with ongoing or recent bleeding from duodenal, gastric, or anastomotic ulcers. Primary control of haemostasis from spurting vessels was achieved in 90% of cases using polidocanol and in 86.6% using thrombin. Definitive haemostasis was obtained in 80% of patients in both groups. When a non-bleeding vessel was visible, injection of polidocanol or thrombin effectively prevented rebleeding in 90.9% and 85.7% of cases, respectively. When a non-bleeding sentinel clot was present, injection of polidocanol or thrombin provided definitive haemostasis in 100% and 92.8% of cases, respectively. No statistically significant difference was evident between the two agents. In the polidocanol group, one local haemorrhagic complication was noted. No general or local complications were recorded in the thrombin group.

  14. Obscure gastrointestinal bleeding and small bowel pathology: comparison between wireless capsule endoscopy and multidetector-row CT enteroclysis.

    Science.gov (United States)

    Filippone, Antonella; Cianci, Roberta; Milano, Angelo; Valeriano, Sergio; Di Mizio, Veronica; Storto, Maria Luigia

    2008-01-01

    Obscure gastrointestinal bleeding is defined as bleeding of unknown origin, that persists or recurs after negative conventional barium contrast studies and upper and lower tract endoscopy. The causes of such a bleeding frequently arise in the small bowel, and they are represented by mucosal vascular abnormalities, neoplasms and other conditions such as Crohn's disease, Meckel's diverticulum, and vasculitis. Conventional barium contrast studies and push enteroscopy allow only a limited small bowel examination; moreover, intraoperative endoscopy may be inconclusive, since the small bowel is difficult to evaluate given its length and tortuous course. In the same way, angiographic diagnosis is stricktly related to the activity rate of hemorrhage. Wireless capsule endoscopy and multidetector-row CT enteroclysis are two recently developed minimally invasive techniques that may provide a complete small bowel examination, the first offering a direct visualization of the mucosal aspect, the second allowing evaluation of mural and extramural pathologies. This review is an update of the technique and clinical application of capsule endoscopy and multidetector-row CT enteroclysis in patients suffering from obscure small bowel bleeding.

  15. Isolated hepatic artery injury in blunt abdominal trauma presenting as upper gastrointestinal bleeding: treatment with transcatheter embolisation.

    Science.gov (United States)

    Taslakian, Bedros; Ghaith, Ola; Al-Kutoubi, Aghiad

    2012-11-15

    Liver injury in blunt abdominal trauma is common. However, not often does blunt trauma cause injury to the anatomical structures of the porta hepatis. Isolated injury of the hepatic artery has been rarely reported in the literature. Such injury may be lethal and requires immediate diagnosis and management. This report describes an unusual case of blunt abdominal trauma resulting in hepatic and gastroduodenal artery dissection, with pseudoaneurysm formation complicated by active upper gastrointestinal bleeding. The injury was managed by transcatheter embolisation. Awareness of this diagnosis should facilitate management of similar trauma cases.

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

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    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 perfor...

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

    Science.gov (United States)

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

    2015-01-01

    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

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

    Science.gov (United States)

    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.

  19. Survey of H2-antagonist usage in acute upper gastrointestinal hemorrhage.

    Science.gov (United States)

    Bhatt, B D; Meriano, F V; Phipps, T L; Ho, H; Zuckerman, M J

    1990-02-01

    H2-antagonists are frequently used in the management of upper gastrointestinal (UGI) hemorrhage despite their lack of proven efficacy. In order to determine the pattern of H2-antagonist usage for this indication, we retrospectively reviewed the charts of 137 patients admitted with acute UGI bleeding over a 1-year period at two teaching hospitals in West Texas. An H2-antagonist was ordered in 89% of patients (77%) intravenous, 12% oral). It was administered within 2 h of admission in 25% of these patients, within 4 h in 54%, and within 8 h in 78%. An H2-antagonist was ordered among the initial six orders in 49% and among the initial 10 orders in 77% of patients. Considering orders for specific therapies, an H2-antagonist was in the initial three orders in 60% of patients and among the initial six orders in 97%. Of the patients who were prescribed an H2-antagonist and who also had upper endoscopy, the drug was ordered prior to endoscopy in 86%. This review of H2-antagonist usage in the management of acute UGI bleeding has identified a prescribing pattern of writing for these drugs early in the sequence of order writing, with the drugs being given early in the course of hospitalization.

  20. To Investigate the Efficacy of Octreotide Combined with Omeprazole in Treating Gastrointestinal Bleeding%奥曲肽联合奥美拉唑对上消化道出血的疗效分析

    Institute of Scientific and Technical Information of China (English)

    杨睿

    2014-01-01

    上消化道出血作为消化内科上的一种常见急症,主要是指涵盖屈氏韧带及以上消化道病变诱发的出血,其中胃、食管、十二指肠、胰胆、空肠病出血尤为突出,临床多表现为黑便、呕血,严重情况下易出现急性周围循环衰竭。本文主要立足于上消化道出血角度,深入探究奥美拉唑联合奥曲肽治疗方案对其的应用价值。%The upper gastrointestinal bleeding as a common emergency in the history of digestive diseases,is mainly refers to cover closely ligament and above the digestive tract lesions induced bleeding,including stomach,esophagus,duodenum,pancreas bile,especial y jejunum bleeding disease, clinical manifestations of the black,hematemesis,more around the most case of severe acute circulatory failure. In this paper,based on the Angle of upper gastrointestinal bleeding,delve into omeprazole combined the octreotide therapy for its application value.

  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

    Directory of Open Access Journals (Sweden)

    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. Omeprazole treatment of gastrointestinal bleeding on clinical observation and analysis%奥美拉唑治疗上消化道出血的临床疗效

    Institute of Scientific and Technical Information of China (English)

    张振宇

    2014-01-01

    目的:观察分析奥美拉唑治疗上消化道出血临床疗效。方法:选取本院2009年5月-2012年9月上消化道出血患者80例,分为对照组和观察组各40例。观察组在常规治疗的基础上采用奥美拉唑进行治疗,对照组只用常规方法治疗。观察两组止血和不良反应情况。结果:观察组止血率与再出血率均优于对照组。在治疗过程中,组均未发现不良反应。结论:奥美拉唑治疗上消化道出血效果显著,止血起效时间短,不良反应轻微。%Objective:To observe the clinical efficacy of gastrointestinal bleeding Analysis of omeprazole treatment. Methods: A hospital in May 2009 September 2012 80 patients with upper gastrointestinal bleeding, divided into control group and observation group, 40 cases, with no difference among the two groups of basic physical condition, age, gender will not affect the results, observation group omeprazole treatment on the basis of conventional treatment, the control group only conventional therapy. Results: gastrointestinal bleeding continues on the observation group were four cases, bleeding rate of 90%;the control group, 8 patients with gastrointestinal bleeding continued bleeding rate of 80%. In the course of treatment, observation and treatment groups were found adverse reactions. Conclusions: In the treatment of gastrointestinal bleeding during omeprazole treatment significantly shorter onset time to stop bleeding, help stop bleeding and prevention of rebleeding after the effect of adverse reactions were mild, less bleeding continues, and reduce the amount of bleeding, is one of the best drug for the treatment of gastrointestinal bleeding.

  3. Appendicular bleeding: an excepcional cause of lower hemorrhage

    Directory of Open Access Journals (Sweden)

    Marta Magaz-Martínez

    Full Text Available Chronic complications of acute appendicitis managed in a conservative manner are not frequent. We present a case of acute lower gastrointestinal hemorrhage in a young patient with a previous acute appendicitis without surgical intervention. The colonoscopy detected an appendicular bleeding which was surgically treated. The anatomopathological diagnosis was granulomatous appendicitis. The clinical evolution of the patient was favorable without bleeding recurrence. Appendicular hemorrhage can be an unusual complication -however potentially severe- of acute appendicitis not treated surgically.

  4. Bleeding risk stratification in an era of aggressive management of acute coronary syndromes

    Institute of Scientific and Technical Information of China (English)

    Emad; Abu-Assi; Sergio; Raposeiras-Roubín; José; María; García-Acu?a; José; Ramón; González-Juanatey

    2014-01-01

    Major bleeding is currently one of the most common non-cardiac complications observed in the treatment of patients with acute coronary syndrome(ACS). Hemorrhagic complications occur with a frequency of 1% to 10% during treatment for ACS. In fact, bleeding events are the most common extrinsic complication associated with ACS therapy. The identification of clinical characteristics and particularities of the antithrombin therapy associated with an increased risk of hemorrhagic complications would make it possible to adopt prevention strategies, especially among those exposed to greater risk. The international societies of cardiology renewed emphasis on bleeding risk stratification in order to decide strategy and therapy for patients with ACS. With this review, we performed an update about the ACS bleeding risk scores most frequently used in daily clinical practice.

  5. 99mTechnetium-labelled red blood cell scintigraphy as an alternative to angiography in the investigation of gastrointestinal bleeding: clinical experience in a district general hospital.

    Science.gov (United States)

    Bearn, P.; Persad, R.; Wilson, N.; Flanagan, J.; Williams, T.

    1992-01-01

    99mTechnetium-labelled red blood cell scintigraphy (99mTc RBC scintigraphy) was used as the second-line investigation to localise bleeding in 23 patients (11 male, 12 female; mean age 67 years) presenting with active bleeding per rectum. Scintigraphy was available on a 24 h basis. A total of 18 patients had positive scans (78%). Surgery was performed urgently in 11 patients and the site of bleeding, as predicted by scintigraphy, was confirmed in 9 (82%). 99mTc RBC scintigraphy was less useful in patients who were not bleeding actively or who were being investigated for chronic anaemia. This study suggests that 99mTc RBC scintigraphy can play a useful role in the preoperative localisation of unexplained gastrointestinal bleeding in hospitals with nuclear medicine facilities, but confirms it has little place in the management of patients unless they are bleeding actively. PMID:1319696

  6. Pseudoaneurysm of gastroduodenal artery due to duodenal ulcer causing jaundice and interstitial pancreatitis but not gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Jovanović Miodrag

    2004-01-01

    Full Text Available Aneurysms and pseudoaneurysms of the gastroduodenal artery are rare with less then 50 cases reported. Most frequently they are one of the consequences of pancreatitis much rarer duodenal ulcer or operative trauma during gastrectomy for duodenal ulcer or choledochotomy. We report on a 47 year-old man, chronic heavy alcohol consumer in whom a chronic postbulbar duodenal ulcer destroyed much of the back wall of the duodenum, eroded gastroduodenal artery causing pseudo-aneurysm but without noticeable gastrointestinal bleeding. The patient had jaundice of obstructive type and elevated amilase. After Billroth II gastrectomy, suture of the gastroduodenal artery, cholecystectomy and T tube drainage of the common bile duct the patient developed intestinal obstruction caused by two interintestinal abscesses so that he had to be reoperated. After that he had a successful recovery, his general health greatly improved, he gained 15 kg in weight but two years after surgery he again started with heavy drinking and soon died due to serious brain damage. The case is rare and unusual at least for few reasons: First, the pseudoaneurysm was caused by duodenal ulcer. Second, a serious gastrointestinal bleeding did not take place. Third, the pseudoaneurysm was diagnosed by Doppler ultrasonography while angiography failed to opacity it due to thrombosis of the artery.

  7. Portal, mesenteric, and splenic vein thromboses after endovascular embolization for gastrointestinal bleeding caused by a splenic arteriovenous fistula.

    Science.gov (United States)

    Ding, Pengxu; Li, Zhen; Han, Xin-Wei; Wang, Zhong-Gao; Zhang, Wen-Guang; Fu, Ming-Ti

    2014-07-01

    We present an unusual case of portal, mesenteric, and splenic vein thromboses after endovascular embolization for gastrointestinal bleeding caused by a splenic arteriovenous fistula. The thromboses were successfully treated with anticoagulation therapy. The patient was a 37-year-old woman who presented with portal hypertension manifested by gastrointestinal bleeding with no evidence of liver disease. Splenic arteriography confirmed the presence of a high-flow arteriovenous fistulous communication from the splenic artery directly into the splenic vein. The arteriovenous fistula was successfully treated with percutaneous transarterial embolization by embolization coils and the patient achieved effective hemostasis. Low-molecular-weight heparin and warfarin were administrated to prevent thrombosis in the portal venous system after the procedure. Although anticoagulants were immediately administered, thromboses of the portal, mesenteric, and splenic veins were diagnosed by contrast-enhanced computed tomography after 10 days. Complete recanalization of the portal venous system confirmed by contrast-enhanced computed tomography was achieved by administering warfarin orally for 3 months.

  8. Recurrent Lower Gastrointestinal Bleeding: Ileal GIST Diagnosed by Video Capsule Endoscopy—A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Jie Ling

    2013-01-01

    Full Text Available Introduction. Gastrointestinal stromal tumor (GIST in the ileum is an extremely rare cause of recurrent lower gastrointestinal bleeding (GIB. Case Report. An 89-year-old man was admitted with melana. He had extensive PMH of CAD post-CABG/AICD, AAA repair, chronic anemia, myelodysplastic syndrome, lung cancer after resection, and recurrent GIB. Prior EGDs, colonoscopies, and upper device-assisted enteroscopy showed duodenal ulcer, A-V malformation s/p cauterization, and angioectasia. On admission, Hb was 6.0 g/dL. An endoscopic capsule study showed an ulcerated tumor in the ileum. CT showed no distant metastasis. The lesion was resected successfully and confirmed as a high-grade GIST. The patient was discharged with no further bleeding. Discussion. Early diagnosis for patients with ileal GIST is often challenging. Video capsule endoscopy and double balloon enteroscopy could be useful diagnostic tools. Surgical removal is the first line for a resectable GIST. Imatinib has become the standard therapy. Conclusion. This is a unique case of an ileal GIST in a patient with recurrent GIB which was diagnosed by video capsule. Complicated medical comorbidities often lead to a significant delay in diagnosis. Therefore, we recommend that if GIB does not resolve after appropriate treatments for known causes, the alternative diagnosis for occult GIB must be considered, including malignancy such as GIST.

  9. [Applying uncertainty theory in caring for the family of a von Willebrand disease patient experiencing first time upper gastrointestinal bleeding].

    Science.gov (United States)

    Chung, Ai-Lun; Shun, Shiow-Ching; Lin, Chih-Yu

    2009-10-01

    The purpose of this report was to describe the nursing experience in helping a primary caregiver cope with uncertainty as his mother experienced upper gastrointestinal (UGI) bleeding underlying von Willebrand disease and Scleromyxedema in an Emergency Department between 10 and 18 July 2008. Mishel's Uncertainty Theory was applied to assess the caregiver's uncertainty and patient disease progression. Data were collected through clinical observation, chart review, and interviews. The caregiver's nursing problems were identified as (1) uncertainty caused by symptoms of the rare disease and the probability of recurrent bleeding in the future; (2) uncertainty caused by lack of knowledge about the disease; (3) uncertainty caused by lack of confidence in home caring issues after UGI bleeding. During the nursing period, we provided clinical information related to the disease and offered psychological support to the caregiver based on our Mishel's Uncertainty Scale assessment. Successful strategies utilized by our intervention helped the caregiver reduce level of uncertainty, increase confidence to care for his mother, and improve the quality of further home care.

