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Xiao F, Xun Y, Hu W, Xia Q, Zhang J. Transcatheter Angiographic Embolization of Percutaneous Nephrolithotomy-Related Bleeding: A Single-Center Experience. Int J Clin Pract 2022; 2022:4422547. [PMID: 35685502 PMCID: PMC9158794 DOI: 10.1155/2022/4422547] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To evaluate the clinical characteristics and angiographic features of transcatheter angiographic embolization (TAE) in patients with active bleeding after percutaneous nephrolithotomy (PCNL). METHODS Between 2009 and 2018, 45 patients who underwent TAE for hemorrhage control after PCNL were reviewed retrospectively. Patient clinical characteristics and angiographic features of TAE were analyzed. RESULTS Of the 3148 patients, 45 (1.4%) patients were treated with TAE after PCNL. The interval from the bleeding episode to TAE was 3 days (1,6). Arterial laceration, arteriovenous fistula, and negative angiographic finding were found in 28 (62.2%), 7 (15.6%), and 10 patients (22.2%). Thirty-five patients (92.1%) achieved primary clinical success. The median-corrected hemoglobin decrease from bleeding episode to TAE was 52 g/L (25.25, 71.00). The median-corrected hemoglobin decrease rate from bleeding episode to TAE was 13.11 g/L·d (5.60, 26.12). The hemoglobin decrease from bleeding episode to TAE was lesser in negative angiographic patients (28.50 (10.75,51.25) g/L VS 53.7 (35.0,73.13) g/L) than in positive angiographic patients (P < 0.05). CONCLUSIONS TAE is a safe and effective treatment for post-PCNL bleeding patients. Previous kidney surgery is associated with a higher risk of TAE. Patients with bleeding from multiple negative angiographic findings can be considered for prophylactic embolization.
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Affiliation(s)
- Fan Xiao
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Yang Xun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Weijie Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Qidong Xia
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Jiaqiao Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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Kubota Y, Yamauchi H, Nakatani K, Iwai T, Ishido K, Masuda T, Maruhashi T, Tanabe S. Factors for unsuccessful endoscopic hemostasis in patients with severe peptic ulcer bleeding. Scand J Gastroenterol 2021; 56:1396-1405. [PMID: 34455892 DOI: 10.1080/00365521.2021.1969593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Although the first approach for peptic ulcer bleeding is endoscopic hemostasis, quick determination of a hemostatic strategy is important in patients with vitals indicating shock. However, the unsuccessful factors for endoscopic treatment have yet to be sufficiently examined. We aimed to investigate the factors for unsuccessful endoscopic hemostasis in severe peptic ulcer bleeding. MATERIALS AND METHODS Unsuccessful factors were retrospectively investigated in 150 eligible patients who underwent endoscopic hemostasis for shock-presenting peptic ulcer bleeding at our critical care center between April 2007 and March 2021. RESULTS There were 123 and 27 cases of successful and unsuccessful endoscopic hemostasis, respectively. Causative diseases included gastric ulcer bleeding in 124 patients (82.7%) and duodenal ulcer bleeding in 26 patients (17.3%). Shock index (SI) (1.46 vs. 1.60) (p = .013), exposed blood vessel diameter (1.4 mm vs. 3.1 mm) (p < .001) identified on contrast-enhanced computed tomography (CE-CT), duodenal ulcer bleeding (p = .012), and Forrest classification Ia (p = .004) were extracted as independent factors for unsuccessful endoscopic hemostasis. In receiving operating curve analysis, when the cut-off value for the SI was set at 1.53, the sensitivity and specificity were 70.4% and 63.4%, respectively. When the cut-off value for the exposed blood vessel diameter was set at 1.9 mm, these were 88.9% and 83.7%, respectively. CONCLUSIONS When these factors (SI ≥ 1.53, exposed blood vessel diameter ≥1.9 mm identified on CE-CT, duodenal ulcer bleeding, and Forrest Ia) are present in patients with severe peptic ulcer bleeding, non-endoscopic hemostasis, such as interventional radiology (IVR) and surgery, should be considered.
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Affiliation(s)
- Yo Kubota
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroshi Yamauchi
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan.,Department of Emergency and Disaster medical center, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kento Nakatani
- Department of Emergency and Disaster medical center, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tomohisa Iwai
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kenji Ishido
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tomonari Masuda
- Department of Emergency and Disaster medical center, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takaaki Maruhashi
- Department of Emergency and Disaster medical center, Kitasato University School of Medicine, Sagamihara, Japan
| | - Satoshi Tanabe
- Department of Research and Development Center for New Frontiers, Kitasato University School of Medicine, Sagamihara, Japan
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Baş S, Zarbaliyev E. The Role of Dual-Energy Computed Tomography in Locating Gastrointestinal Tract Perforations. Cureus 2021; 13:e15265. [PMID: 34189003 PMCID: PMC8233572 DOI: 10.7759/cureus.15265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 12/15/2022] Open
Abstract
Objective With each passing day, dual-energy computed tomography (DECT) is being used more frequently in the evaluation of abdominal pathologies. In this article, we aimed to assess the role of dual-energy CT in locating gastrointestinal perforations, which are among the causes of acute abdomen. Materials and methods All patients who underwent DECT due to acute abdomen in a COVID-19 designated hospital between June 1st, 2020 and December 31st, 2020, who were found to have gastrointestinal tract (GIT) perforation and underwent surgery were included in the study. DECT results and intraoperative findings of the patients were compared. Results Thirteen patients (nine males and four females) who underwent DECT for acute abdomen and were diagnosed with perforation in the gastrointestinal system were included in the study. The mean age of the patients was 57.6 years (range: 11-85 years). Two patients had gastric perforation, three had duodenal perforations, and one patient had a perforation in the gallbladder wall. Two patients were diagnosed with jejunal perforations, one patient with Meckel's diverticulum, and three patients with colorectal perforation. Although free air was detected in the abdomen of one patient, perforation could not be located. In patients with GIT perforation who were operated on following DECT imaging, the perforation location shown on DECT correlated 100% with the perforation locations detected during surgery. Conclusion DECT is significantly effective in planning surgical treatment and determining the foci of perforation in GIT perforations.