  10. Endoscopic Management of Gastrointestinal Leaks and Bleeding with the Over-the-Scope Clip: A Prospective Study

    Science.gov (United States)

    Goenka, Mahesh Kumar; Rai, Vijay Kumar; Goenka, Usha; Tiwary, Indrajit Kumar

    2017-01-01

    Background/Aims The over-the-scope clip (OTSC) is a device used for endoscopic closure of perforations, leaks and fistulas, and for endoscopic hemostasis. To evaluate the clinical effectiveness and safety of OTSC. Methods Between October 2013 and November 2015, 12 patients underwent OTSC placement by an experienced endoscopist. OTSC was used for the closure of gastrointestinal (GI) leaks and fistula in six patients, three of which were iatrogenic (esophageal, gastric, and duodenal) and three of which were inflammatory. In six patients, OTSC was used for hemostasis of non-variceal upper GI bleeding. Endoscopic tattooing using India ink was used to assist the accurate placement of the clip. Results All subjects except one with a colonic defect experienced immediate technical success as well as long-term clinical success, during a mean follow-up of 6 weeks. Only one clip was required to close each of the GI defects and to achieve hemostasis in all patients. There were no misfirings or complications of clips. The procedure was well tolerated, and patients were hospitalized for an average of 8 days (range, 3 to 10). Antiplatelet therapy was continued in patients with GI bleeding. Conclusions In our experience, OTSC was safe and effective for the closure of GI defect and to achieve hemostasis of non-variceal GI bleeding. PMID:27802375

  11. Transfusion requirements in patients with gastrointestinal bleeding: a study in a Blood Unit at a referral hospital

    Directory of Open Access Journals (Sweden)

    A. Garrido

    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.

  12. Enhanced gastric mucosal haemostasis after upper gastrointestinal haemorrhage.

    OpenAIRE

    Allison, M C; Fullarton, G M; Brown, I.L.; Crean, G P; McColl, K E

    1991-01-01

    An endoscopic technique for the measurement of gastric mucosal bleeding time has been developed to study gastric haemostasis in patients with acute upper gastrointestinal haemorrhage. The relation of gastric mucosal bleeding time to skin bleeding time and nonsterodial anti-inflammatory drug usage was examined in 61 control patients and in 47 patients presenting with bleeding peptic ulcers or erosions. Gastric mucosal bleeding time was shorter in patients with haemorrhage (median 2 minutes, ra...

  13. Predicting Calcium Values for Gastrointestinal Bleeding Patients in Intensive Care Unit Using Clinical Variables and Fuzzy Modeling

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    G Khalili-Zadeh-Mahani

    2016-07-01

    Full Text Available Introduction: Reducing unnecessary laboratory tests is an essential issue in the Intensive Care Unit. One solution for this issue is to predict the value of a laboratory test to specify the necessity of ordering the tests. The aim of this paper was to propose a clinical decision support system for predicting laboratory tests values. Calcium laboratory tests of three categories of patients, including upper and lower gastrointestinal bleeding, and unspecified hemorrhage of gastrointestinal tract, have been selected as the case studies for this research. Method: In this research, the data have been collected from MIMIC-II database. For predicting calcium laboratory values, a Fuzzy Takagi-Sugeno model is used and the input variables of the model are heart rate and previous value of calcium laboratory test. Results: The results showed that the values of calcium laboratory test for the understudy patients were predictable with an acceptable accuracy. In average, the mean absolute errors of the system for the three categories of the patients are 0.27, 0.29, and 0.28, respectively. Conclusion: In this research, using fuzzy modeling and two variables of heart rate and previous calcium laboratory values, a clinical decision support system was proposed for predicting laboratory values of three categories of patients with gastrointestinal bleeding. Using these two clinical values as input variables, the obtained results were acceptable and showed the capability of the proposed system in predicting calcium laboratory values. For achieving better results, the impact of more input variables should be studied. Since, the proposed system predicts the laboratory values instead of just predicting the necessity of the laboratory tests; it was more generalized than previous studies. So, the proposed method let the specialists make the decision depending on the condition of each patient.

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

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    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  16. Massive and life-threatening upper gastrointestinal bleeding due to invasive hepatocellular carcinoma: A case report

    Directory of Open Access Journals (Sweden)

    Semih Hot, M.D.

    2016-01-01

    Conclusions: The incidence of patients with massive bleeding due to gastric invasion of HCC is low, and only a few cases have been reported in the literature. Our purpose while presenting this rare case is to increase the awareness about the issue.

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

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    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.

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

    Science.gov (United States)

    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.

  19. Prevalence of gastric varices and results of sclerotherapy with N-butyl 2 cyanoacrylate for controlling acute gastric variceal bleeding

    Institute of Scientific and Technical Information of China (English)

    Khalid Mumtaz; Shahid Majid; Hasnain A Shah; Kashif Hameed; Ashfaq Ahmed; Saeed Hamid; Wasim Jafri

    2007-01-01

    AIM: To study the prevalence, predictors and control of bleeding following N-butyl 2 cyanoacrylate (NBC)sclerotherapy of gastric varix (GV).METHODS: We analyzed case records of 1436 patients with portal hypertension, who underwent endoscopy during the past five years for variceal screening or upper gastrointestinal (GI) bleeding. Fifty patients with bleeding GV underwent sclerotherapy with a mean of 2 mL NBC for control of bleeding. Outcome parameters were primary hemostasis (bleeding control within the first 48 h), recurrent bleeding (after 48 h of esophagogastro-duodenoscopy) and in-hospital mortality were analyzed.RESULTS: The prevalence of GV in patients with portal hypertension was 15% (220/1436) and the incidence of bleeding was 22.7% (50/220). Out of the 50 bleeding GV patients, isolated gastric varices (IGV-Ⅰ) were seen in 22 (44%), gastro-oesophageal varices (GOV) on lesser curvature (GOV-Ⅰ ) in 16 (32%), and GOV on greater curvature (GOV-Ⅱ) in 15 (30%). IGV- Ⅰ was seen in 44% (22/50) patients who had bleeding as compared to 23% (39/170) who did not have bleeding (P <0.003). Primary hemostasis was achieved with NBC in all patients. Re-bleeding occurred in 7 (14%) patients after 48 h of initial sclerotherapy. Secondary hemostasis was achieved with repeat NBC sclerotherapy in 4/7(57%). Three patients died after repeat sclerotherapy,one during transjugular intrahepatic portosysternic stem shunt (TIPSS), one during surgery and one due to uncontrolled bleeding. Treatment failure-related mortality rate was 6% (3/50).CONCLUSION: GV can be seen in 15% of patients with portal hypertension and the incidence of bleeding is 22.7%. NBC is highly effective in controlling GV bleeding.In hospital mortality of patients with bleeding GV is 6%.

  20. Obscure Gastrointestinal Bleeding from an Ampullary Tumour in a Patient with a Remote History of Renal Cell Carcinoma: A Diagnostic Conundrum

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    Rhonda M Janzen

    1998-01-01

    Full Text Available Metastasis of renal cell carcinoma to the ampulla of Vater is a rare occurrence. The outlined case, which presented as an upper gastrointestinal bleed, is only the eighth such reported case in the English-language literature. This case is the longest reported time interval between surgical nephrectomy to presentation with ampullary metastasis at 17.5 years. The ampullary source of bleeding in this case was initially obscure and missed by conventional gastroscopy. Diagnosis was made with a side-viewing endoscope, emphasizing the usefulness of this instrument in the investigation of active bleeding from a small bowel source.

  1. DSA以及栓塞术在治疗消化道出血中的临床价值分析%A Study of Clinical Value of DSA and Embolization in the Treatment of Gastrointestinal Bleeding

    Institute of Scientific and Technical Information of China (English)

    赵年; 李春华; 李德秀; 张维珍

    2016-01-01

    目的:分析DSA检查及栓塞治疗在临床诊断和治疗急性消化道大出血的效果。方法本次研究的对象是随机选取了2014年6月-2015年6月我院收治的30例消化道出血的患者,进行腹腔动脉、肠系膜上下动脉造影,对可能出血的部位进行选择性插管造影,其中17例患者明确诊断并行栓塞治疗。结果30例患者中20例造影阳性(66.7%),10例阴性(33.3%)。18例接受了栓塞治疗,16例出血停止,一个月内无复发出血;1例栓塞后次日死亡;1例栓塞三天后复发出血,进行外科手术后痊愈。结论 DSA检查对急性消化道大出血具有较好的诊断价值,栓塞介入治疗对消化道出血止血效果优良,值得临床深入研究。%Objective To analyze the clinical effect of DSA and embolization therapy in acute gastrointestinal hemorrhage.Methods The study object, 30 cases with gastrointestinal bleeding, were randomly selected from June 2014 to June 2015 in our hospital, all of them had celiac artery and mesenteric angiography, and have selective catheterization to the possible bleeding sites, including 17 patients with definite diagnosis who had embolization. Results Twenty cases of angiography in 30 patients were positive (66.7%) and 10 (33.3%) were negative. 18 cases underwent embolization, and 16 cases stopped bleeding after embolization, with no recurrence of bleeding for a month. One case died the next day after embolization, one case had the recurrence of bleeding after three days of embolism, but recovered after surgery.Conclusion DSA examination has good diagnostic value of acute digestive tract hemorrhage. The hemostatic effect of embolization in interventional therapy for gastrointestinal bleeding is good and worthy of clinical research.

  2. Role of Self-Expandable Metal Stents in Acute Variceal Bleeding

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    Fuad Maufa

    2012-01-01

    Full Text Available Acute variceal bleeding continues to be associated with significant mortality. Current standard of care combines hemodynamic stabilization, antibiotic prophylaxis, pharmacological agents, and endoscopic treatment. Rescue therapies using balloon tamponade or transjugular intrahepatic portosystemic shunt are implemented when first-line therapy fails. Rescue therapies have many limitations and are contraindicated in some cases. Placement of fully covered self-expandable metallic stent is a promising therapeutic technique that can be used to control bleeding in cases of refractory esophageal bleeding as an alternative to balloon tamponade. These stents can be left in place for as long as two weeks, allowing for improvement in liver function and institution of a more definitive treatment.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  4. Novel approaches to upper gastrointestinal conditions: a focus on bleeding and malignancy

    NARCIS (Netherlands)

    I.L. Holster (Ingrid)

    2014-01-01

    markdownabstract__Abstract__ Gastrointestinal (GI) conditions account for substantial burden and use of healthcare resources. It is estimated that GI conditions are responsible for 15-20% of general practitioner visits, hospital admissions, and drug use. Many of those conditions are related to the

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

    Directory of Open Access Journals (Sweden)

    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

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

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    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.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  8. Diagnosis agreement between capsule endoscopy and double-balloon enteroscopy in obscure gastrointestinal bleeding at a referral center

    Directory of Open Access Journals (Sweden)

    Enrique Pérez-Cuadrado-Robles

    2015-08-01

    Full Text Available Background and aim: Capsule endoscopy and double-balloon enteroscopy are well-recognized procedures in obscure gastrointestinal bleeding, with many factors that may influence their diagnosis yield. The aim of the present study was to characterize the degree of agreement between both techniques with focus on the type of lesion in a large cohort of patients at a referral center. Material and method: One thousand two hundred and nine capsules were administered in 1,078 patients and 381 enteroscopies were performed in 361 patients with obscure-gastrointestinal bleeding from 2004 to 2014. Results: Both procedures were carried out in 332 patients (mean age: 65.22 ± 15.41, 183 men and they have a similar diagnosis yield (70.5% vs. 69.6%, p = 0.9. Overall enteroscopy diagnosis yield was higher within patients with a previous positive capsule endoscopy (79.3% vs. 27.9%, p < 0.001. The degree of agreement was very good for polyps (0.89 [95% CI: 0.78-0.99], good for vascular lesions (0.66 [95% CI: 0.55-0.77] and tumors (0.66 [95% CI: 0.55-0.76] and moderate for ulcers (0.56 [95% CI: 0.46-0.67]. Diverticula (0.39 [95% CI: 0.29-0.5] achieved a fair agreement. The results of CE and DBE differed in 73 patients (22%. Conclusions: The present study confirms that although overall diagnostic yield by capsule endoscopy and double-balloon enteroscopy is similar, there are many factors which can modify these values, mainly the type of lesion.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  10. Stent grafting of acute hepatic artery bleeding following pancreatic head resection

    Energy Technology Data Exchange (ETDEWEB)

    Stoupis, Christoforos [University of Berne, Inselspital, Department of Diagnostic, Interventional and Pediatric Radiology, Berne (Switzerland); Kreisspital, Radiology, Maennedorf (Switzerland); Ludwig, Karin; Triller, Juergen [University of Berne, Inselspital, Department of Diagnostic, Interventional and Pediatric Radiology, Berne (Switzerland); Inderbitzin, Daniel [University of Berne, Inselspital, Clinic for Visceral and Transplantation Surgery, Berne (Switzerland); Do, Dai-Do [University of Berne, Inselspital, Clinic for Angiology, Berne (Switzerland)

    2007-02-15

    The purpose of this study was to report the potential of hepatic artery stent grafting in cases of acute hemorrhage of the gastroduodenal artery stump following pancreatic head resection. Five consecutive male patients were treated because of acute, life-threatening massive bleeding. Instead of re-operation, emergency angiography, with the potential of endovascular treatment, was performed. Because of bleeding from the hepatic artery, a stent graft (with the over-the-wire or monorail technique) was implanted to control the hemmorhage by preserving patency of the artery. The outcome was evaluated. In all cases, the hepatic artery stent grafting was successfully performed, and the bleeding was immediately stopped. Clinically, immediately after the procedure, there was an obvious improvement in the general patient condition. There were no immediate procedure-related complications. Completion angiography (n=5) demonstrated control of the hemorrhage and patency of the hepatic artery and the stent graft. Although all patients recovered hemodynamically, three individuals died 2 to 10 days after the procedure. The remaining two patients survived, without the need for re-operation. Transluminal stent graft placement in the hepatic artery is a safe and technically feasible solution to control life-threatening bleeding of the gastroduodenal artery stump. (orig.)

  11. 上消化道出血182例患者的临床分析%Clinical Analysis of Upper Gastrointestinal Bleeding in 182 Patients

    Institute of Scientific and Technical Information of China (English)

    顾莹

    2011-01-01

    目的 探讨上消化道出血的常见病因,观察肿瘤标志物在胃癌出血患者中的异常率,分析患者未能行胃镜检查明确出血病因的原因.方法 对我院出院诊断考虑为"上消化道出血"的182例患者临床资料进行回顾性分析.结果 182例上消化道出血患者中,消化道溃疡出血61例(占33%),胃癌出血12例(占7%),食管、胃底静脉曲张破裂出血8例占4%;其中男性分别占85%(52/61)、67%(8/12)、8/8.胃癌患者癌胚抗原异常率为33%(4/12).89例上消化道出血患者病因未明的原因:患者或家属拒绝胃镜检查48例(占54%),因心肌梗死、不稳定型心绞痛、心功能不全不宜行胃镜检查7例占8%.结论 (1)上消化道出血最常见原因为消化性溃疡合并出血,其次为胃癌出血及食管、胃底静脉曲张破裂出血;(2)此3类出血患者均男多于女;(3)肿瘤标志物用于协助诊断胃癌的意义有限;(4)患者或家属拒绝行胃镜检查或必要时胃镜复查是不能明确上消化道出血病因的最常见原因.%Objective To explore the common causes of upper gastrointestinal bleeding, observe the incidence of abnormal tumor markers in gastric cancer patients with bleeding, and to analyze why patients unable to get the specific reasons for bleeding by gastroscopy. Methods Clinical data of 182 cases with discharge diagnosis of upper gastrointestinal bleeding were Retrospectively analyzed. Results Of the 182 cases with upper gastrointestinal bleeding, 61 cases ( 33% ) had peptic ulcer bleeding, 12 cases had gastric cancer bleeding ( 7% ), 8 cases had esophageal and gastric variceal bleeding ( 4% ), among which males accounted for 85% ( 52/61 ), 67% ( 8/12 ) and 8/8 respectively. Incidence of ahnormal carcinoemhryonic antigen was 33% ( 4/12 ) in patients with gastric cancer. Etiology of 89 cases with upper gastrointestinal bleeding were unknown :48 cases ( 54% ) or their families refused endoscopy, 7 cases ( 8% ) should

  12. Hemospray application in nonvariceal upper gastrointestinal bleeding: results of the Survey to Evaluate the Application of Hemospray in the Luminal Tract

    NARCIS (Netherlands)

    Smith, L.A.; Stanley, A.J.; Bergman, J.J.; Kiesslich, R.; Hoffman, A.; Tjwa, E.T.; Kuipers, E.J.; Holstein, C.S. von; Oberg, S.; Brullet, E.; Schmidt, P.N.; Iqbal, T.; Mangiavillano, B.; Masci, E.; Prat, F.; Morris, A.J.