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Affiliation(s)
- Serap Baş
- Department of Radiology, Gaziosmanpaşa Hospital, İstanbul Yeni Yüzyıl University, İstanbul, TUR
| | - Elbrus Zarbaliyev
- Department of General Surgery, Gaziosmanpaşa Hospital, İstanbul Yeni Yüzyıl University, Istanbul, TUR
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Kunitomo A, Misawa K, Sato Y, Ito Y, Ito S, Hosoi T, Okuno M, Higaki E, Oshiro T, Natsume S, Kinoshita T, Senda Y, Abe T, Komori K, Inaba Y, Shimizu Y. Gastroduodenal artery pseudoaneurysm hemorrhage 1 year after laparoscopic distal gastrectomy: a case report. Surg Case Rep 2020; 6:38. [PMID: 32072361 PMCID: PMC7028872 DOI: 10.1186/s40792-020-00802-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background Postoperative bleeding originating from pseudoaneurysms after radical gastrectomy is not common, but it can be fatal. In particular, delayed bleeding that occurs after the seventh postoperative day is rare. Case presentation A 54-year-old man underwent laparoscopic distal gastrectomy, D2 lymph node dissection, and Roux en-Y reconstruction for duodenal neuroendocrine tumors. Drainage was performed for a postoperative pancreatic fistula and abdominal abscess. On the 28th postoperative day, he passed a large amount of bloody stool; therefore, emergency esophagogastroduodenoscopy (EGD) and angiography were performed. However, neither examination demonstrated any bleeding foci or pseudoaneurysm. He was conservatively observed and discharged on the 50th postoperative day. Approximately 1 year after the surgery, he passed a bloody stool and experienced hemorrhagic shock. An EGD revealed exposed blood vessels at the duodenal blind end. His condition was diagnosed as a pseudoaneurysm arising from gastroduodenal artery, which ruptured into the duodenum, based on abdominal contrast-enhanced computed tomography findings. Emergency angiography was performed, and the pseudoaneurysm and artery were successfully embolized. Conclusions This case illustrates that there is a possibility of delayed bleeding even 1 year after gastrectomy. Such cases may be serious and require immediate and careful management.
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Affiliation(s)
- Aina Kunitomo
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya City, 464-8681, Japan.
| | - Kazunari Misawa
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya City, 464-8681, Japan
| | - Yozo Sato
- Department of Diagnostic & Interventional Radiology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya City, 464-8681, Japan
| | - Yuichi Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya City, 464-8681, Japan
| | - Seiji Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya City, 464-8681, Japan
| | - Takahiro Hosoi
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya City, 464-8681, Japan
| | - Masataka Okuno
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya City, 464-8681, Japan
| | - Eiji Higaki
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya City, 464-8681, Japan
| | - Taihei Oshiro
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya City, 464-8681, Japan
| | - Seiji Natsume
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya City, 464-8681, Japan
| | - Takashi Kinoshita
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya City, 464-8681, Japan
| | - Yoshiki Senda
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya City, 464-8681, Japan
| | - Tetsuya Abe
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya City, 464-8681, Japan
| | - Koji Komori
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya City, 464-8681, Japan
| | - Yoshitaka Inaba
- Department of Diagnostic & Interventional Radiology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya City, 464-8681, Japan
| | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya City, 464-8681, Japan
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Hotta M, Yamamoto K, Cho K, Takao Y, Fukuoka T, Uchida E. Stomach arteriovenous malformation resected by laparoscopy-assisted surgery: A case report. Asian J Endosc Surg 2016; 9:135-7. [PMID: 27117962 DOI: 10.1111/ases.12259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 06/30/2015] [Accepted: 10/11/2015] [Indexed: 01/16/2023]
Abstract
Arteriovenous malformations of the stomach are an uncommon cause of upper GI bleeding. We report a case of stomach arteriovenous malformation in an 85-year-old Asian man who presented with massive hematemesis. Initial esophagogastroduodenoscopy did not detect this lesion, but contrast multi-detector CT confirmed GI bleeding. Multi-detector CT revealed a mass of blood vessels underlying the submucosa that arose from the right gastroepiploic artery. Repeat esophagogastroduodenoscopy showed that the lesion was a submucosal tumor with erosion and without active bleeding in the lower body of the stomach on the greater curvature. We performed partial gastrectomy via laparoscopy-assisted surgery. The histopathological diagnosis was arteriovenous malformation.
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Affiliation(s)
- Masahiro Hotta
- Department of Surgery, Kitamurayama Hospital, Higashine, Japan
| | | | - Kazumitsu Cho
- Department of Surgery, Kitamurayama Hospital, Higashine, Japan
| | - Yoshimune Takao
- Department of Surgery, Kitamurayama Hospital, Higashine, Japan
| | - Takeshi Fukuoka
- Department of Surgery, Kitamurayama Hospital, Higashine, Japan
| | - Eiji Uchida
- Department of Surgery, Nippon Medical School, Bunkyoku, Japan
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Kim J, Kim YH, Lee KH, Lee YJ, Park JH. Diagnostic Performance of CT Angiography in Patients Visiting Emergency Department with Overt Gastrointestinal Bleeding. Korean J Radiol 2015; 16:541-9. [PMID: 25995683 PMCID: PMC4435984 DOI: 10.3348/kjr.2015.16.3.541] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 02/16/2015] [Indexed: 01/07/2023] Open
Abstract
Objective 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. Materials and Methods 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. Results 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). Conclusion 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.
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Affiliation(s)
- Jihang Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam 436-707, Korea
| | - Young Hoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam 436-707, Korea
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam 436-707, Korea
| | - Yoon Jin Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam 436-707, Korea
| | - Ji Hoon Park
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam 436-707, Korea
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Li L, Zhang Y, Chen Y, Zhu KS, Chen DJ, Zeng XQ, Wang XB. A multicentre retrospective study of transcatheter angiographic embolization in the treatment of delayed haemorrhage after percutaneous nephrolithotomy. Eur Radiol 2014; 25:1140-7. [PMID: 25537978 DOI: 10.1007/s00330-014-3491-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 09/08/2014] [Accepted: 11/05/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective is to determine the timing and indications of transcatheter angiographic embolization (TAE) for delayed haemorrhage after percutaneous nephrolithotomy (PCNL). METHODS The medical records of 144 patients who underwent arteriography and TAE for delayed post-PCNL haemorrhage at five university hospitals between January 2005 and December 2012 were reviewed retrospectively. RESULTS The mean time to the onset of post-PCNL haemorrhage was 10.5 days (2 - 30 days). Clinical presentation included sudden onset bleeding in 51 patients (35.4 %), intermittent bleeding in 67 patients (46. 5 %), and continuous slow bleeding in 26 patients (18.1 %). Hemodynamic instability occurred in 32 patients (22.2 %). The mean haemoglobin decrease from the first post-PCNL day to the day of TAE was 49.5 g/L (31.0 - 79.0 g/L). Renal arteriography showed pseudoaneurysms in 69 (47.9 %) patients, arteriovenous fistulas in 28 (19.4 %) patients, mixed arterial and arteriovenous lesions in 17 (11.8 %) patients, arterial lacerations in 23 (16.0 %) patients, and negative angiographic finding in seven (4.9 %) patients. TAE was successful in stopping bleeding in all 137 patients with vascular lesions. There were no major complications associated with TAE. CONCLUSIONS TAE should be the recommended treatment for delayed post-PCNL haemorrhage in patients with hemodynamic instability and/or corrected haemoglobin decrease >30 g/L following conservative management. KEY POINTS • Delayed haemorrhage after percutaneous nephrolithotomy occurs more than 24 hours postoperatively. • Angio-embolization is a safe and effective treatment for delayed post-PCNL haemorrhage. • Angio-embolization can treat hemodynamic instability and/or corrected haemoglobin decrease >30 g/L.
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Affiliation(s)
- Long Li
- The Division of Interventional Radiology, Department of Radiology, Guangdong Provincial Corps Hospital of Chinese People's Armed Police Forces, Guangzhou Medical University, 268 Yanling Road, Guangzhou City, Guangdong Province, 510507, China
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Song W, Yuan Y, Peng J, Chen J, Han F, Cai S, Zhan W, He Y. The delayed massive hemorrhage after gastrectomy in patients with gastric cancer: characteristics, management opinions and risk factors. Eur J Surg Oncol 2014; 40:1299-306. [PMID: 24731269 DOI: 10.1016/j.ejso.2014.03.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 12/02/2013] [Accepted: 03/22/2014] [Indexed: 01/28/2023] Open
Abstract
AIMS This study was designed to investigate the clinical features of delayed massive hemorrhage (DMH) after gastrectomy in patients with gastric cancer (GC). METHODS This study retrospectively reviewed 1536 GC patients with major gastrectomy between 1998 and 2011. Based on the time onset of postoperative bleeding, patients were divided into early postoperative hemorrhage (EPH), delayed massive hemorrhage (DMH), and no-bleeding groups. Postoperative mortality, bleeding treatment, and risk factors of hemorrhage were explored. RESULTS In sum, 15 (0.9%) patients suffered from DMH, with three (20%) dead cases. None of 18 (1.2%) patients with EPH died, but there were three dead cases in no-bleeding group. DMH had more extra-intestinal bleeding (P = 0.037) than EPH. Angiographic embolization was performed in 12 (80%) of DMH patients and successful in ten cases. Surgical procedures were applied in only two embolization-failed cases. Extended lymphadenectomy (P = 0.038), vascular skeletonization (P = 0.012) and advanced TNM stage (P < 0.001) were correlated with DMH. CONCLUSIONS DMH can be successfully managed with angiographic embolization, followed by alternative surgery. Extensive lymphadenectomy and vascular skeletonization should be discreetly performed during gastrectomy.
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Affiliation(s)
- W Song
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Y Yuan
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - J Peng
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - J Chen
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - F Han
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - S Cai
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - W Zhan
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Y He
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China.
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Cherian MP, Mehta P, Kalyanpur TM, Hedgire SS, Narsinghpura KS. Arterial interventions in gastrointestinal bleeding. Semin Intervent Radiol 2011; 26:184-96. [PMID: 21326563 DOI: 10.1055/s-0029-1225661] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The diagnosis and management of gastrointestinal (GI) bleeding are complicated. A multitude of pathologic processes results in GI bleeding, and often, the bleeding is intermittent in nature. Of the available diagnostic tools, angiography has been the gold standard. Management of patients requires a multidisciplinary approach involving gastroenterologists, interventional radiologists, and surgeons. Therapeutic arterial interventions include pharmacologic control with the use of intraarterial vasopressin, embolization with temporary and permanent embolizing materials, and catheter-induced vasospasm.
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Affiliation(s)
- Mathew P Cherian
- Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, India
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10
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Jeong O, Park YK, Ryu SY, Kim DY, Kim HK, Jeong MR. Predisposing factors and management of postoperative bleeding after radical gastrectomy for gastric carcinoma. Surg Today 2011; 41:363-8. [PMID: 21365417 DOI: 10.1007/s00595-010-4284-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 01/05/2010] [Indexed: 02/06/2023]
Abstract
PURPOSE To promote proper management of postoperative bleeding, we investigated the clinical manifestations, predisposing factors, diagnostic approaches, and treatments of bleeding complications after gastric cancer surgery. METHODS Using a prospectively constructed database, we reviewed retrospectively 39 patients who suffered bleeding complications from among a total 1027 patients who underwent surgery for gastric cancer between 2004 and 2008. RESULTS Operating time (hazard ratio [HR] 1.842, 95% confidence interval [CI] 1.524-2.367) and body mass index (HR 1.454, 95% CI 1.128-1.792) were significant predisposing factors for postoperative bleeding after gastric cancer surgery. Luminal bleeding occurred in 16 patients: as simple anastomosis site bleeding, treated successfully with conservative or endoscopic treatment, in 13; and as pseudoaneurysmal bleeding in 3, treated successfully with surgery in 2, but resulting in the death of 1. Abdominal bleeding occurred in 23 patients, requiring surgery in 9 and arterial embolization in 1. The most common finding at reoperation was bleeding from the mesocolon surface. The mean hospital stay of patients with postoperative bleeding was 21 (± 20) days. CONCLUSIONS Postoperative bleeding can be managed successfully with a tailored approach, considering its origins and clinical manifestations. Arterial pseudoaneurysms are a rare cause of luminal bleeding, but they can be fatal and should be suspected when extensive luminal bleeding presents after gastric cancer surgery.