    2014-01-01

    BACKGROUND: Hemospray TM (TC-325) is a novel hemostatic agent licensed for use in nonvariceal upper gastrointestinal bleeding (NVUGIB) in Europe. GOALS: We present the operating characteristics and performance of TC-325 in the largest registry to date of patients presenting with NVUGIB in everyday c

  13. Determination of correlation of Adjusted Blood Requirement Index with outcome in patients presenting with acute variceal bleeding

    Institute of Scientific and Technical Information of China (English)

    Naheed Akhtar; Bader Faiyaz Zuberi; Syed Riazul Hasan; Raj Kumar; Salahuddin Afsar

    2009-01-01

    AIM: To determine the correlation of Adjusted Blood Requirement Index (ABRI) with the 7th day outcome in patients presenting with acute variceal bleeding.METHODS: All patients presenting with acute variceal hemorrhage (AVH) were included. Patients with previous band ligation, sclerotherapy, gastrointestinal or hepatic malignancies were excluded. Patients were managed as per standard protocol for AVH with terlipressin and band ligation. ABRI scores were calculated using the formula outcome of alive or expired up to the 7th day after treatment. The correlation between ABRI and mortality was estimated and a receiver operative characteristic (ROC) curve was plotted.RESULTS: A total of 113 patients (76 male; 37 female) were included. On assessment, 18 were in Child's Pugh Class A, 82 in Class B and 13 were in Class C. The median number of blood units transfused ± inter-quartile range was 3.0 ± 2.0. The median ± inter-quartile range for ABRI was 1.3 ± 1.1. The ROC curve of ABRI for expiry showed a significantly large area of 0.848 ( P < 0.0001; 95% CI: 0.75-0.95). A significant correlation of log transformation of ABRI with an outcome of mortality was present ( P < 0.0001). CONCLUSION: ABRI correlates strongly with mortality.

  14. The р53 expression in cells of marginal zone of duodenal ulcers during acute bleeding

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    Sulayeva O.N.

    2009-01-01

    Full Text Available The aim of the work was to estimate the intensity and tissue distribution of proapoptogen p53 expression in duodenal mucosa in patients with acute bleeding caused by peptic ulcers. In 31 patients (1st group the healing of ulcer was detected after effective endoscopic hemostasis and in 15 patients rebleeding took place (2nd group. Performed immunocytochemical investigation allow to determine that acute ulcer bleeding was associated with activation of marginal zone cells apoptosis which was maximal in covering epithelium, vascular endothelium and regions infiltrated by lymphocytes. In patients with rebleeding the higher values of р53 expression were detected in crypts epithelium and in endothelium of dilatating vessels accompanied with intensive edema and lymphocytes infiltration of lamina propria and muscularis mucosae with perifocal activation of cells death. Additionally to apoptosis in 2nd group duodenum the necrosis of cells and epithelium desquamation were found, reflecting the tissue disintegration of duodenal mucosa.

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

    Directory of Open Access Journals (Sweden)

    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.

  16. Brunner’s Gland Hamartoma: A Rare Cause of Gastrointestinal Bleeding – Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    David R Stolpman

    2002-01-01

    Full Text Available An unusual cause of upper gastrointestinal bleeding is described in a previously healthy 45-year-old man who was admitted to hospital with weakness and fatigue, and had experienced an episode of melena two days before admission. His medical and surgical history was unremarkable. Upon admission to hospital, he showed evidence of iron-deficiency anemia, with a hemoglobin concentration of 61 g/L (normal range 135 to 175 g/L, a mean corpuscular volume of 73 fL (normal range 85.0 to 95.0 fL and a ferritin concentration of 1.0 µg/L (normal range in males 15 to 400 µg/L. Upper gastrointestinal endoscopy revealed a 3.5 cm ulcerated submucosal mass in the third portion of the duodenum, for which mucosal biopsies were nondiagnostic. A subsequent endoscopic ultrasound revealed a 2.7×4.0 cm hyperechoic, cystic, submucosal tumour in the third portion of the duodenum. Endoscopic ultrasound-guided fine needle aspiration revealed no malignant cells. The patient eventually underwent a resection of the third portion of his duodenum. Surgical pathology revealed that this tumour was a Brunner’s gland hamartoma, 4.5 cm in its greatest dimension.

  17. Analysis of Diagnosis and Treatment for Cirrhosis With Upper Gastrointestinal Bleeding%肝硬化合并上消化道出血患者的临床诊断与治疗分析

    Institute of Scientific and Technical Information of China (English)

    李向阳

    2015-01-01

    Objective To investigate the effect of digestion and clinical diagnosis and treatment of cirrhosis with upper gastrointestinal bleeding. Methods 98 cases of cirrhosis with upper gastrointestinal bleeding were chosen from January 2012 to March 2015 in our hospital. Results The causes of hemorrhage esophageal varices rupture bleeding 48.98%, portal hypertensive gastropathy hemorrhage 25.51%, peptic ulcer bleeding in 15.31%, acute gastric mucosa lesion hemorrhage 8.16%, stomach cancer hemorrhage 2.04%. The treatment success rate was 90.82% and mortality rate was 1.02%. Conclusion The need to clear as soon as possible causes of bleeding in the diagnosis and treatment of upper gastrointestinal bleeding in patients with cirrhosis, according to the cause of symptomatic treatment, in order to improve the success rate of treatment.%目的:探讨肝硬化合并上消化道出血的出血原因、临床诊断及治疗方法与效果。方法收集2012年1月~2015年3月间在我院接受治疗的98例肝硬化合并上消化道出血患者的临床资料,对其进行回顾性分析。结果本组出血原因中食管静脉曲张破裂出血48.98%、门脉高压性胃病出血25.51%、消化性溃疡出血15.31%、急性胃粘膜病变出血8.16%、胃癌出血2.04%;治疗成功率为90.82%,死亡率1.02%。结论肝硬化合并上消化道出血诊治中需及早明确出血原因,根据病因给予对症治疗,以提高治疗成功率。

  18. Importance of Heparin Provocation and SPECT/CT in Detecting Obscure Gastrointestinal Bleeding on 99mTc-RBC Scintigraphy: A Case Report.

    Science.gov (United States)

    Haghighatafshar, Mahdi; Gheisari, Farshid; Ghaedian, Tahereh

    2015-08-01

    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 Tc-red blood cell (RBC) and Meckel's scintigraphies for several times were negative in detection of bleeding site. However, Tc-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 Tc-RBC scintigraphy accompanied by fused SPECT/CT images should be kept in mind for management of intestinal bleeding especially in difficult cases.

  19. Unexplained gastrointestinal bleed due to arteriobiliary fistula after percutaneous liver biopsy.

    Science.gov (United States)

    Smirniotopoulos, John; Barone, Paul; Schiffman, Marc

    We represent a case of a 54-year-old male who presented to the emergency department with right upper quadrant abdominal pain and melena three weeks after percutaneous liver biopsy. He was found to have anemia secondary to an upper gastrointestinal hemorrhage, unresponsive to multiple blood transfusions. Angiography later revealed an arteriobiliary fistula with contrast extravasation entering the duodenum. The fistula was successfully embolized and the patient was discharged without complication. This report demonstrates the importance in considering a vascular intrahepatic fistula in patients with right upper quadrant abdominal pain after remote liver biopsy.

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

    DEFF Research Database (Denmark)

    Laursen, Stig B; Dalton, Harry R; Murray, Iain A;

    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...... identified, and outcomes of patients classified as low risk. RESULTS: There were differences in age (P = .0001), need for intervention (P systems identified low-risk patients with high levels of sensitivity (>97%). The GBS at cut-off values...

  1. 消化道出血病因及误诊原因分析%Analysis of etiology and misdiagnosed reasons in gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    徐少华; 汪祖春; 李燕

    2012-01-01

    Objective To analysis of 343 cases of etiology and misdiagnosed reasons in gastrointestinal bleeding.Methods For the 343 cases of gastrointestinal bleeding cases,diagnosis based on laboratory tests,endoscopy,capsule endoscopy,selective angiography,radionuclide scanning,enhanced spiral CT scan or laparotomy.Results Cause of upper gastrointestinal bleeding in ulcerative disease is most prevalent,lower gastrointestinal bleeding is most common in intestinal cancer,patients over 65 years a high incidence of tumors in patients under the age of 65.Misdiagnosed cases to be mainly melena on the right colon mistaken for gastrointestinal bleeding in common,ulcerative colitis,proctitis and rectal cancer mistaken for more common bleeding hemorrhoids or diarrhea.Conclusion Ulcerative lesions and tumors in the most common cause of gastrointestinal bleeding,elderly patients should be alert to the tumor.%目的 分析343例消化道出血病例的原因以及误诊漏诊的原因.方法 对于343例消化道出血病例,诊断根据实验室检查、纤维内镜、胶囊内镜检查、选择性动脉造影、核素扫描、增强螺旋CT扫描或剖腹探查术结果.结果 上消化道出血的原因以溃疡性病变最为多见,下消化道出血以肠癌最为多见,65岁以上患者肿瘤发病率高于65岁以下患者.误诊以主要表现为黑便的右半结肠癌误认为上消化道出血,溃疡性结、直肠炎及直肠癌误诊为痔疮或痢疾出血多见.结论 消化道出血病因以溃疡性病变和肿瘤最为常见,老年患者应警惕肿瘤.

  2. 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?

    Directory of Open Access Journals (Sweden)

    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.

  3. Dieulafoy's Lesions of the Rectum: A Rare Cause of Lower Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Robert Enns

    2001-01-01

    Full Text Available Dieulafoy's lesions located outside of the stomach are rare occurrences. Lesions found within the colon typically present with painless, massive hematochezia (ie, greater than 5 U. If they can be accurately located, endoscopic therapy in the form of adrenaline injection, sclerotherapy or cauterization appears to have long term success. The present report details the case of a 72-year-old man who presented with massive hematochezia and who was discovered to have a Dieulafoy's lesion within the rectum. The lesion was located just distal to a previous surgical anastomosis, and was successfully treated with adrenaline and electrocautery. Colonic Dieulafoy's lesions are rare but should always be considered in the differential diagnosis of massive hematochezia, because endoscopic therapy appears to result in complete cessation of bleeding.

  4. [Severe lower gastrointestinal bleeding due to GIST tumor. Radiological embolization and surgery].

    Science.gov (United States)

    Navas, Diana; Ríos, Antonio; Febrero, Beatriz; Rodríguez, José Manuel; Lloret, Francisco; Parrilla, Pascual

    2014-01-01

    Antecedentes: los tumores del estroma gastrointestinal (GIST) se identificaron hace muy poco tiempo. Son tumores que no suelen alertar con síntomas mientras permanecen en fase localizada, operable y curable. Aunque son poco frecuentes, cuando no se diagnostican y tratan oportunamente son muy agresivos. Su manifestación clínica más común es la hemorragia gastrointestinal por erosión de la mucosa, pero su presentación como hemorragia baja del tubo digestivo severa es excepcional. Caso clínico: se comunica un caso de hemorragia baja del tubo digestivo severa estabilizada por radiología intervencionista, que posteriormente requirió cirugía para su tratamiento definitivo. Conclusiones: la embolización radiológica está cada vez más difundida como tratamiento de hemorragias en distintos sitios porque permite la estabilización hemodinámica de los pacientes. No hay que olvidar, sin embargo, que en los casos de hemorragia baja del tubo digestivo, de origen desconocido, es necesario investigar las posibles causas.

  5. The application of gastroscopy in children with upper gastrointestinal bleeding%纤维胃镜在小儿上消化道出血诊治中的应用

    Institute of Scientific and Technical Information of China (English)

    黎小秀; 邹明艳; 张雪宇; 黄立文

    2012-01-01

    目的 探讨纤维胃镜在小儿上消化道出血诊治中的应用价值.方法 采用日本产OLYMPUS GIF-XP20型纤维胃镜检查对2007年12月至2011年5月收治的102例上消化道出血患儿行胃镜检查及幽门螺杆菌(Hp)定性检查.结果 上消化道出血病因中以消化性溃疡为主(其中胃溃疡20例,十二指肠球部溃疡39例);其次是急性胃黏膜病变.24 h内行胃镜检查者定位诊断率100%;24~48 h内检查者定位诊断率为90.6%;超过48 h以上检查者诊断率为85.5%.Hp阳性60例,阳性率58.8%.本组102例上消化道出血患儿,成功插镜率100%.结论 小儿上消化道出血多由于消化性溃疡所致,与Hp感染相关.早期纤维胃镜可明确出血病因,简单易行,安全可靠,是小儿上消化道出血诊断的首选方法.%Objective To study the clinical significance of gastroscopy in children with upper gastrointestinal bleeding. Methods One hundred and two childish cases of upper gastrointestinal bleeding during December 2007 to May 2011 were treated with Japanese made OLYMPUS GIF - XP20 gastroscopy, and they were concurrently examined for Helicobacter pylori ( Hp ). Results Peptic ulcer was the main etiological cause for upper gastrointestinal bleeding ( including 20 cases of gastric ulcer and 39 cases of duodenal ulcer ), followed by acute gastric mucosal lesions. The diagnostic rate of gastroscopy by experts within 24 h was 100% , it was 90.6% within 24 ~48 h, and the diagnostic rate over 48 h was 85. 5%. Hp - positive infection was seen in 60 cases with a positive rate of 58. 8%. Among 102 cases of upper gastrointestinal bleeding in children of this group, the successful rate of insertion of gastroscopy was 100% . Conclusion As more children with upper gastrointestinal bleeding caused by peptic ulcer associated with Hp infection, early gastroscopy can confirm the cause of bleeding, it is simple, safe and reliable, and it is the preferred method for diagnosis of upper

  6. Dieulafoy Lesion in the Ascending Colon Presenting with Gastrointestinal Bleeding and Severe Anemia Complicated by a Coexisting Severe Resistant Chronic Idiopathic Thrombocytopenic Purpura

    Directory of Open Access Journals (Sweden)

    Sherif Ali Eltawansy

    2014-01-01

    Full Text Available Background. GI (gastrointestinal bleeding can be due to a variety of etiologies ranging from being common like bleeding peptic ulcer disease or esophageal varices. One of the rarely documented causes is the Dieulafoy lesion which is known as an abnormally large ectatic artery that penetrates the gut wall, occasionally eroding through the mucosa causing massive bleeding. In addition to that, we refer to the uncommon presentation of Dieulafoy lesion itself as it is well known to be found in the stomach, esophagus, duodenum, and jejunum but not the ascending colon as in our case. The patient had a coexisting ITP (idiopathic thrombocytopenic purpura that was resistant to different therapies. Case Report. We report a case of a 48-year-old Egyptian female known for chronic ITP resistant to treatment. The patient presented with bright red bleeding per rectum and severe life threatening anemia. Endoscopic study showed a Dieulafoy lesion. Endoscopic clipping was successful in controlling the bleeding. Conclusion. Dieulafoy lesion is a rare reason for GI bleeding and can present in common or unexpected places. Also extreme caution should be used in patients with bleeding tendency due to different reasons, like ITP in our case.