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Affiliation(s)
- Oh Jeong
- Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, Republic of Korea
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Lee S, Welman CJ, Ramsay D. Investigation of acute lower gastrointestinal bleeding with 16- and 64-slice multidetector CT. J Med Imaging Radiat Oncol 2009; 53:56-63. [PMID: 19453529 DOI: 10.1111/j.1754-9485.2009.02038.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- S Lee
- Department of Radiology, Fremantle Hospital and Health Service, Fremantle, Western Australia, Australia.
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12
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Syed MI, Shaikh A. Accurate localization of life threatening colonic hemorrhage during nuclear medicine bleeding scan as an aid to selective angiography. World J Emerg Surg 2009; 4:20. [PMID: 19580686 PMCID: PMC2702346 DOI: 10.1186/1749-7922-4-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Accepted: 05/27/2009] [Indexed: 12/30/2022] Open
Abstract
Purpose To describe a new technique to help localize life threatening colorectal bleeding during nuclear medicine bleeding scan to aid in selective angiography. Methods During the gastrointestinal bleeding scan, a simple metallic marker (paper clip) was used to localize the bleeding site on the patient body. Angiography was then performed within 2 hours. The marker was then used to guide superselective angiography and embolization. Results 5 cases of patients with colorectal bleeding were performed using this technique with cessation of bleeding in 4/5 initial attempts. 1 patient required a repeat angiogram that did demonstrate the bleeding on the second attempt allowing superselective angiography and embolization that resulted in cessation of bleeding. This patient with a rectal bleed required selection of additional vessels guided by the marker on the second attempt. Conclusion The dilemma of positive scintigraphic evidence of colonic bleeding with negative arteriography can be resolved with the use of a metal marker during the scintigram to guide superselective angiography. Although in our small series of patients this technique appears to be simple and effective, further clinical investigation is warranted with a larger patient population. This technique may offer a role in therapy in coordination with the colorectal surgeon for the high risk patient in an otherwise life threatening situation.
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Affiliation(s)
- Mubin I Syed
- Wright State University School of Medicine, Dept of Radiological Sciences, Dayton, Ohio, USA.
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13
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Khan MI, Baqai MT, Baqai MF, Mufti N. Exsanguinating upper GI bleeds due to Unusual Arteriovenous Malformation (AVM) of stomach and spleen: a case report. World J Emerg Surg 2009; 4:15. [PMID: 19409093 PMCID: PMC2687422 DOI: 10.1186/1749-7922-4-15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Accepted: 05/01/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this paper we are reporting one case of exsanguinating upper gastrointestinal tract (GIT) bleed requiring massive blood transfusion and immediate life saving surgery. CASE PRESENTATION A 30 years old female, 12 weeks pregnant was referred to our hospital from the earth-quake affected area of Kashmir with history of upper abdominal pain, haematemesis and melaena for one week. After stabilizing the patient, upper gastro-intestinal endoscopy was performed. It revealed gastric ulcer just distal to the gastro-esophageal junction on the lesser curvature. Biopsy from the ulcer edge led to profuse spurting of the blood and patient went into state of shock. Immediate resuscitation led to rebleeding and recurrence of post haemorrahagic shock. CONCLUSION The patient was immediately explored and total gastrectectomy with splenectomy concluded as life saving procedure. A review of literature was conducted to make this report possible.
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Affiliation(s)
- Mohammad Iqbal Khan
- Department of surgery, Islamic International Medical College, Rawalpindi, Pakistan.
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14
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Weldon DT, Burke SJ, Sun S, Mimura H, Golzarian J. Interventional management of lower gastrointestinal bleeding. Eur Radiol 2008; 18:857-67. [PMID: 18185932 DOI: 10.1007/s00330-007-0844-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 11/16/2007] [Accepted: 12/10/2007] [Indexed: 01/08/2023]
Abstract
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.
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Affiliation(s)
- Derik T Weldon
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa, IA 52242-1107, USA
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15
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Raju GS, Gerson L, Das A, Lewis B. American Gastroenterological Association (AGA) Institute technical review on obscure gastrointestinal bleeding. Gastroenterology 2007; 133:1697-717. [PMID: 17983812 DOI: 10.1053/j.gastro.2007.06.007] [Citation(s) in RCA: 404] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This literature review and the recommendations therein were prepared for the AGA Institute Clinical Practice and Economics Committee. The paper was approved by the Committee on March 12, 2007, and by the AGA Institute Governing Board on May 19, 2007.
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Affiliation(s)
- Gottumukkala S Raju
- Department of Medicine, University of Texas Medical Branch, Galveston, Galveston, Texas, USA
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16
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Relative Threshold of Detection of Active Arterial Bleeding: In Vitro Comparison of MDCT and Digital Subtraction Angiography. AJR Am J Roentgenol 2007; 189:W238-46. [DOI: 10.2214/ajr.07.2290] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Abstract
AIM: To assess the role of retrograde terminal ileoscopy in hematochezia patients with normal colonoscopy.
METHODS: Between January 1997 and March 2005, 39 hematochezia patients (males 36, females 3, mean age 44.7 years) with a reported normal colonoscopy underwent a repeat colonoscopy. After reaching the cecum, attempt was made to localize the ileocecal valve and intubate the terminal ileum. Any abnormality in the mucosa of the terminal ileum was carefully recorded and biopsies were obtained from suspicious-looking lesions.