  7. 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

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    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.

  8. 消化道出血患者药物治疗体会%Experience of drug treatment in patients with gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    杨倩

    2014-01-01

    目的:研究消化道出血患者的病因与药物治疗效果。方法回顾性分析2010年3月~2013年3月我院收治的消化道出血患者136例的临床资料。观察及分析患者的发病原因,以及泮托拉唑钠、奥曲肽与氨甲苯酸联合治疗的临床效果。结果136例患者的病因依次为消化性溃疡、急性胃黏膜病变、肝硬化食管静脉曲张破裂与胃癌。发病诱因为饮食不当、饮酒、药物、精神因素与劳累等因素。实施泮托拉唑钠、奥曲肽、氨甲苯酸联合治疗消化性溃疡的优良率为95.9%,治疗急性胃黏膜病变的优良率为93.3%,治疗肝硬化食管静脉曲张破裂的优良率为90.9%,治疗胃癌的优良率为100%。结论消化道出血疾病的病因是消化性溃疡,诱因常是口服刺激性的药物。采用泮托拉唑钠、奥曲肽、氨甲苯酸联合治疗消化道出血具有较高的应用价值,值得临床进一步推广应用。%Objective To study the etiology and clinical efficacy of drug treatment on patients with gastrointestinal hemorrhage. Methods Clinical data of 136 cases with gastrointestinal bleeding from March 2010 to March 2013 in our hospital were retrospectively analyzed.Aetiological agent and clinical efficacy of pantoprazole sodium, octreotide combined with aminomethylbenzoic acid treatment were observed and analyzed. Results The causes of 136 cases of patients were peptic ulcer, acute gastric mucosal lesion, cirrhosis esophageal varices and gastric cancer. The predisposing factors were improper diet, alcohol, drugs, mental factors and fatigue factors. The excellent and good rate of implementation of pantoprazole sodium, omeprazole, combined with aminomethylbenzoic acid for peptic ulcer was 95.9%, the excellent and good rate of treatment of acute gastric mucosal lesion was 93.3%, the excellent and good rate for liver cirrhosis with esophageal varices was 90.9%, and the excellent and good rate of gastric cancer was

  9. Significance of Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs in patients with bleeding from upper part of the gastrointestinal tract

    Directory of Open Access Journals (Sweden)

    Golubović Gradimir

    2007-01-01

    Full Text Available Background/Aim. Helicobacter pylori (H. pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs use are considered to be the most important risk factors having influence on the onset of bleeding gastroduodenal lesions. Whether there is an interaction between H. pylori infection and the use of NSAIDs in the development of peptic ulcer disease is still controversial. The aim of the present study was to evaluate the prevalence of NSAIDs use and H. pylori infection in patients presented with bleeding gastroduodenal lesions. Methods. During the period from January 2003 - December 2003 we prospectively obtained data of all the patients (n=106 presented with signs of upper gastrointestinal bleeding. All the patients were admitted to the intensive care unit, with the endoscopy performed within 12 hours after admission. Histologic analysis was used for the detection of H. pylori infection. The NSAIDs and aspirin use data were obtained by anamnesis. Results. The results of our study revealed that the most common sources of upper gastrointestinal bleeding were duodenal (57 patients, 53.77% and ventricular (36 patients, 33.96% ulcers. The majority of the examined cases were associated with both H. pylori infection and NSAIDs use. A statistically significant difference among the studied groups of patients was proven. Conclusion. The majority of bleeding gastroduodenal lesions were associated with the coexistence of H. pylori infection and NSAIDs use, while their independent influences were statistically less important. Eradication of H. pylori infection in patients using NSAIDs might prevent upper gastrointestinal hemorrhage and reduce peptic ulcer bleeding risk. .

  10. Mucormycosis as a rare cause of severe gastrointestinal bleeding after multivisceral transplantation.

    Science.gov (United States)

    Irtan, S; Lamerain, M; Lesage, F; Verkarre, V; Bougnoux, M-E; Lanternier, F; Zahar, J R; Salvi, N; Talbotec, C; Lortholary, O; Lacaille, F; Chardot, C

    2013-12-01

    Mucormycosis, an emerging fungal infection in solid organ transplant patients, is mostly located in rhino-orbito-cerebral, pulmonary, and cutaneous areas, or disseminated with poor prognosis. A 4-year-old girl with chronic intestinal pseudo-obstruction syndrome underwent a modified multivisceral transplantation, including half of the stomach, the duodeno-pancreas, the small bowel, and the right colon. On postoperative day 5, a digestive perforation was suspected. Surgical exploration found a small necrotic area on the native stomach, which was externally drained. The next day, massive gastric bleeding occurred. During the emergency laparotomy, 2 hemorrhagic ulcers were found and resected from the transplanted stomach. Pathology and fungal culture showed mucormycosis caused by Lichtheimia (formerly Absidia) ramosa in both the transplanted and native stomach. High-dose intravenous liposomal amphotericin B was immediately started. No other site of fungal infection was found. The child recovered, and 3 years after transplantation, is alive and well, off parenteral nutrition. The originality of this case is the very early presentation after transplantation, the unusual site, and the complete recovery after rapid medico-surgical management. The origin of the fungus and treatment are discussed.

  11. 消化道出血病因及检查手段分析%Analysis of etiology and checking methods of gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    薛萌; 张连峰; 张宇恒

    2012-01-01

    Objective To investigate the etiology and checking methods of 424 gastrointestinal hemorrhage cases, to instruct clinical diagnosis and therapy. Methods TotallyThe date of 424 patients admitted to The First Affiliated Hospital of Zhengzhou University with gastrointestinal hemorrhage from October 2009 to October 2011 were analyzed, the etiology and checking methods was summarized. Results Totally 281 cases were located in upper gastrointestinal, 143 cases were located in lower gastrointestinal. Peptic ulcer (37. 1% ) was the leading cause for upper gastrointestinal bleeding, next were esophagogastric variceal bleeding(27. 4% ) and tumour( 15. 7% ). Ulcerative colitis(24. 5% ) was the leading cause for lower gastrointestinal bleeding, next were tumour(21. 0% ) , gastroscope and colonoscopy will still be the priority checking methods of gastrointestinal hemorrhage, in the negative cases, operation and push en-teroscopy were the highest checking methods to diagnosze the etiology. Conclusions The most common site of gastrointestinal bleeding located in upper gastrointestinal, the first causation of bleeding was peptic ulcer in upper gastrointestinal and ulcerative colitis in lower gastrointestinal respectively. The enteroscopy is recommended in diagnosis of gastrointestinal bleeding.%目的 回顾性分析424例消化道出血的病因及检查手段,指导临床诊治.方法 分析从2009年10月至2011年10月在郑州大学第一附属医院住院的424例消化道出血患者的临床资料,对其病因及检查方法进行总结.结果 281例位于上消化道,143例位于下消化道,上消化道出血最常见病因为消化性溃疡(37.1%),其次是食管胃底静脉曲张(27.4%)及肿瘤(15.7%),下消化道出血的主要病因是溃疡性结肠炎(24.5%)和肿瘤(21.0%),胃肠镜仍是消化道出血的首选检查,在胃肠镜阴性的病例中,以手术及小肠镜诊出率最高.结论 上消化道出血病因以消化性溃疡占首位,下消化

  12. Endoscopic findings in patients with upper gastrointestinal bleeding clinically classified into three risk groups prior to endoscopy

    Institute of Scientific and Technical Information of China (English)

    Leonardo Tammaro; Maria Carla Di Paolo; Angelo Zullo; Cesare Hassan; Sergio Morini; Sebastiano Caliendo; Lorella Pallotta

    2008-01-01

    AIM: To investigate in a prospective study whether a simplified clinical score prior to endoscopy in upper gastrointestinal bleeding (UGIB) patients was able to predict endoscopic findings at urgent endoscopy.METHODS: All consecutive UGIB patients referred to a single endoscopic center during a 16 mo period were enrolled. Before endoscopy patients were stratified according to a simple clinical score (T-score),including T1 (high-risk), T2 (intermediate-risk) and T3 (low-risk). Endoscopy was performed in all cases within 2 h, and high-risk stigmata were considered for further analysis.RESULTS: Out of the 436 patients included into the study, 126 (29%) resulted to be T1, 135 (31%) T2,and 175 (40%) T3. Overall, stigmata of recent haernorrhage (SRH) were detected in 118 cases (27%). SRH occurred more frequently in Tt patients than in T2/T3 cases (85% vs 3.2%; x2 = 304.5309, P < 0.001). Older age (t = 3.311; P <0.01) and presence of comorbidities (x2 = 14.7458; P < 0.01) were more frequently detected in T1 than in T2/T3 patients.CONCLUSION: Our simplified clinical score appeared to be associated with the detection of endoscopic findings which may deserve urgent endoscopy. A further,randomised study is needed to assess its accuracy in safely scheduling endoscopy in UGIB patients.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    administrative registry data from all hospitals in Denmark between 1997 and 2011. The study included patients aged 30 years and over admitted with a first myocardial infarction who survived at least 30 days after discharge. The association between PPIs and risk of gastrointestinal bleeding according to NSAID...... of NSAID, and type of PPI used. FUNDING, COMPETING INTERESTS, DATA SHARING: AMSO has received a grant from the Danish Council of Independent Research (grant 12-132760). GHG is supported by an unrestricted research scholarship from the Novo Nordisk Foundation....... 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...

  15. Acute scrotum due to arterial bleeding mimicking non-seminomatous germ cell tumor

    Institute of Scientific and Technical Information of China (English)

    F.Christoph; M.Schradert; A.Amirmaki; K.Miller

    2004-01-01

    Men with testicular tumors usually present with painless increase in testis size incidentally noticed by the patient. We report a case of a young patient presenting as an emergency with acute onset of massive right-sided testicular pain without previous injury. After physical examination testicular torsion could not be excluded. Ultrasound examination of the tesds was suspicious for tesdcular tumor. Surgical exploration of the right testis by inguinal approach was performed revealing subcapsular arterial bleeding due to a small nonseminomatous germ cell tumor non-palpable on clinical examination. (Asian J Andro12004 Dec;6:379-381)

  16. Clnical Analysis of Hepatocirrhosis with Upper Gastrointestinal Bleeding%肝硬化合并上消化道出血的临床分析

    Institute of Scientific and Technical Information of China (English)

    李孝国

    2013-01-01

    目的:分析肝硬化并发上消化道出血的相关临床情况。方法选取30例肝硬化并发上消化道出血患者,均采用综合方式救治,分析临床救治效果及发病相关因素。结果治疗后总有效率86.7%,有效率60.0%,显效率26.7%;发病与性别和年龄有相关性,男性、40~60岁患者更常见。结论肝硬化并发上消化道出血临床危险程度高,应及早救治,以减少临床病死率。%Objective To analyse the clinical situations of hepatocirrhosis with upper gastrointestinal bleeding. Methods 30 cases of patients with hepatocirrhosis with upper gastrointestinal bleeding were selected, and all treated by integrated approach. Results The total effective rate was 86.7%, the effective rate was 60.0%, and the efifciency rate was 26.7%after treatment. Conclusion There has high degree of risk of hepatocirrhosis with upper gastrointestinal bleeding, the clinical should treat as early as possible to reduce the mortality.

  17. Comparison of emergency endoscopic variceal ligation plus octride or octride alone for acute esophageal variceal bleeding

    Institute of Scientific and Technical Information of China (English)

    LIU Jin-song; LIU Jun

    2009-01-01

    Background Octride was the main method for the treatment of esophageal variceal bleeding (EVB). The aim of this study was to compare the cost-effect and safety between esophageal variceal ligation (EVL) plus octride and octride alone in acute esophageal bleeding.Methods A total of 101 cirrhotic patients with EVB were involved in this study and received emergency EVL+octride (EVL group) or only octride therapy randomly. The cost, efficacy and safety were analyzed and compared between the two groups.Results Among 51 patients in EVL group, 5 (10%) patients failed. Among 50 patients in the octride treatment group, 13 patients (26%) failed. The difference was significant (P<0.05). The average blood transfusion volume was (2.4±2.2) units in the EVL group and (6.4±3.4) units in the octride treatment group (P <0.05). Hospital stay was (7.4±1.3) days in the EVL group and (11.4±3.3) days in the octride treatment group (P<0.05). The average hospital cost was (10 983±1147) yuan in the EVL group and (13 921 ±2107) yuan in the octride treatment group (P<0.05). Conclusion Emergency endoscopic ligation plus octride is superior to octride alone in the treatment of acute EVB with lower cost and higher efficacy with enough safety.

  18. Characteristics and risk factors of major and clinically relevant non-major bleeding in cancer patients receiving anticoagulant treatment for acute venous thromboembolism-the CATCH study

    NARCIS (Netherlands)

    Kamphuisen, P.W.; Lee, A.Y.Y.; Meyer, Guy; Bauersachs, R.; Janas, M.S.; Jarner, M.F.; Khorana, A.A.

    2015-01-01

    Background: Cancer patients with acute venous thromboembolism (VTE) receiving anticoagulant treatment have a substantial risk of bleeding complications. Aims: To assess the rate, site and risk factors of clinically relevant bleeding (CRB; major or clinically relevant non-major bleeding) in cancer pa

  19. 分析患者发生上消化道出血的相关因素%Analyze the Related Factors in Patients With Upper Gastrointestinal Bleeding

    Institute of Scientific and Technical Information of China (English)

    陶云建

    2015-01-01

    目的:探析患者发生上消化道出血的相关因素。方法随机选取2013年1月~2015年1月,我院接诊并收治的上消化道出血患者96例,对患者发生上消化道出血的相关因素进行回顾性分析总结。结果96例患者经治疗后总体疗效较佳,2例医治无效死亡(死亡率2.08%),其余94例均痊愈出院;男性患者多于女性患者,P70岁14例,占14.58%,不同年龄段的患者发生上消化道出血的概率存在差异,P 70 years old in 14 cases, accounting for 14.58% of patients of different ages occur there are obvious differences in the probability of upper gastrointestinal bleeding,P< 0.05.Conclusion Factors medication, age, sex, life stress, work intensity, dietary laws and history of gastrointestinal ulcers and other upper gastrointestinal bleeding has a close relationship. In the clinical diagnosis and treatment process, we should strengthen the importance of these factors, as wel as develop appropriate treatment programs to reduce the amount of bleeding and bleeding times, reduce the relapse rate and improve the efficacy and reduce mortality.