RESULTS: During the study period there were 39 patients admitted for hematochezia in whom colonoscopy till cecum did not reveal any abnormality. Full-length colonoscopy till the cecum could be performed in all the patients. The terminal ileum could be intubated in 36 patients. No abnormality was noted in 31 patients. Ileal ulcers were noted in two patients. Nodularity along with ulceration of the ileal mucosa, a Dieulafoy’s lesion, and an angiomatous malformation were noted in one patient each. Histological examination of the biopsies obtained from the ulcers revealed typical tuberculous lesion in the patient with nodularity and ulceration. One of the patients had typhoid ulcers and another had non-specific ulcers.
CONCLUSION: Retrograde terminal ileoscopy gives limited but valuable information, in patients with hematochezia and should be attempted in all such patients.
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Affiliation(s)
- S-P Misra
- Department of Gastroenterology, Motilal Nehru Medical College, University of Allahabad, Allahabad 211 001, India.
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18
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Wang HH, Bai B, Wang KB, Xu W, Ye YS, Zhang WF. Interventional therapy for acute hemorrhage in gastrointestinal tract. World J Gastroenterol 2006; 12:134-6. [PMID: 16440433 PMCID: PMC4077477 DOI: 10.3748/wjg.v12.i1.134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
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 2002 and 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.
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Affiliation(s)
- Hong-Hui Wang
- Department of Radiology, Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, Medical China.
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19
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Johannessen EA, Wang L, Reid SWJ, Cumming DRS, Cooper JM. Implementation of radiotelemetry in a lab-in-a-pill format. LAB ON A CHIP 2006; 6:39-45. [PMID: 16372067 DOI: 10.1039/b507312j] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
A miniaturised lab-in-a-pill device has been produced incorporating a temperature and pH sensor with wireless communication using the 433.92 MHz ISM band. The device has been designed in order to enable real time in situ measurements in the gastrointestinal (GI) tract, and accordingly, issues concerning the resolution and accuracy of the data, and the lifetime of the device have been considered. The sensors, which will measure two key parameters reflecting the physiological environment in the GI (as indicators for disease) were both controlled by an application specific integrated circuit (ASIC). The data were sampled at 10-bit resolution prior to communication off chip as a single interleaved data stream. This incorporated a power saving serial bitstream data compression algorithm that was found to extend the service lifetime of the pill by 70%. An integrated on-off keying (OOK) radio transmitter was used to send the signal to a local receiver (base station), prior to acquisition on a computer. A permanent magnet was also incorporated in the device to enable non-visual tracking of the system. We report on the implementation of this device, together with an initial study sampling from within the porcine GI tract, showing that measurements from the lab-on-a-pill, in situ, was within 90% of literature values.
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Affiliation(s)
- Erik A Johannessen
- Dept. Electronic and Electrical Engineering, University of Glasgow, Rankine Building, 79-85 Oakfield Avenue, Glasgow G12 8LT, UK
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20
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Duchesne J, Jacome T, Serou M, Tighe D, Gonzales A, Hunt J, Marr A, Weintraub S. CT-Angiography for the Detection of a Lower Gastrointestinal Bleeding Source. Am Surg 2005. [DOI: 10.1177/000313480507100505] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The evaluation of lower gastrointestinal bleeding (LGIB) often involves the collaborative efforts of the gastroenterologist, radiologist, and surgeon. Efforts to localize the acute LGIB have traditionally involved colonoscopy, technetium-labeled red blood cell (RBC) scintigraphy, angiography, or a combination of these modalities. The sensitivity of each method of diagnosis is limited, with the most common cause of a negative study the spontaneous cessation of hemorrhage. Other technical factors include vasospasm, lack of adequate contrast volume or exposure time, a venous bleeding source, and a large surface bleeding area. We report the use of multidetector computed tomography (MDCT), or CT-angiography (CT-A), in the initial evaluation of LGIB, and speculate on the incorporation of this technique into a diagnostic algorithm to treat LGIB. MDCT may offer a very sensitive means to evaluate the source of acute LGIB, while avoiding some of the morbidity and intense resource use of contrast angiography, and may provide unique morphologic information regarding the type of pathology. Screening with the more rapid and available MDCT, followed by either directed therapeutic angiography or surgical management, may represent a reasonable algorithm for the early evaluation and management of acute LGIB in which an active bleeding source is strongly suspected.
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Affiliation(s)
- J. Duchesne
- Departments of Surgery, LSU School of Medicine in New Orleans, New Orleans, Louisiana
| | - T. Jacome
- Departments of Surgery, LSU School of Medicine in New Orleans, New Orleans, Louisiana
| | - M. Serou
- Departments of Radiology, LSU School of Medicine in New Orleans, New Orleans, Louisiana
| | - D. Tighe
- Departments of Radiology, LSU School of Medicine in New Orleans, New Orleans, Louisiana
| | - A. Gonzales
- Departments of Radiology, LSU School of Medicine in New Orleans, New Orleans, Louisiana
| | - J.P. Hunt
- Departments of Surgery, LSU School of Medicine in New Orleans, New Orleans, Louisiana
| | - A.B. Marr
- Departments of Surgery, LSU School of Medicine in New Orleans, New Orleans, Louisiana
| | - S.L. Weintraub
- Departments of Surgery, LSU School of Medicine in New Orleans, New Orleans, Louisiana
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21
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Ríos A, Montoya MJ, Rodríguez JM, Serrano A, Molina J, Parrilla P. Acute lower gastrointestinal hemorrhages in geriatric patients. Dig Dis Sci 2005; 50:898-904. [PMID: 15906766 DOI: 10.1007/s10620-005-2662-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Age is a risk factor in acute lower gastrointestinal hemorrhages (LGIH). The objectives here were to analyze: (1) diagnostic and therapeutic handling, (2) related morbidity and mortality, (3) the indications for surgery, and (4) the evolution of acute LGIH in patients > or =80 years. Forty-three patients >80 years with acute LGIH were reviewed retrospectively. In 86% (n = 37) related comorbidities were found, in 9% (n = 4) there had been prior colorectal surgery, 19% (n = 8) were antiaggregated, and 7% (n = 3) were anticoagulated. One hundred thirty-two cases of acute LGIH in patients <80 years were used as a control group. Student's t test and the chi-square test were applied. On arrival at the emergency ward 11 cases (26%) had hemodynamic instability and 8 of these were stabilized using conservative measures. In 39 cases an endoscopy was performed, allowing for an etiological diagnosis in 59% (n = 23) of cases, above all in those carried out in an urgent or semiurgent way. The arteriography permitted an etiological diagnosis in two of the four cases in which it was carried out. In seven patients (16%) urgent surgery was indicated: three were hemorrhoidectomies, three were subtotal colectomies, and one was a resection of the small intestine. The morbidity rate was 10% (n = 4) in the patients who were not treated and 14% (n = 1) in those treated, with a mortality rate of 8% (n = 3) and 14% (n = 1), respectively. The rate of relapse of bleeding after discharge from hospital was 42% (n = 18), with nine of these needing to be readmitted into hospital. In comparison with the control group, they present a different bleeding etiology (diverticulosis as opposed to the benign anal-rectal and small intestinal pathology in the younger population; P = 0.017), surgery is indicated with less frequency (9 versus 33%; P = 0.007), and there is a higher relapse rate (42 versus 26%; P = 0.045). Acute LGIH in geriatric patients relents in most cases with the use of conservative measures, although there is a high percentage of related morbidity and mortality, and of relapse of bleeding.