  20. Gastrointestinal events with clopidogrel

    DEFF Research Database (Denmark)

    Grove, Erik Lerkevang; Würtz, Morten; Schwarz, Peter

    2013-01-01

    Clopidogrel prevents cardiovascular events, but has been linked with adverse gastrointestinal (GI) complications, particularly bleeding events.......Clopidogrel prevents cardiovascular events, but has been linked with adverse gastrointestinal (GI) complications, particularly bleeding events....

  1. Diagnosis of a Bleeding Dieulafoy Lesion on Computed Tomography and Its Subsequent Embolization

    Directory of Open Access Journals (Sweden)

    Robert M Penner

    2004-01-01

    Full Text Available Dieulafoy lesions are a potentially serious cause of gastrointestinal bleeding. Because they may bleed intermittently, and only be endoscopically evident during hemorrhage, their diagnosis can be challenging. This is the first case to be reported in the English literature of a patient with a Dieulafoy lesion diagnosed during computed tomography (CT examination. Reduced acquisition times required for multislice helical CT allow the application of CT angiography in the diagnosis of gastrointestinal bleeding. CT scans are now widely used in the diagnostic algorithm for acute gastrointestinal hemorrhage, and the present case illustrates that with fortuitous timing, they can provide critical information and an opportunity for selected angiography and coil embolization.

  2. [Multiple gastro-intestinal stromal tumors (GIST) in a patient with type I neurofibromatosis revealed by chronic bleeding: pre-operative radiological diagnosis].

    Science.gov (United States)

    Guillaud, Olivier; Dumortier, Jérôme; Bringuier, Pierre-Paul; Saurin, Jean-Christophe; Poncet, Gilles; Boulez, Jean; Henry, Luc; Chayvialle, Jean-Alain; Scoazec, Jean-Yves

    2006-02-01

    Recent studies have pointed out a high incidence of GIST, usually multiple and of small intestinal location, in patients with type I neurofibromatosis. We here report an additional case, revealed by chronic gastro-intestinal bleeding and diagnosed at pre-operative imaging studies. A 56-year-old patient, with known type I neurofibromatosis, was referred to our department for the exploration of chronic gastro-intestinal bleeding during anti-aggregant therapy. Endoscopical examination was negative. Enteroscanner showed the presence of four tumor lesions, 3 in the jejunum and 1 in the ileum. Segmental surgical resections were performed. At histological examination, 2 of among the 3 jejunal lesions were diagnosed as typical GIST, of low risk of malignancy, CD117+, CD34+, whereas the last jejunal and ileal lesions were identified as fibroid tumors. Mutations of c-kit gene and of the gene coding for PDGF-Ralpha were not detected. Post-operative recovery was uneventful; no recurrent bleeding was observed. Our case report underlines the potential role of enteroscanner in the management of patients with type I neurofibromatosis with possible digestive complications. It also emphasizes the importance of an accurate diagnosis of the digestive tumors associated with type I neurofibromatosis: GISTs are frequent in this setting and must not be misdiagnosed as neurofibromas.

  3. Effective salvage of acute massive uterine bleeding using intrauterine balloon tamponade in a uterine adenomyosis patient on dienogest.

    Science.gov (United States)

    Nishino, Kimihiro; Hayashi, Kazumasa; Chaya, Jyunya; Kato, Noriko; Yamamuro, Osamu

    2013-03-01

    We present the case of a 37-year-old nulliparous woman in whom acute massive uterine bleeding during dienogest therapy was successfully treated using intrauterine balloon tamponade. Abnormal uterine bleeding and several cases of profuse bleeding causing severe anemia in association with dienogest therapy have been reported, but this is the first reported case involving hypovolemic shock. While successful control of postpartum hemorrhage with intrauterine balloon tamponade has been well described, applications for non-obstetric bleeding, particularly in the presence of underlying diseases, such as adenomyosis, have only rarely been reported. This procedure can be easily, promptly, and safely implemented without analgesia, anesthesia, or laparotomy; it can be used with a minimally dilated external cervical os or narrow uterine cavity; and it can preserve fertility.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  5. Upper gastrointestinal bleeding as a risk factor for dialysis and all-cause mortality: a cohort study of chronic kidney disease patients in Taiwan

    OpenAIRE

    Liang, Chih-Chia; Chou, Che-Yi; Chang, Chiz-Tzung; Wang, I-Kuan; Huang, Chiu-Ching

    2016-01-01

    Objective Impaired renal function is associated with higher risk of upper gastrointestinal bleeding (UGIB) in patients with chronic kidney disease and not on dialysis (CKD-ND). It is unclear if UGIB increases risk of chronic dialysis. The aim of the study was to investigate risk of chronic dialysis in CKD-ND patients with UGIB. Setting All CKD-ND stage 3–5 patients of a CKD programme in one hospital between 2003 and 2009 were enrolled and prospectively followed until September 2012. Primary a...

  6. 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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  7. Variceal bleeding from ileum identified and treated by single balloon enteroscopy

    Institute of Scientific and Technical Information of China (English)

    Mario Traina; Ilaria Tarantino; Luca Barresi; Filippo Mocciaro

    2009-01-01

    We report a case of acute uncontrolled gastrointestinal bleeding in a patient with liver cirrhosis. The upper and lower endoscopy were negative for bleeding lesions. We decided to perform the examination of the small bowel using single-balloon enteroscopy. The lower enteroscopy revealed signs of bleeding from varices of the ileum. In this report, we showed that the injection of a sclerosant solution can be accomplished using a freehand technique via the single balloon enteroscopy.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. Nursing coordination in endoscopic treatment of non - variceal upper gastrointestinal bleeding with titanium clips%内镜下钛夹治疗上消化道非静脉曲张出血60例的护理配合

    Institute of Scientific and Technical Information of China (English)

    王连英

    2012-01-01

    目的 通过对60例上消化道非静脉曲张出血患者采用金属钛夹在内镜下直接止血,总结护理配合技巧和要点.方法 用金属钛夹推送器安装钦夹,对准出血部位释放金属钛夹达到止血目的.结果 60例非静脉曲张上消化道出血,根据Forrest分级标准,Ⅰa6例,Ⅰb38例,Ⅱa9例,Ⅱb7例.共用金属钛夹125枚,所有病例内镜下首次止血成功率100%,术后无不良反应及并发症.结论 掌握内镜性能,正确使用金属钛夹推送器,可确保内镜下金属钛夹治疗消化道出血的成功.%Objective To sum up nursing coordination skills in the treatment of non -variceal upper gastrointestinal bleeding with titanium clips. Methods Data of 60 patients with a-cute non - variceal upper gastrointestinal tract bleeding were collected. The bleeding site was identified by endoscope, and both ends of the bleeding area were clipped with a titanium clip adjuster. Results Sixty patients with non - variceal upper gastrointestinal bleeding were divided into Ia stage ( n = 6), Ib stage ( n = 38),Ⅱa stage (n = 9) and Ⅱb stage (n = 7), according to Forrest classification standards. A total of 125 titanium clips were used and the bleedings were stopped immediately in all cases and the success rate was 100 %. No postoperative adverse reactions and complications were found. Conclusion A good command of endoscope and proper use of titanium clip adjuster can ensure the success of endoscopic treatment for gastrointestinal bleeding.

  10. Comparison of Glasgow-Blatchford score and full Rockall score systems to predict clinical outcomes in patients with upper gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Mokhtare M

    2016-10-01

    Full Text Available Marjan Mokhtare, Vida Bozorgi, Shahram Agah, Mehdi Nikkhah, Amirhossein Faghihi, Amirhossein Boghratian, Neda Shalbaf, Abbas Khanlari, Hamidreza Seifmanesh Colorectal Research Center, Rasoul Akram Hospital, Tehran, Iran Background: Various risk scoring systems have been recently developed to predict clinical outcomes in patients with upper gastrointestinal bleeding (UGIB. The two commonly used scoring systems include full Rockall score (RS and the Glasgow-Blatchford score (GBS. Bleeding scores were assessed in terms of prediction of clinical outcomes in patients with UGIB. Patients and methods: Two hundred patients (age >18 years with obvious symptoms of UGIB in the emergency department of Rasoul Akram Hospital were enrolled. Full RS and GBS were calculated. We followed the patients for records of rebleeding and 1-month mortality. A receiver operating characteristic curve by using areas under the curve (AUCs was used to statistically identify the best cutoff point. Results: Eighteen patients were excluded from the study due to failure to follow-up. Rebleeding and mortality rate were 9.34% (n=17 and 11.53% (n=21, respectively. Regarding 1-month mortality, full RS was better than GBS (AUC, 0.648 versus 0.582; P=0.021. GBS was more accurate in terms of detecting transfusion need (AUC, 0.757 versus 0.528; P=0.001, rebleeding rate (AUC, 0.722 versus 0.520; P=0.002, intensive care unit admission rate (AUC, 0.648 versus 0.582; P=0.021, and endoscopic intervention rate (AUC, 0.771 versus 0.650; P<0.001. Conclusion: We found the full RS system is better for 1-month mortality prediction while GBS system is better for prediction of other outcomes. Keywords: full Rockall score, Glasgow-Blatchford score, gastrointestinal bleeding, mortality, prognosis

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

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    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.

  12. 《急性上消化道出血急诊诊治流程专家共识(修订稿)》的阐释%Interpretation of Expert Consensus About the Emergency Diagnosis and Treatment of Acute Upper Gastrointestinal Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    周荣斌; 林霖

    2015-01-01

    The Expert Consensus About Diagnosis and Treatment of Acute Upper Gastrointestinal Tract Bleeding is the first international guideline formulated and agreed by experts of emergency treatment. It includes the essence of diagnosis and treatment of acute upper gastrointestinal tract bleeding from the perspectives of multiple subjects and provides standardized and practical diagnosis and treatment processes and methods for the treatment of acute upper gastrointestinal tract bleeding. In this paper,we interpreted the Expert Consensus About Diagnosis and Treatment of Acute Upper Gastrointestinal Tract Bleeding, confirmed its clinical significance,summarized its core content and evaluated its highlights. We also summarized the emergency diagnosis and treatment of acute upper gastrointestinal tract bleeding,pointed out the defects of the consensus and put forward the prospects for the new consensus.%《急性上消化道出血急诊诊治流程专家共识》是国际上首个由急诊专家制定并达成的指南性文件,包含了多学科急性上消化道出血的诊治精髓,为急性上消化道出血的救治提供了规范的、实用的诊治流程和方法。本文初步阐释了2011年《急性上消化道出血急诊诊治流程专家共识(修订稿)》,肯定了其临床意义,总结了其核心内容,评价了其制定亮点,归纳了急性上消化道出血的急诊诊治流程,指出了其存在的不足,同时提出了对新共识的展望。

  13. 208例上消化道出血患者的病因分析及胃镜诊断体会%Analysis of etiology and endoscopic diagnosis in 208 cases of upper gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    谢艳英; 韩敏

    2012-01-01

    Objective To investigate the causes of 208 cases of upper gastrointestinal bleeding and evaluate the value of gastroscopy on the diagnosis. Methods Retrospectively analyzed 208 cases of upper gastrointestinal bleeding received gastroscopy in our hospital from Jun. 2010 to Jun. 2012. Results Peptic ulcer was a major cause of upper gastrointestinal bleeding in different age groups, the rate of peptic ulcer bleeding in young-middle-aged group (42.4% ) was higher than that in elderly group (27.7%, P <0. 05). Gastrointestinal tumor was a common cause of upper gastrointestinal bleeding in the elderly, the rate of gastrointestinal tumor bleeding in elderly group (23. 7% ) was higher than that in the young-middle-aged group (7. 6%, P < 0. 01). The correct diagnosis rate by emergency gastroscopy was 97. 5% , higher than that in the non-emergency gastroscopy (87.5% , P<0.05). Conclusion Peptic ulcer is the main cause of upper gastrointestinal bleeding. Emergency gastroscopy can be the primary method on the diagnosis of upper gastrointestinal bleeding.%目的 对208例上消化道出血患者的病因进行分析,探讨胃镜的诊断价值.方法 回顾性分析我院2010年6月-2012年6月收治的208例上消化道出血患者胃镜诊断结果.结果 消化性溃疡是不同年龄组上消化道出血的主要病因,中青年组消化性溃疡出血比率(42.4%)高于老年组(27.7%,P<0.05).消化道肿瘤在老年组上消化道出血中所占的比例为23.7%,明显高于中青年组的7.6%(P<0.01),是老年人上消化道出血的常见原因.急诊胃镜组病因检出率为97.5%,高于非急诊胃镜组的87.5%(P<0.05).结论 上消化道出血的病因较多,以消化性溃疡最为常见.胃镜对上消化道出血病因诊断有较高价值,可作为首选方法.

  14. 主动脉瓣狭窄合并消化道出血病例分析%The clinical features of gastrointestinal bleeding complicating aortic stenosis

    Institute of Scientific and Technical Information of China (English)

    刘芳; 江成功; 冯雪茹; 刘梅林

    2013-01-01

    Objective To deepen the understanding about Heyde's syndrome by investigating the clinical characteristics and prognosis of the patients with aortic valve stenosis complicating with gastrointestinal bleeding.Methods Patients with aortic valve stenosis and gastrointestinal bleeding coincidently admitted to our hospital from 2001 to 2011 were retrieved and analyzed.Results In all the 443 157 in-patients,474 patients were diagnosed with aortic valve stenosis (0.11%,474/443 157) and 14 patients (9 males and 5 females,aged 53-87 years old) with gastrointestinal bleeding coincidently (2.95 %,14/474).Among the 14 patients,3 were moderate aortic valve stenosis,11 severe aortic valve stenosis.The aortic valve peak flow velocity was 324-709 (480.54 ± 188.25) cm/s and the mean aortic valve pressure gradient was 21.04-91.56 (56.93 ± 29.90) mm Hg (1 mm Hg =0.133 kPa).Heavy gastrointestinal bleeding was manifested in all the 14 patients with 1 of haematemesis and 13 of hematochezia.Hemoglobin (Hb) and red blood cell (RBC) count were significantly lower than the normal range [(69 ±28) g/L and (2.71 ±2.04) × 1012/L,P <0.05].Their mean corpuscular volume(MCV),mean corpuscular hemoglobin (MCH),mean corpuscular hemoglobin concentration (MCHC),platelet (PLT) count,prothrombin time (PT) and international normalized ratio (INR) were in normal range [(90.21 ± 2.94) r,(29.39 ± 1.99) pg,(327.57 ± 14.82) g/L,(185.13 ±22.55) × 109/L,(11.4 ± 1.04) s and 1.22 ±0.44,respectively].Among all the 14 patients,13 were over 65 years old and they all accepted gastrointestinal imaging (13/14).Vascular malformation of intestine was found in 6 patients with 4 lesions located in descending colon and 2 located in sigmoid colon.Hemorrhage foci were found in 2 patients with one of colon cancer,and another of duodenal ulcer,while no definite hemorrhage foci were found in the other 11 patients.A total of 6 patients with severe aortic valve stenosis underwent aortic valve replacement (AVR

  15. Balancing Potency of Platelet Inhibition with Bleeding Risk in the Early Treatment of Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    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

  16. The use of hemospray in portal hypertensive bleeding; a case series.

    Science.gov (United States)

    Smith, L A; Morris, A J; Stanley, A J

    2014-02-01

    Hemospray is a haemostatic agent licensed for endoscopic haemostasis of non-variceal upper gastrointestinal bleeding (NVUGIB) in Europe and Canada. Hemospray has been shown to be safe and effective in achieving haemostasis in bleeding peptic ulcers in a prospective clinical study and several further case series have described the use of hemospray in other non-variceal causes of gastrointestinal bleeding. Portal hypertensive gastropathy and colopathy are common in patients with portal hypertension. As hemospray is an easy to apply, non-contact method, which can cover large areas of mucosa, it may be of benefit in acute non-variceal portal hypertensive bleeding. We present data from the first four consecutive patients presenting to our institution with acute haemorrhage secondary to non-variceal diffuse portal hypertensive bleeding treated with hemospray.

  17. Therapeutic Options for Patients Bleeding with Peptic Ulcers

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    ABR Thomson

    1994-01-01

    Full Text Available It is likely that the best outcome for the patient with an acute upper gastrointestinal bleed (GIB includes early diagnosis: for a bleeding lesion with a high risk of rebleeding, in an older patient with systolic h.ypotension or in a person with multiple medical problems. Early therapeutic endoscopy with meticulous control of intragastric pH will Likely achieve the best outcome. The ideal pH criterion to stop bleeding or to prevent recurrence is unknown. An algorithm is presented to guide the clinical management of patients with GIB, and to focus on important questi.ons for future therapeutic studies.

  18. Pitfalls and Limitations of Radionuclide Hepatobiliary and Gastrointestinal System Imaging.

    Science.gov (United States)

    Low, Chen Sheng; Ahmed, Haseeb; Notghi, Alp

    2015-11-01

    Radionuclide imaging for the hepatobiliary and gastrointestinal system covers a wide range of different indications and imaging techniques. This wide variety allows the different functional assessments of both systems. Therefore, the understanding of each technique and its indications is essential. Cholescintigraphy is a well-established method in the assessment of acute and chronic cholecystitis. It also has a role in the detection of biliary atresia. The assessment of gastrointestinal transit is also well-established in radionuclide imaging for functional investigation of the gastrointestinal tract. Furthermore, detection of acute gastrointestinal bleeding with radionuclide imaging is also standard practice. This article aims to review the pitfalls and limitations in all of these areas.

  19. Acute pylephlebitis following gastrointestinal infection: an unrecognized cause of septic shock.

    Science.gov (United States)

    Altamirano, José; Zapata, Laura; Poblano, Manuel; Rodríguez, Agustín; Camargo, Leonardo; Martínez, Belinda; Bataller, Ramón

    2010-09-01

    Pylephlebitis is the septic thrombosis of the portal vein. Hypercoagulability and intra-abdominal sepsis are the main predisposing factors. A 25-year-old man presented to a primary health care center complaining of fever, epigastric pain, and jaundice. He was initially diagnosed with a gastrointestinal infection and alcoholic hepatitis and, due to his unstable clinical status, was referred to the emergency room. A diagnosis of acute pylephlebitis complicated with septic shock was made. Treatment with a wide-spectrum antibiotic and anticoagulation was initiated. Fifteen days later, recanalization of the portal vein was achieved and clinical status was improved. Pylephlebitis following gastrointestinal infection is a potential cause of septic shock.

  20. 机械通气患者消化道出血的高危因素分析%Risk factors of gastrointestinal bleeding in patients supported with mechanical ventilation

    Institute of Scientific and Technical Information of China (English)

    楚玉峰; 姜毅; 孟玫; 蒋进皎; 张继承; 任宏生; 王春亭

    2010-01-01

    Objective To identify the incidence and risk factors of gastrointestinal bleeding in patients supported with mechanical ventilation over 48 hours. Method A total of 127 ICU patients supported with mechanical ventilation for over 48 hours were enrolled from January 1, 2007 to December 31, 2008 for the retrospective study. Exclusion criteria included the history of gastrointestinal bleeding and ulcer, recent gastrointestinal surgery, brain death and active bleeding from nose or throat. Demographics of patients including age, diagnosis at admission, duration of ICU stay, duration of mechanical ventilation, pattern and parameters of ventilation, ICU mortality, A-PACHE II score, multiple organ dysfunction score, and the results of biochemical assays including renal, hepatic and coagulation functions were recorded. Risk factors of gastrointestinal bleeding were analyzed by using univariate analysis And multiple logistic-regression analysis. Results Of the 127 patients, the incidence of gastrointestinal bleeding was 41.7% . and among them 3.9% patients suffered from clinically significant bleeding. However, the independent risk factors of gastrointestinal bleeding were the peak inspiratory pressure > 30 cmH20 (RR = 3.73, 95% CI = 1.59-9.46), renal failure (RR = 1.16,95% CI = 1.02 - 2.32), PLT count <50× 109 L-1(RR = 2.67, 95% CI = 1.32 - 15.78) and prolonged APTT (RR = 4.58, 95%CI = 2.32 - 12.96). The good entetal nutrition had a beneficial effect to the avoidance of gastrointestinal bleeding ( RR = 0.30, 95% CI = 0. 13 - 0.67). Conclusions The incidence of gastrointestinal bleeding is high in patients supported with mechanical ventilation, and the bleeding usually occurs within the first 48 hours. High pressure ventilator setting, renal failure, decreased PLT count and prolonged APTT are significant risk factors of gastrointestinal bleeding. However, the good enteral nutrition is the independent protective factors.%目的 具有保护作用.Logistic多元回

  1. A 75 years old man with edema and inferior gastrointestinal bleeding Hombre de 75 años con edemas y sangrado digestivo inferior

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    Gabriel Jaime Varela Aguirre

    2004-02-01

    Full Text Available 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. 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.

  2. Effect of recombinant Factor VIIa on outcome of acute variceal bleeding

    DEFF Research Database (Denmark)

    Bendtsen, Flemming; D'Amico, Gennaro; Rusch, Ea;

    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...... vasoactive drug infusion and Child-Pugh score >8. RESULTS: 497 patients were eligible for the meta-analysis; 308 (62%) had active variceal bleeding at endoscopy (oozing or spurting) and 283 of these had a Child-Pugh score >8. Analysis on the composite endpoint in all patients with bleeding from oesophageal...... varices did not show any beneficial treatment effect. However, failure rate for the primary composite end-point was significantly lower in treated patients with active bleeding at endoscopy (17%) compared to placebo (26%, p=0.049). This difference was highly significant in patients with Child-Pugh score...

  3. Acute gastrointestinal haemorrhage on board a cruise ship in the Antarctic Peninsula.

    Science.gov (United States)

    Carron, Mathieu; Globokar, Peter; Sicard, Bruno A

    2016-01-01

    Antarctic tourism on board cruise ships has expanded since the 1990s, essentially in the Antarctic Peninsula. Due to remoteness, medical cases may evolve into life threatening conditions as emergency medical evacuations are challenging. We discuss the case of a young crew member who suddenly fainted with an epigastric pain and abundant rectal bleeding while on board a cruise ship heading to the Deception Island (62°57.6 South, 60°29.5 West), 44 h away from Ushuaia by sea. A medical evacuation was necessary to save the patient whose haemoglobin level rapidly decreased from 11 g/dL to 8.7 g/dL over an 8 h period due to uncontrolled gastrointestinal bleeding. Following discussions between the French, Chilean and Argentinean Medical Top Side Support and Maritime Rescue Authorities and despite poor weather conditions, an emergency medical evacuation by air to Chile was made possible. The evacuation, which was 2 days shorter compared to an evacuation by sea, allowed the patient to reach a hospital facility in time to save his life whereas he decompensated in haemorrhagic shock. As passengers on cruise ships are typically elderly and often following anticoagulant therapies, the risk of bleeding is most important. Facing a gastric haemorrhage, a transfusion is often required. In remote areas, transfusion of fresh whole blood to stabilize a critical patient until he reaches a hospital must be considered.

  4. Clinical Analysis of 113 Caes of Upper Gastrointestinal Bleeding with Ischemic Myocardial Injury%上消化道出血伴发缺血性心肌损伤113例临床分析

    Institute of Scientific and Technical Information of China (English)

    文玉; 李晓燕; 罗娟; 戴薇; 张磊

    2011-01-01

    Objective To investigate the pathogenesis, clinical manifestations, relevant examinations,treatments and prognosis of ischemic myocardial injury (IMI) with upper gastrointestinal bleeding (UGIB).Method We restropectively analyzed the clinical data of 113 cases of ischemic myocardial injury (IMI) with upper gastrointestinal bleeding (UGIB).Results 66 inpatients had no typical performance of myocardial injury (58.40%) , 97 inpatients was getting better and discharged from hospital (85.84%) , 16 inpatients died (14.16%).Conclusions The clinical manifestations of patients who have ischemic myocardial injury (IMI) with upper gastrointestinal bleeding (UGIB) are atypical.Under these conditions, IMI is easily overlooked.Therefore, to find revelant manifestations of atypical IMI in time has significance in treating IMI with upper gastrointestinal bleeding (UGIB).%目的 探讨上消化道出血(upper gastrointestinal bleeding,UGIB)伴发缺血性心肌损伤(ischemicmyocardial injury,IMI)的发病机制、临床表现、相关检查、治疗及预后.方法 回顾性分析上消化道出血伴发缺血性心肌损伤113例.结果 113例中66例(58.40%)无典型心肌损伤临床表现,病情好转出院97例(85.84%),死亡16例(14.16%).结论 当上消化道出血与缺血性心肌损伤并存时,心肌损伤的表现往往不典型而易被忽视,因此及时发现不典型心肌损伤的相关表现,对于正确处理上消化道出血与心肌损伤具有重要的意义.

  5. Transcatheter artery embolization guided by MSCTA in emergency treatment of massive gastrointestinal bleeding%MSCTA指导下急诊动脉栓塞治疗消化道大出血

    Institute of Scientific and Technical Information of China (English)

    陈光斌; 李江山; 唐先志; 张自力; 敖锋

    2012-01-01

    Objective To investigate the clinical value of transcatheter arterial embolization guided by MSCTA in emergency of massive gastrointestinal bleeding. Methods Fourteen patients with massive gastrointestinal bleeding were examined with MSCTA at the same time of anti-shock treatment. Emergency arterial embolization was performed after locating of the bleeding site and bleeding artery by MSCTA. In the course of artery embolization, gelfoam particles were used with super-selective catheterization technique. Results After embolization, bleeding stopped immediately in 12 patients. For 2 patients with continuous bleeding, emergent surgical operation was performed in one patient, and the other with venous hemorrhage was cured with endoscopy. Conclusion Transcatheter arterial embolization guided by MSCTA is simple, rapid, accurate and safe for the treatment of massive gastrointestinal bleeding.%目的 探讨MSCTA指导下行急诊动脉栓塞治疗消化道大出血的临床价值.方法 对14例消化道大出血病例,术前在抗休克治疗同时急诊行MSCTA检查,明确出血部位或出血动脉后行急诊动脉栓塞术,超选择插管至出血动脉支,并以明胶海绵颗粒进行栓塞.结果 动脉栓塞后,12例患者有效控制了出血,休克得到纠正.1例明确出血部位及性质后行急诊手术治疗,1例疑静脉出血,后行急诊内镜治疗.结论 MSCTA指导下行急诊动脉栓塞术治疗消化道大出血简便迅速、准确性高、安全性好、并发症少.

  6. Early Diagnosis of Helicobacter pylori Infection in Vietnamese Patients with Acute Peptic Ulcer Bleeding: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Duc Trong Quach

    2017-01-01

    Full Text Available Aims. To investigate H. pylori infection rate and evaluate a combined set of tests for H. pylori diagnosis in Vietnamese patients with acute peptic ulcer bleeding (PUD. Methods. Consecutive patients with acute PUB were enrolled prospectively. Rapid urease test (RUT with 3 biopsies was carried out randomly. Patients without RUT or with negative RUT received urea breath test (UBT and serological and urinary H. pylori antibody tests. H. pylori was considered positive if RUT or any noninvasive test was positive. Patients were divided into group A (RUT plus noninvasive tests and group B (only noninvasive tests. Results. The overall H. pylori infection rate was 94.2% (161/171. Groups A and B had no differences in demographic characteristics, bleeding severity, endoscopic findings, and proton pump inhibitor use. H. pylori-positive rate in group A was significantly higher than that in group B (98.2% versus 86.7%, p=0.004. The positive rate of RUT was similar at each biopsy site but significantly increased if RUT results from 2 or 3 sites were combined (p<0.05. Conclusions. H. pylori infection rate in Vietnamese patients with acute PUB is high. RUT is an excellent test if at least 2 biopsies are taken.

  7. Early Diagnosis of Helicobacter pylori Infection in Vietnamese Patients with Acute Peptic Ulcer Bleeding: A Prospective Study

    Science.gov (United States)

    Quach, Duc Trong; Luu, Mai Ngoc; To, Thuy-HuongThi; Bui, Quy Nhuan; Tran, Tuan Anh; Tran, Binh Duy; Vo, Minh-Cong Hong; Tanaka, Shinji; Uemura, Naomi

    2017-01-01

    Aims. To investigate H. pylori infection rate and evaluate a combined set of tests for H. pylori diagnosis in Vietnamese patients with acute peptic ulcer bleeding (PUD). Methods. Consecutive patients with acute PUB were enrolled prospectively. Rapid urease test (RUT) with 3 biopsies was carried out randomly. Patients without RUT or with negative RUT received urea breath test (UBT) and serological and urinary H. pylori antibody tests. H. pylori was considered positive if RUT or any noninvasive test was positive. Patients were divided into group A (RUT plus noninvasive tests) and group B (only noninvasive tests). Results. The overall H. pylori infection rate was 94.2% (161/171). Groups A and B had no differences in demographic characteristics, bleeding severity, endoscopic findings, and proton pump inhibitor use. H. pylori-positive rate in group A was significantly higher than that in group B (98.2% versus 86.7%, p = 0.004). The positive rate of RUT was similar at each biopsy site but significantly increased if RUT results from 2 or 3 sites were combined (p < 0.05). Conclusions. H. pylori infection rate in Vietnamese patients with acute PUB is high. RUT is an excellent test if at least 2 biopsies are taken. PMID:28133477

  8. Acute respiratory failure and active bleeding are the important fatality predictive factors for severe dengue viral infection.

    Directory of Open Access Journals (Sweden)

    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.

  9. Gastrointestinal Fistulas in Acute Pancreatitis With Infected Pancreatic or Peripancreatic Necrosis

    OpenAIRE

    Wei JIANG; 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 ...

  10. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  11. Acute Atherothrombotic Disease and Severe Bleeding: A Difficult Clinical Presentation in Medical Practice.

    Science.gov (United States)

    Căldăraru, Cristina; Popa, C; Fruntelată, Ana; Bălănescu, Ş

    2015-01-01

    Management of antithrombotic therapy in elderly patients with unstable atherothrombotic disease and increased risk of bleeding is a major clinical challenge. We report the case of a 79 year- old diabetic man with rheumatoid arthritis on both oral corticosteroids and NSAID therapy with mild renal dysfunction, who presented to our hospital because of disabling claudication. Prior to admission he had several episodes of TIA. He also had recurrent small rectal bleeding and mild anemia attributed to his long-standing hemorrhoid disease. Angiography showed a sub-occlusive left internal carotid artery stenosis associated with a significant LAD stenosis and complex peripheral artery disease. Cataclysmic bleeding and hemorrhagic shock occurred in the third day post admission. Withdrawal of all antithrombotic treatment, blood transfusion and emergency sigmoidectomy were performed for bleeding colonic diverticulosis. Subsequently antiplatelet therapy was reinitiated and the patient successfully underwent left carotid artery endarterectomy and LAD stenting. He was discharged from hospital on the 21(st) day post admission and is doing well at 24 months follow-up.