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Affiliation(s)
- Antonio Ríos
- Servicio de Cirugía General y Digestivo I, Departamento de Cirugía, Unidad de Endoscopias, Hospital Universitario Virgen de la Arrixaca, El Palmar 30120, Murcia.
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22
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Waugh J, Madan A, Sacharias N, Thomson K. Embolization for major lower gastrointestinal haemorrhage: five-year experience. ACTA ACUST UNITED AC 2005; 48:311-7. [PMID: 15344979 DOI: 10.1111/j.0004-8461.2004.01313.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The management of major lower gastrointestinal haemorrhage has changed dramatically in the last 15 years. Innovations in coaxial catheter technology have allowed the interventional radiologist to reach the small peripheral mesenteric arteries and perform superselective embolization with a variety of agents. The present large series represents the 5-year experience of this technique at the Alfred Hospital, Melbourne, in a patient cohort with a high number of comorbidities. Technical success was achieved in 96% of cases. The clinical symptoms of mesenteric ischaemia developed in four patients after embolization and were managed conservatively in two. The procedure-related mortality was low when compared with the published complication rates for emergency surgery, in this clinical setting.
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Affiliation(s)
- J Waugh
- Department of Radiology, Alfred Hospital, Melbourne, Prahran, Victoria 3181, Australia.
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23
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Ríos Zambudio A, Capel Alemán A, Del Pozo Rodríguez M. [Massive lower gastrointestinal bleeding treated with superselective embolization]. GASTROENTEROLOGIA Y HEPATOLOGIA 2004; 27:345-6. [PMID: 15117616 DOI: 10.1016/s0210-5705(03)70472-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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24
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Tew K, Davies RP, Jadun CK, Kew J. MDCT of acute lower gastrointestinal bleeding. AJR Am J Roentgenol 2004; 182:427-30. [PMID: 14736676 DOI: 10.2214/ajr.182.2.1820427] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We evaluated the use of MDCT in the diagnosis and management of lower gastrointestinal bleeding (hematochezia). CONCLUSION MDCT is proposed as an alternative first-line investigation to locate lower gastrointestinal bleeding before placing the patient under observation or performing embolization or surgery.
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Affiliation(s)
- Khimseng Tew
- Department of Radiology, North Western Adelaide Health Service, The Queen Elizabeth Hospital Campus, Adelaide, South Australia 5011, Australia
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25
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Abstract
The management of GI hemorrhage has undergone tremendous evolution in recent decades. Once commonly managed by surgeons, the almost continuous introduction of new technologies and pharmacotherapies has dramatically improved clinicians' ability to identify and control sources of bleeding without surgery. Although a gastroenterologist can successfully manage most cases of GI hemorrhage endoscopically, surgical consultation remains an important consideration for the emergency physician in selected cases.
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Affiliation(s)
- Nahid Hamoui
- Department of Surgery, Keck School of Medicine, 1510 San Pablo Street, Suite 514, Los Angeles, CA 90033, USA
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26
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Abstract
This article discussed the diagnosis and management of acute GI bleeding, prophylaxis against GI bleeding, acute pancreatitis, and acalculous cholecystitis. These diseases are commonly encountered in the ICU setting. Acute GI bleeding is usually obvious and with GI and with available interventional radiologic techniques, patients rarely need surgery. Conversely, acalculous cholecystitis is difficult to diagnosis; therefore, a high degree of suspicion needs to be exercised with all critically ill patients.
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Affiliation(s)
- Deborah D Proctor
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, 1080 LMP, New Haven, CT 06520, USA.
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27
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Abstract
Nonvariceal UGI bleeding is one of the most common emergencies that gastroenterologists encounter, and continues to be a significant cause of morbidity and mortality. The keys to management are rapid resuscitation and stabilization; appropriate triage based on pre-endoscopic risk factors; early endoscopy to achieve prompt diagnosis and implement hemostatic therapy to high-risk lesions; and aggressive antisecretory therapy (in the case of peptic ulcer bleeding) to reduce the risk of continued or recurrent bleeding.
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Affiliation(s)
- Christopher S Huang
- Section of Gastroenterology, Boston Medical Center, 88 East Newton Street, D-408, Boston, MA 02118, USA
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28
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Blocksom JM, Tokioka S, Sugawa C. Current therapy for nonvariceal upper gastrointestinal bleeding. Surg Endosc 2003; 18:186-92. [PMID: 14625723 DOI: 10.1007/s00464-003-8155-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2003] [Accepted: 05/29/2003] [Indexed: 01/30/2023]
Abstract
Upper gastrointestinal bleeding continues to plague physicians despite the discovery of Helicobacter pylori and advances in medical therapy for peptic ulcer disease. Medical therapy with new nonsteroidal anti-inflammatory medications and somatostatin/octreotide and intravenous proton pump inhibitors provides hope for reducing the incidence of and treating bleeding peptic ulcer disease. Endoscopic therapy remains the mainstay for diagnosis and treatment of upper gastrointestinal bleeding. Many methods of endoscopic hemostasis have proven useful in upper gastrointestinal hemorrhage. Currently, combination therapy with epinephrine injection and bicap or heater probe therapy is most commonly employed in the United States. Angiography and embolization play a role primarily when endoscopic therapy is unsuccessful.