  12. Application of CRUSADE score for evaluating of risk of gastrointestinal bleeding due to antiplatelet agents%CRUSADE评分在抗血小板药物致消化道出血风险评估中的应用

    Institute of Scientific and Technical Information of China (English)

    孙钧安; 夏宗玲; 罗璨

    2014-01-01

    目的:探讨CRUSADE评分在抗血小板药物致消化道出血风险评估中的作用。方法1010年9月至1013年9月在浙江省慈溪市第三人民医院内科住院、冠心病诊断明确并入院前一直服用抗血小板药物至少1年的患者纳入本研究,根据是否因服用抗血小板药物而发生消化道出血分为1组,对1组患者进行CRUSADE评分,分析CRUSADE评分与消化道出血的关系。结果共收集到服用抗血小板药物≥1年的冠心病患者787例,发生消化道出血者40例,纳入消化道出血组;应用等距抽样法从余747例患者中随机选出160例纳入无消化道出血组。消化道出血组男性31例,女性9例,年龄45~88(71±9)岁;无消化道出血组男性100例,女性60例,年龄36~89(65±13)岁;1组患者年龄差异有统计学意义( P﹤0.05)。消化道出血组与无消化道出血组患者中应用阿司匹林肠溶片、硫酸氢氯吡格雷片和两药联用者分别占55%(11/40)、10%(4/40)、35%(14/40)和54%(86/160)、7%(11/160)、39%(63/160),差异无统计学意义(P﹥0.05),有消化道出血和溃疡病史者分别占30.0%(11/40)和11.9%(19/160),差异有统计学意义( P﹤0.05)。消化道出血组CRUSADE评分为高危与极高危者各11例(各17.5%),无消化道出血组分别为13例(8.1%)和17例(10.6%),差异有统计学意义( P﹤0.05)。结论 CRUSADE评分有助于判断接受抗血小板治疗的冠心病患者消化道出血风险。建议CRUSADE评分为高危与极高危的冠心病患者应用抗血小板药时联合使用质子泵抑制剂,以预防或减轻消化道出血。%Objective To explore the role of CRUSADE score for evaluating the risk of gastrointestinal bleeding due to antiplatelet agents. Methods The hospitalized patients with coronary heart disease and received antiplatelet therapy for more than 1 year before hospitalization in department

  13. Microbiota alterations in acute and chronic gastrointestinal inflammation of cats and dogs.

    Science.gov (United States)

    Honneffer, Julia B; Minamoto, Yasushi; Suchodolski, Jan S

    2014-11-28

    The intestinal microbiota is the collection of the living microorganisms (bacteria, fungi, protozoa, and viruses) inhabiting the gastrointestinal tract. Novel bacterial identification approaches have revealed that the gastrointestinal microbiota of dogs and cats is, similarly to humans, a highly complex ecosystem. Studies in dogs and cats have demonstrated that acute and chronic gastrointestinal diseases, including inflammatory bowel disease (IBD), are associated with alterations in the small intestinal and fecal microbial communities. Of interest is that these alterations are generally similar to the dysbiosis observed in humans with IBD or animal models of intestinal inflammation, suggesting that microbial responses to inflammatory conditions of the gut are conserved across mammalian host types. Studies have also revealed possible underlying susceptibilities in the innate immune system of dogs and cats with IBD, which further demonstrate the intricate relationship between gut microbiota and host health. Commonly identified microbiome changes in IBD are decreases in bacterial groups within the phyla Firmicutes and Bacteroidetes, and increases within Proteobacteia. Furthermore, a reduction in the diversity of Clostridium clusters XIVa and IV (i.e., Lachnospiraceae and Clostridium coccoides subgroups) are associated with IBD, suggesting that these bacterial groups may play an important role in maintenance of gastrointestinal health. Future studies are warranted to evaluate the functional changes associated with intestinal dysbiosis in dogs and cats.

  14. Transjugular intrahepatic portosystemic shunt for gastrointestinal bleeding due to hepatocellular carcinoma complicated by portal vein embolus (report of 4 cases)%肝癌并门静脉栓子后消化道出血的经颈静脉肝内门体静脉分流术治疗(附4例报告)

    Institute of Scientific and Technical Information of China (English)

    张军华; 李玉; 韩萍; 张金龙; 张弢

    2014-01-01

    Objective To investigate the effect of transjugular intrahepatic portosystemic shunt (TIPS) on gastrointestinal bleed-ing due to advanced-stage hepatocellular carcinoma complicated by portal vein embolus. Methods Four patients with acute upper gastrointestinal bleeding were diagnosed with portal vein cancer embolus by contrast-enhanced CT and MRI scanning of the abdomen, of whom 3 patients were complicated by wide embolus formation in superior mesenteric vein (including 1 patient with spleen vein embolus formation). Hemostatic treatment by TIPS was undertaken and the stents were placed where distal embolus could be observed by angiogra-phy. Results After undergoing TIPS, no re-bleeding was found in 3 patients followed up for 4-6 weeks and 1 patient followed up for 8 weeks, and abdominal symptoms were obviously relieved or disappeared. Conclusions TIPS is a safe and effective way to treat gas-trointestinal bleeding due to hepatocellular carcinoma complicated by portal vein embolus, and is worthy of promotion.%目的:探讨肝癌晚期合并门静脉栓子后消化道出血的经颈静脉肝内门体静脉分流术(transjugular intrahepatic portosystemic shunt, TIPS)治疗效果。方法4例急性上消化道出血患者经CT及核磁腹部增强扫描确诊为门静脉癌栓,其中3例合并肠系膜上静脉内广泛栓子形成(含1例脾静脉内栓子形成)。行TIPS止血治疗,将支架放置于造影所见栓子的远端。结果 TIPS治疗后,3例随访4~6周、1例随访8周未再发生出血,腹部不适症状明显减轻或消失。结论 TIPS治疗肝癌并门静脉栓子形成后的急性上消化道出血,安全可行,疗效可靠,值得推广。

  15. 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

    Directory of Open Access Journals (Sweden)

    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

  16. New Insight for the Diagnosis of Gastrointestinal Acute Graft-versus-Host Disease

    Directory of Open Access Journals (Sweden)

    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.

  17. Positive predictive value of ICD-9th codes for upper gastrointestinal bleeding and perforation in the Sistema Informativo Sanitario Regionale database.

    Science.gov (United States)

    Cattaruzzi, C; Troncon, M G; Agostinis, L; García Rodríguez, L A

    1999-06-01

    We identified patients whose records in the Sistema Informativo Sanitario Regionale database in the Italian region of Friuli-Venezia Giulia showed a code of upper gastrointestinal bleeding (UGIB) and perforation according to codes of the International Classification of Diseases (ICD)-9th revision. The validity of site- and lesion-specific codes (531 to 534) and nonspecific codes (5780, 5781, and 5789) was ascertained through manual review of hospital clinical records. The initial group was made of 1779 potential cases of UGIB identified with one of these codes recorded. First, the positive predictive values (PPV) were calculated in a random sample. As a result of the observed high PPV of 531 and 532 codes, additional hospital charts were solely requested for all remaining potential cases with 533, 534, and 578 ICD-9 codes. The overall PPV reached a high of 97% for 531 and 532 site-specific codes, 84% for 534 site-specific codes, and 80% for 533 lesion-specific codes, and a low of 59% for nonspecific codes. These data suggest a considerable research potential for this new computerized health care database in Southern Europe.

  18. Intraabdominal Intravascular Papillary Endothelial Hyperplasia (Masson’s Tumor: A Rare and Novel Cause of Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Michael C. Meadows

    2010-03-01

    Full Text Available Intravascular papillary endothelial hyperplasia (IPEH, or Masson’s tumor, a rare benign vascular lesion, occurs mainly in the head, neck, and hands in the human population. Aberrant tumor locations have been rarely reported. We present a case of a patient with chronic abdominal pain and melena of variable severity due to a Masson’s tumor, with no apparent Masson’s tumor-associated comorbidities, along with a comprehensive review of the literature. Using PubMed, a search engine provided by the U.S. National Library of Medicine and the National Institutes of Health, we searched for all reports of Masson’s tumor limited within the abdominal cavity. Furthermore, keywords such as ‘intravascular papillary endothelial hyperplasia’, ‘renal’, ‘gastrointestinal’, ‘hepatic’ and ‘intraabdominal’ were used to facilitate the search. We thus found fourteen cases of intraabdominal Masson’s tumors published. Six (42.9% of these were located in the renal vein, 4 (28.6% were reported in the gastrointestinal tract, 1 (7.1% in the adrenal gland, 1 (7.1% in the liver, and 1 (7.1% instance with multiple lesion sites including the renal hilum and retroperitoneum. Among these patients, 9 (64.3% were female and 5 (35.7% male, with a mean age of 38.9 years (7–69. IPEH is a reactive process, having three subtypes, all involving the proliferation of epithelial cells around a thrombus in the setting of venous stasis. In its pure form, the organized thrombus is solely localized within the vascular lumen. Mixed-form IPEH is formed in preexisting vascular lesions (such as arteriovenous malformation, hemangioma, pyogenic granuloma, etc.. The rarest form is the extravascular variety, which arises in hematomas often from recent trauma to the area. In its pure form, IPEH has a zero recurrence rate when an R0 resection is performed; all mixed and extravascular forms show the highest recurrence rates. The exact histogenesis of these epithelial cells

  19. New oral anticoagulants: clinical indications, monitoring and treatment of acute bleeding complications.

    Science.gov (United States)

    Fenger-Eriksen, C; Münster, A-M; Grove, E L

    2014-07-01

    New oral anticoagulants like the direct thrombin inhibitor, dabigatran (Pradaxa®), and factor Xa-inhibitors, rivaroxaban (Xarelto®) and apixaban (Eliquis®) are available for prophylaxis and treatment of thromboembolic disease. They are emerging alternatives to warfarin and provide equal or better clinical outcome together with reduced need for routine monitoring. Methods for measuring drug concentrations are available, although a correlation between plasma drug concentrations and the risk of bleeding has not been firmly established. Standard laboratory measures like prothrombin time and activated partial thromboplastin time are not sensitive enough to detect thrombin or factor Xa inhibition provided by new oral anticoagulants. Thus, these standard tests may only be used as a crude estimation of the actual anticoagulation status. Further challenges regarding patients receiving new oral anticoagulants who presents with major bleeding or need for emergency surgery pose a unique problem. No established agents are clinically available to reverse the anticoagulant effect, although preclinical data report prothrombin complex concentrate as more efficient than fresh frozen plasma or other prohaemostatic agents. This review summaries current knowledge on approved new oral anticoagulants and discusses clinical aspects of monitoring, with particular focus on the management of the bleeding patient.

  20. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  1. Therapeutic effect analysis of reoperation in the treatment of upper gastrointestinal bleeding after gastrectomy%胃切除术后上消化道大出血的再手术治疗效果分析

    Institute of Scientific and Technical Information of China (English)

    杨文斌

    2016-01-01

    Objective:To analyze the clinical therapeutic effect of reoperation in the treatment of upper gastrointestinal bleeding after gastrectomy.Methods:46 cases of patients with upper gastrointestinal bleeding after gastrectomy were treated with reoperation.The curative effect of reoperation was observed.Results:After reoperation,31 cases were cured,13 cases were effective and the total effective rate was 95.65%.The incidence rate of postoperative complication was 4.35%.Conclusion:Reoperation was the effective method in the treatment of upper gastrointestinal bleeding after gastrectomy.%目的:分析再手术治疗胃切除术后上消化道大出血的临床疗效。方法:收治胃切除术后上消化道大出血患者46例,均行再次手术治疗。观察再次手术治疗效果。结果:再次手术后,痊愈31例,有效13例,总有效率95.65%。术后并发症发生率4.35%。结论:再手术是治疗胃切除术后上消化道大出血的有效方法。

  2. Abdominal compartment syndrome from bleeding duodenal diverticulum

    Directory of Open Access Journals (Sweden)

    Vakhtang Tchantchaleishvili

    2012-01-01

    Full Text Available Duodenal diverticuli are acquired false diverticuli of unknown etiology. Although mostly asymptomatic, they can occasionally cause upper gastrointestinal hemorrhage, rarely with massive bleeding. In this report, we present (to the best of our knowledge the first reported case of duodenal diverticular bleeding, causing abdominal compartment syndrome. Albeit a rare event, duodenal diverticular bleeding should be included in the differential diagnosis of upper gastrointestinal bleeding. As with our case, a multidisciplinary approach to managing such patients is crucial.

  3. Burden of Acute Gastrointestinal Illness in Gálvez, Argentina, 2007

    OpenAIRE

    Thomas, M Kate; Perez, Enrique; Shannon E Majowicz; Reid-Smith, Richard; Albil, Silvia; Monteverde, Marcos; McEwen, Scott A.

    2010-01-01

    This study evaluated the magnitude and distribution of acute gastrointestinal illness (GI) in Gálvez, Argentina, and assessed the outcome of a seven-day versus 30-day recall period in survey methodology. A cross-sectional population survey, with either a seven-day or a 30-day retrospective recall period, was conducted through door-to-door visits to randomly-selected residents during the ‘high’ and the ‘low’ seasons of GI in the community. Comparisons were made between the annual incidence rat...

  4. The HAS-BLED Score Identifies Patients with Acute Venous Thromboembolism at High Risk of Major Bleeding Complications during the First Six Months of Anticoagulant Treatment.

    Directory of Open Access Journals (Sweden)

    Judith Kooiman

    Full Text Available The HAS-BLED score enables a risk estimate of major bleeds in patients with atrial fibrillation on vitamin K-antagonists (VKA treatment, but has not been validated for patients with venous thromboembolism (VTE. We analyzed whether the HAS-BLED score accurately identifies patients at high risk of major bleeds during VKA treatment for acute VTE.Medical records of 537 patients with acute VTE (primary diagnosis pulmonary embolism in 223, deep vein thrombosis in 314 starting VKA treatment between 2006-2007 were searched for items on the HAS-BLED score and the occurrence of major bleeds during the first 180 days of follow-up. The hazard ratio (HR for the occurrence of major bleeds comparing non-high with high-risk patients as defined by a HAS-BLED score ≥ 3 points was calculated using Cox-regression analysis.Major bleeds occurred in 11/537 patients (2.0%, 5.2/100 person years, 95% CI 2.8-9.2. Cumulative incidences of major bleeds were 1.3% (95% CI 0.1-2.5 in the non-high (HAS-BLED < 3 and 9.6% (95%CI 2.2-17.0 in the high-risk group (HAS-BLED ≥ 3, (p <0.0001 by Log-Rank test, with a HR of 8.7 (95% CI 2.7-28.4. Of the items in the HAS-BLED score, abnormal renal function (HR 10.8, 95% CI 1.9-61.7 and a history of bleeding events (HR 10.4, 95% CI 2.5-42.5 were independent predictors of major bleeds during follow-up.Acute VTE patients with a HAS-BLED score ≥ 3 points are at increased risk of major bleeding. These results warrant for correction of the potentially reversible risk factors for major bleeding and careful International Normalized Ratio monitoring in acute VTE patients with a high HAS-BLED score.

  5. Lactic Acidosis Induced by Linezolid Mimics Symptoms of an Acute Intracranial Bleed: A Case Report and Literature Review

    Science.gov (United States)

    Zuccarini, Nichole Suzzanne; Yousuf, Tariq; Wozniczka, Daniel; Rauf, Anis Abdul

    2016-01-01

    Lactic acidosis is common and most often associated with disturbed acid-base balance. Rarely, it can be a life-threatening medication side effect. Hence, determining the etiology of lactic acidosis early in patients is paramount in choosing the correct therapeutic intervention. Although lactic acidosis as an adverse drug reaction of linezolid is a well-recognized and documented clinical entity, the occurrence of such mimicking an acute intracranial bleed has not been reported to our knowledge. The following case is presented as an example of such an occurrence. A 67-year-old woman presented to the emergency department for lethargy, nausea and syncope. The head CT did not demonstrate any bleeding or mass effect, but lab results were significant for elevated lactic acid. The patient recently underwent left total hip replacement surgery, which was complicated by a methicillin-resistant Staphylococcus aureus (MRSA) infection. She received 6 weeks of oral linezolid therapy. And upon learning that key part of her history, the linezolid was discontinued. Her lactic acid rapidly normalized and she was discharged home. Several publications demonstrate that linezolid induces lactic acidosis by disrupting crucial mitochondrial functions. It is essential that clinicians are aware that linezolid can cause lactic acidosis. And, the important reminder is that adverse drug reactions can often mimic common diseases. If it is not recognized early, ominous clinical consequences may occur. In conclusion, linezolid should be suspected and included in the differential diagnosis if lactic acidosis exists with an uncommon clinical picture. PMID:27635182

  6. Fístula colecistocólica: una causa poco frecuente de hemorragia digestiva baja Cholecistocolic fistula: an uncommon cause of lower gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    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

  7. Life threatening bleeding from duodenal ulcer after Roux-en-Y gastric bypass: Case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    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.

  8. 不明原因消化道出血45例分析%Analysis of 45 cases of obscure gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    鞠香丽; 徐秀英

    2015-01-01

    Objective To investigate the etiology of obscure gastrointestinal bleeding ( OGIB) and the value of cap-sule endoscopy in the diagnosis of OGIB .Methods The data of 45 cases of OGIB who were defined no clear hemor-rhage by recepting endoscopy and colonoscopy inspection and furtherly finished capsule endoscopy examination in the First Affiliated Hospital of China Medical University from Jan .2004 to Aug .2013 were analyzed retrospectively .Re-sults Forty-two cases of OGIB patients were proved to have small intestinal lesions , there were 29 cases of small bowel vascular malformations , 2 cases of small bowel inflammation , 1 case of small bowel ascariasis , 1 case of small bowel ul-cer, 1 case of small bowel polyps , 1 case of duodenal vascular malformation , 2 cases of small bowel vascular malforma-tion with small bowel mucosa lesions , 2 cases of small bowel vascular malformation associated with small bowel ascaria -sis, 1 case of small bowel vascular malformation with small bowel ulcer , small bowel lymphangiectasia , 1 case of small bowel vascular malformation with small bowel erosion and 1 case of ileal diverticula with ileal lymphangiectasia .The most common cause of OGIB was small bowel vascular malformations (83.33%, 35/42).Conclusion Capsule endos-copy can provide more direct clues to discover the cause of OGIB and guide clinical treatment .%目的:探讨不明原因消化道出血( obscure gastrointestinal bleeding , OGIB)的病因及胶囊内镜在其诊断方面的应用价值。方法回顾性分析中国医科大学附属第一医院2004年1月-2013年8月45例经胃镜、结肠镜检查未发现出血灶并进一步行胶囊内镜的OGIB患者的临床资料。结果入选的45例OGIB患者中共有42例检出小肠病变,其中单纯小肠血管畸形29例,小肠炎症2例,小肠蛔虫病1例,小肠溃疡1例,小肠息肉1例,十二指肠血管畸形1例,小肠血管畸形伴小肠黏膜下病变2例,

  9. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  10. Risk of upper gastrointestinal bleeding in a cohort of new users of low-dose ASA for secondary prevention of cardiovascular outcomes

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    Lucía Cea 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.

  11. Analysis of relationship between upper gastrointestinal bleeding caused by cirrhosis and seasonal variation of time series%肝硬化上消化道出血与季节变化的时间序列分析

    Institute of Scientific and Technical Information of China (English)

    张萃艺; 孙保国; 周厚明; 张诗军; 陈泽雄

    2011-01-01

    目的 运用时间序列分析法探讨肝硬化上消化道出血发病的季节规律.方法 以"肝硬化"和"上消化道出血"为关键词,检索中山大学附属第一医院病案室1999-01-01-2006-12-31住院病例共469例.按照中国阴阳历的季节划分标准划分季节,统计各季节发病构成比;运用χ2分析Child-Pugh分级分布与四季的关系;运用时间序列分析法分析肝硬化上消化道出血的时间规律;运用相关分析法分析肝硬化上消化道出血的时间规律与气温的关系.结果 1999-2006年,肝硬化上消化道出血冬、春季发病构成比明显高于夏、秋季,并且各年变化趋势相似;Child-Pugh分级B、C 级冬、春季发病率明显高于夏季(P<0.05),B+C级冬、春季发病率高于夏、秋季(P<0.05);肝硬化上消化道出血发病1~4月、12月及冬、春季的季节指数均>100,且再出血冬、春季的季节指数>100;肝硬化上消化道出血各月患者人数构成比与该月平均气温呈明显负相关(r=-0.886,P<0.01).结论 肝硬化上消化道出血事件的发生与季节变化有一定关系,主要发生在冬、春季,冬、春季节人体内热外寒的体质可能是肝硬化患者发生上消化道出血的内在机制.%Objective To research the relationship between upper gastrointestinal bleeding caused by cirrhosis and seasonal variation of time series. Methods The cases with key words of “hepatic cirrhosis” and “upper gastrointestinal bleeding” were retrieved from 1999 -01 -01 to 2006 - 12 -31 in the record room of the first affiliated hospital of Sun Yat - sen University. Totally, 469 cases of upper gastrointestinal bleeding are retrieved. Seasons was divided by Chinese lunisolar calendar. And incidence of upper gastrointestinal bleeding was recorded in different seasons. The relationship between distribution of four seasons and Child -Pugh classification were analyzed byX2 analysis. The time pattern of upper gastrointestinal bleeding in

  12. Radiological study of gastrointestinal motor activity after acute cisplatin in the rat. Temporal relationship with pica.

    Science.gov (United States)

    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.

  13. Spontaneous perforation of pyometra presenting as acute abdomen and pneumoperitoneum mimicking those of gastrointestinal origin.

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  15. Acute gastrointestinal injury in the intensive care unit: a retrospective study

    Directory of Open Access Journals (Sweden)

    Chen HS

    2015-10-01

    Full Text Available HuaiSheng Chen,1,* HuaDong Zhang,1,* Wei Li,1 ShengNan Wu,1 Wei Wang2 1Intensive Care Unit, 2Endocrinology Department, Second Affiliated Hospital of Jinan University, Shenzhen People’s Hospital, Shenzhen, People’s Republic of China *These authors contributed equally to this work Background: Acute gastrointestinal injury (AGI is a common problem in the intensive care unit (ICU. This study is a review of the gastrointestinal function of patients in critical care, with the aim to assess the feasibility and effectiveness of grading criteria developed by the European Society of Intensive Care Medicine (ESICM Working Group on Abdominal Problems (WGAP. Methods: Data of patients who were admitted to the ICU of Shenzhen People’s Hospital, Shenzhen, People’s Republic of China, from January 2010 to December 2011 were reviewed. A total of 874 patients were included into the current study. Their sex, age, ICU admissive causes, complication of diabetes, AGI grade, primary or secondary AGI, mechanical ventilation (MV, and length of ICU stay (days were recorded as risk factors of death. These risk factors were studied by unconditioned logistic regression analysis. Results: All the risk factors affected mortality rate. Unconditional logistic regression analysis revealed that the mortality rate of secondary AGI was 71 times higher than primary AGI (odds ratio [OR] 4.335, 95% CI [1.652, 11.375]. When the age increased by one year, the mortality probability would increase fourfold. Mortality in patients with MV was 63-fold higher than for patients with non-MV. Mortality rate increased 0.978 times with each additional day of ICU stay. Conclusion: Secondary AGI caused by severe systemic conditions can result in worsened clinical outcomes. The 2012 ESICM WGAP AGI recommendations were to some extent feasible and effective in guiding clinical practices, but the grading system lacked the support of objective laboratory outcomes. Keywords: critical care, acute

  16. Clinical application value of 64 slice spiral CT in the diagnosis of upper gastrointestinal bleeding%64层螺旋CT在上消化道出血诊断中的临床应用价值分析

    Institute of Scientific and Technical Information of China (English)

    王振栋; 马淑华; 黎叶芳; 袁珠

    2016-01-01

    Objective:To explore the clinical application value of 64 slice spiral CT in the diagnosis of upper gastrointestinal bleeding.Methods:70 patients with upper gastrointestinal bleeding were selected.They were given x-ray barium meal examination and 64 slice spiral CT examination.We compared the test results of two kinds.Results:The detection rate of 64 slice spiral CT was 100%,and the detection rate of X-ray was 95.71%(P<0.05).The consistent rate of CT diagnosis of bleeding was 100%,which was significantly better than 85.71% of X-ray(P<0.05).Conclusion:The clinical application value of 64 slice spiral CT in the diagnosis of upper gastrointestinal bleeding was significant.%目的:探讨64层螺旋CT在上消化道出血诊断中的临床应用价值。方法:收治上消化道出血患者70例,均接受 X 线钡餐检查和64层螺旋 CT检查,比较两种检查结果。结果:64层螺旋 CT检出率100%,X 线检出率95.71%(P<0.05)。CT诊断出血原因相符率100%,显著优于X线的85.71%(P<0.05)。结论:64层螺旋CT在上消化道出血诊断中的临床应用价值显著。

  17. Obscure gastrointestinal bleeding: a complication of radiation enteritis diagnosed by wireless capsule endoscopy Hemorragia digestiva de origen oscuro secundaria a enteritis actínica: diagnóstico por cápsula endoscópica

    Directory of Open Access Journals (Sweden)

    D. Martínez Ares

    2004-02-01

    Full Text Available Obscure gastrointestinal bleeding is a common disorder and may account for as many as 5% of all gastrointestinal hemorrhages. It is often caused by lesions in the small intestine, which were very complicated to examine prior to the advent of wireless capsule endoscopy. Here we present the case of a 31-year-old woman with obscure gastrointestinal bleeding as a complication of radiation enteritis, which was diagnosed only after she underwent an examination with wireless capsule endoscopy. This technique has proven to be far superior to other radiographic and endoscopic methods in diagnosing obscure gastrointestinal bleeding and pathologies of the small intestine in general.La hemorragia digestiva de origen oscuro es una entidad frecuente pudiendo representar hasta un 5% del total de las hemorragias digestivas. Su origen se encuentra en muchas ocasiones en lesiones en el intestino delgado, cuya exploración era muy complicada antes de la aparición de la cápsula endoscópica. Presentamos el caso de una mujer de 31 años con una hemorragia digestiva de origen oscuro secundaria a una enteritis actínica que sólo pudo ser diagnosticada tras ser sometida a la exploración con cápsula endoscópica. Esta técnica se ha mostrado claramente superior a las otras técnicas radiológicas y endoscópicas en el diagnóstico de las hemorragias digestivas de origen oscuro y la patología del intestino delgado en general.

  18. Epinephrine plus argon plasma or heater probe coagulation in ulcer bleeding

    Institute of Scientific and Technical Information of China (English)

    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.

  19. Effects of dialysis modality on blood loss, bleeding complications and transfusion requirements in critically ill patients with dialysis-dependent acute renal failure.

    Science.gov (United States)

    Pschowski, R; Briegel, S; Von Haehling, S; Doehner, W; Bender, T O; Pape, U F; Hasper, D; Jörress, A; Schefold, J C

    2015-11-01

    Blood loss and bleeding complications may often be observed in critically ill patients on renal replacement therapies (RRT). Here we investigate procedural (i.e. RRT-related) and non-procedural blood loss as well as transfusion requirements in regard to the chosen mode of dialysis (i.e. intermittent haemodialysis [IHD] versus continuous veno-venous haemofiltration [CVVH]). Two hundred and fifty-two patients (122 CVVH, 159 male; aged 61.5±13.9 years) with dialysis-dependent acute renal failure were analysed in a sub-analysis of the prospective randomised controlled clinical trial-CONVINT-comparing IHD and CVVH. Bleeding complications including severity of bleeding and RRT-related blood loss were assessed. We observed that 3.6% of patients died related to severe bleeding episodes (between group P=0.94). Major all-cause bleeding complications were observed in 23% IHD versus 26% of CVVH group patients (P=0.95). Under CVVH, the rate of RRT-related blood loss events (57.4% versus 30.4%, P=0.01) and mean total blood volume lost was increased (222.3±291.9 versus 112.5±222.7 ml per patient, P dialysis-dependent acute renal failure in this regard.

  20. Acute lower gastrointestinal hemorrhage originating in the small intestine Hemorragia digestiva baja severa originada en el intestino delgado

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    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

  1. 研究分析消化内科对上消化道出血的临床诊治%Research and analysis of digestion Department of internal medicine on clinical diagnosis and treatment of upper gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    翟兆锋

    2015-01-01

    Objective To analyze and study in Gastroenterology, clinical treatment of upper gastrointestinal bleeding. Methods By choosing the period March 2011 to March 2014, the digestive tract on 88 cases of bleeding in our hospital patients, including 7 cases of peptic ulcer perforation, and the remaining 81 cases before taking conventional drug therapy, compared to patients treated with therapy after upper gastrointestinal bleeding. Results The patients treated were cured by surgery peptic ulcer perforation, the effective rate was 100%;patients treated by conventional drugs, the average bleeding time was (30.3±8.9) hours, bleeding effective rate of 98.4%. Conclusion The effective drug treatment and necessary surgery for upper gastrointestinal bleeding with good clinical diagnosis and treatment effects.%目的:分析和研究消化内科中,对上消化道出血的临床诊治。方法通过选取2011年3月~2014年3月我院收治的88例上消化道出血患者,其中7例行消化性溃疡穿孔手术,余下81例采取常规治疗,对比患者治疗前与治疗后的上消化道出血情况。结果通过消化性溃疡穿孔手术进行治疗的患者均痊愈,有效率为100%;通过常规药物进行治疗的患者,平均止血时间为(30.3±8.9)h,止血有效率为98.4%。结论通过有效的药物治疗和必要的手术治疗,对于上消化道止血具有良好的疗效。

  2. Clinical Observation of Omeprazole Combined With Thrombin for Upper Gastrointestinal Bleeding%奥美拉唑联合血凝酶治疗上消化道出血的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    杨卫东

    2016-01-01

    目的:探讨奥美拉唑联合血凝酶治疗上消化道出血的效果。方法随机将82例上消化道出血患者平均分为两组。对照组行奥美拉唑治疗;观察组在对照组的基础上行血凝酶治疗。结果观察组总有效率、止血时间等均优