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Affiliation(s)
- J M Blocksom
- Department of Surgery, Wayne State University, 6-C UHC, Detroit, MI 48201, USA
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29
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Nguyen N, Croser D, Madigan D, Abu-Sneineh A, Bartholomeusz D, Schoeman M. Embolotherapy for small bowel angiodysplasia. Gastrointest Endosc 2003; 58:797-800. [PMID: 14595328 DOI: 10.1016/s0016-5107(03)02007-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Nam Nguyen
- Department of Gastroenterology, Hepatology and General Medicine, Royal Adelaide Hospital, Adelaide, South Australia
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30
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Angelides S, Gibson MG, Kurtovic J, Riordan S. Abdominal wall hematomata and colonic tumor detected on labeled red blood cell scintigraphy: case report. Ann Nucl Med 2003; 17:399-402. [PMID: 12971639 DOI: 10.1007/bf03006608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Gastrointestinal (GI) bleeding is not uncommon and responsible for considerable morbidity and mortality. Radionuclide red blood cell scintigraphy (RBCS) is a well established imaging modality for identifying patients with ongoing active GI bleeding. However, false positive RBCS are known to occur. The authors report the findings of a RBCS in an elderly female, who developed GI bleeding following the commencement of anticoagulant therapy. Although active GI bleeding was not identified, two abdominal wall hematomata and a cecal adenocarcinoma were detected. Distinguishing features of these lesions are described.
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Affiliation(s)
- S Angelides
- Department of Nuclear Medicinel, The Prince of Wales Hospital, Sydney, Australia.
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31
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Cynamon J, Atar E, Steiner A, Hoppenfeld BM, Jagust MB, Rosado M, Sprayregen S. Catheter-induced vasospasm in the treatment of acute lower gastrointestinal bleeding. J Vasc Interv Radiol 2003; 14:211-6. [PMID: 12582189 DOI: 10.1097/01.rvi.0000058323.82956.e4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To demonstrate results in managing lower gastrointestinal (GI) bleeding with the use of superselective catheterization and intentional induction of vasospasm of the bleeding vessel without the use of embolic agents or vasospasm-inducing medications. MATERIALS AND METHODS A retrospective review of 15 episodes of lower GI bleeding treated in the past 6 years by intentional catheter-induced vasospasm (CIV) to achieve thrombosis of a bleeding source was conducted. Nine patients had angiographically proven inferior mesenteric artery bleeding and six had angiographically proven superior mesenteric artery bleeding. RESULTS Bleeding was stopped initially in all patients after effective treatment of the feeding artery. Only one patient experienced a repeat episode of bleeding 2 days later, which required hemicolectomy. Two other patients who underwent adequate embolization underwent surgery at the discretion of the surgeon involved. The remainder were clinically observed and discharged after return of stable vital signs and hematocrit levels. None of the patients treated had clinically evident intestinal ischemia or infarction. There was one significant repeat incidence of bleeding 2 months after CIV that may have represented recurrent bleeding from the original site. CONCLUSION CIV may be a safe and effective first-line method of embolizing known lower GI bleeding. Whether CIV is used as primary therapy or as the result of spasm incurred during superselective catheterization, the patient may be regarded as successfully treated and followed accordingly, thereby possibly avoiding acute surgical therapy.
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Affiliation(s)
- Jacob Cynamon
- Department of Radiology, Division of Vascular Radiology, Montefiore Medical Center, University Hospital for the Albert Einstein College of Medicine, 111 East 210th Street, Bronx, New York 10467-2490, USA.
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32
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Lefkovitz Z, Cappell MS, Lookstein R, Mitty HA, Gerard PS. Radiologic diagnosis and treatment of gastrointestinal hemorrhage and ischemia. Med Clin North Am 2002; 86:1357-99. [PMID: 12510457 DOI: 10.1016/s0025-7125(02)00080-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Major breakthroughs in catheter, guidewire, and other angiographic equipment currently allow interventional radiologists to diagnose massive life-threatening upper and lower GI hemorrhage and to stop the bleeding safely and effectively using superselective catheterization and microcoil embolization. Similarly, the interventional radiologist can treat acute intestinal ischemia safely and effectively with selective catheterization and papaverine administration and treat chronic mesenteric ischemia by percutaneous angioplasty and stent placement. A multidisciplinary approach, including the gastroenterologist, radiologist, and surgeon, is critical in managing GI bleeding and intestinal ischemia, particularly in patients at high risk or presenting as diagnostic dilemmas.
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Affiliation(s)
- Zvi Lefkovitz
- Department of Radiology, Mount Sinai Medical Center, Mount Sinai School of Medicine, New York, NY, USA
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33
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Cappell MS, Friedel D. The role of sigmoidoscopy and colonoscopy in the diagnosis and management of lower gastrointestinal disorders: technique, indications, and contraindications. Med Clin North Am 2002; 86:1217-52. [PMID: 12510453 DOI: 10.1016/s0025-7125(02)00076-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Flexible sigmoidoscopy and colonoscopy have revolutionized the clinical management of colonic diseases. Colonoscopy has a broad range of indications, including evaluating lower GI symptoms such as lower GI bleeding, evaluating abnormal radiographic findings, and screening and surveillance for colon cancer. Colonoscopy is increasingly being used therapeutically. Patient evaluation, patient instructions, and colonic preparation before colonoscopy are essential for safe and efficient colonoscopy. Intravenous sedation reduces patient pain and anxiety during colonoscopy, but requires monitoring by pulse oximetry and automated measurements of vital signs. An experienced colonoscopist can complete colonoscopy in 90% or more of cases, using maneuvers to maintain the colonic lumen in view, straighten the colonoscope, and avoid looping during colonic intubation.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Woodhull Medical Center, Department of Medicine, State University of New York, Downstate Medical School, Brooklyn, NY, USA
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Abstract
Gastrointestinal bleeding in elderly individuals is a frequent cause of consultation with a physician and of hospital admissions. Co-morbidity and greater medication use in this steadily growing patient group influence the clinical course and adversely affect outcome. Clinical presentation is often predictable and guides subsequent patient management. Due to a surprising lack of prospective controlled data in the area of gastrointestinal bleeding, the selection of diagnostic and therapeutic manoeuvres often depends more on local expertise and availability than on an algorithmic approach. Advances in endoscopic, medical, radiological and surgical treatment modalities offer promising new diagnostic and therapeutic tools, particularly in concerted applications. Outcome studies on the appropriate sequence and linking of these modalities are urgently needed. This chapter will address clinical presentation, aetiology, diagnosis and treatment of both upper and lower gastrointestinal bleeding in the elderly.
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Affiliation(s)
- T Lingenfelser
- Klinik für Gastroenterologie, Universitätsklinik Magdeburg, Leipziger Strasse 44, D-39120 Magdeburg, Germany
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35
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Wassef W, Obando J, Sharma A. Upper Gastrointestinal Bleeding of Nonvariceal Origin in the ICU Setting. J Intensive Care Med 2001. [DOI: 10.1046/j.1525-1489.2001.00105.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wassef W, Obando J, Sharma A. Upper Gastrointestinal Bleeding of Nonvariceal Origin in the ICU Setting. J Intensive Care Med 2001. [DOI: 10.1177/088506660101600301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Upper gastrointestinal bleeding (UGI) is a common medical emergency in the intensive care unit (ICU). Although it can be caused by a number of gastrointestinal disorders, its management usually follows a few simple management rules. Prior to endoscopy, the key to management is to resuscitate the patient, to determine the need for airway protection, and to assess the need for transfusions according to the American Society of Gastrointestinal Endoscopy guidelines. During endoscopy, the key to management is to recognize the cause of the bleeding and to achieve hemostasis. Following endoscopy, the key to management is to determine the need for medical therapy and to determine a proper disposition for the patient given his potential risk for rebleeding. Stress-related erosions syndrome (SRES) is a disease that usually develops in the ICU setting and is known to be associated with a high degree of morbidity and mortality. Although it is approached in the same fashion as other causes of UGI bleeding, patients tend to do better if they are recognized early and treated prophylactically. Criteria for proper patient selection and the recommended prophylactic therapy are reviewed.
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Affiliation(s)
- Wahid Wassef
- Division of Digestive Disease and Nutrition, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, MA
| | - Jorge Obando
- Division of Digestive Disease and Nutrition, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, MA
| | - Ashish Sharma
- Division of Digestive Disease and Nutrition, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, MA
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de Caro G, Cittadini G. Role of angiographic techniques in the preoperative staging and management of gastrointestinal neoplasms. SEMINARS IN SURGICAL ONCOLOGY 2001; 20:130-3. [PMID: 11398206 DOI: 10.1002/ssu.1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Gastrointestinal neoplasms are very common diseases, and their management does not usually require angiography for diagnostic and staging purposes. However, angiography may be required for further refinements in staging of vascular involvement or to obtain a detailed preoperative anatomy of the vessels. Finally, angiographic techniques may be useful for palliative or preoperative locoregional chemotherapy, and to treat hemorrhagic complications. This article reviews the capabilities and limits of angiographic techniques in the assessment and management of tumors of the alimentary tract.
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Affiliation(s)
- G de Caro
- Department of Experimental Medicine, Section of Diagnostic Imaging, S. Martino Hospital, University of Genoa, Italy.
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Abstract
Lower gastrointestinal tract bleeding is a frequent cause of physician consultations and hospital admissions. Clinical presentation is predictable and significantly influences subsequent patient management. Controversy surrounding diagnosis and treatment of lower gastrointestinal bleeding results from a surprising lack of prospective controlled data. Thus, selection of diagnostic and therapeutic manoeuvres often depends more on local expertise and availability than on an algorithm approach. Advances in endoscopic, radiological and surgical equipment and techniques offer promising new diagnostic and therapeutic modalities, particularly in concerted applications. Outcome studies on the appropriate sequence and linking of these modalities are urgently needed. The present chapter will address clinical presentation, aetiology, diagnosis and treatment of lower gastrointestinal tract bleeding.
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Affiliation(s)
- T Lingenfelser
- Innere Medizin II, Dr.-Horst-Schmidt-Kliniken, Department of Gastroenterology and Hepatology, Ludwig-Erhard-Str.100, Wiesbaden, Germany.
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Lee FYJ, Lai PBS, Chong KL, Lau WY. Initial failure of angiography to demonstrate a bleeding pancreatic cancer: a case for provocative agents. HPB (Oxford) 2001; 3:231-4. [PMID: 18333021 PMCID: PMC2020618 DOI: 10.1080/136518201753242271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mesenteric angiography is commonly employed in the modern-day investigation of gastro-intestinal bleeding if the bleeding sites cannot be identified by endoscopic means. Angiography is optimally sensitive in the presence of active bleeding. However, vasospasm may occasionally account for a negative study shortly after bleeding. CASE OUTLINE A 70-year-old lady with inoperable carcinoma of the pancreas presented with gastro-intestinal bleeding. Although upper endoscopy visualised active bleeding from the tumour, which had invaded into the duodenum, haemostasis could not be achieved endoscopically. Therefore, mesenteric angiography was arranged. RESULTS The initial angiography failed to demonstrate the bleeding site, which only became obvious on a repeat study, when embolisation was performed to achieve haemostasis. DISCUSSION Vasospasm probably accounted for the initial negative study, as the second angiography was able to demonstrate contrast extravasation without the use of any anticoagulant or thrombolytic agent. It is not our routine to give pharmacological agents to provoke bleeding after a negative angiography, but for selected patients this manoeuvre may turn out to be more cost-effective.
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Affiliation(s)
- FYJ Lee
- Department of Surgery, Chinese University of Hong KongHong Kong
| | - PBS Lai
- Department of Surgery, Chinese University of Hong KongHong Kong
| | - KL Chong
- Department of Surgery, Chinese University of Hong KongHong Kong
| | - WY Lau
- Department of Surgery, Chinese University of Hong KongHong Kong
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