Ehlers-Danlos syndrome type IV and a novel mutation of the type III procollagen gene as a cause of abdominal apoplexy

Intra-abdominal bleeding as a rare complication after colonic endoscopic mucosal resection in a patient taking direct oral anticoagulants

We describe the case of an 84-year old female who was taking rivaroxaban 30 mg/day and had a medical history of atrial fibrillation. She underwent endoscopic mucosal resection of a 5-mm adenoma located in the hepatic flexure of the transverse colon. Following the procedure, she developed gradually intensifying abdominal pain, with the appearance of small amount of blood in the feces. For that reason, she visited our facility on the 5th day post-endoscopic mucosal resection. At the time of the visit, contrast-enhanced abdominal computed tomography revealed no extravasation or free air; however, bloody ascites was confirmed in the peritoneal cavity. Thus, the patient was diagnosed with post-endoscopic mucosal resection intra-abdominal hemorrhage and hospitalized the same day. After admission, rivaroxaban was discontinued and patient condition monitored. Because subsequent abdominal computed tomography revealed no distinct increase in bloody ascites, no interventional radiological or surgical procedure was performed, and the patient was discharged after providing only conservative treatment. While hemorrhage and perforation are the main complications after colonic endoscopic mucosal resection, so far, there have been a few reports on the occurrence of intra-abdominal hemorrhage following endoscopic mucosal resection. Emergency treatment is sometimes required in patients with intra-abdominal hemorrhage. It is important to keep in mind that this complication, although very rare, may occur, particularly in patients taking anticoagulants.

Abdominal apoplexy because of the rupture of gastroduodenal artery and inferior pancreaticoduodenal artery: A case report

RATIONALE

Abdominal apoplexy is a rare and fatal emergency event, which is coined as a comparison to the cerebrovascular apoplexy. The exact mechanism of abdominal apoplexy was unclear, but arteriosclerosis, hypertension, abdominal aneurysm, and other predisposing angiopathy were considered to be the main reasons of abdominal apoplexy. The development of the imaging technology gave us more opportunities to confirm the diagnosis of abdominal apoplexy. However, the diagnosis and identification of the bleeding sites still continued to be a challenge.

PATIENT CONCERNS

A 55-year-old man presented to the emergency department with chief complains of sudden severe abdominal pain.

DIAGNOSIS

The patient was diagnosed as abdominal apoplexy with 2 synchronous bleeding sites.

INTERVENTIONS

Angiography confirmed diagnosis of abdominal apoplexy and revealed 2 synchronous bleeding sites in gastroduodenal artery (GDA) and inferior pancreaticoduodenal artery (IPDA). Transcatheter embolization was performed immediately.

OUTCOMES

The patient recovered and was discharged very soon. Two months later, the patient totally recovered and the hematoma disappeared in the CT imaging.

LESSONS

The reported case is rare, given the very low incidence of abdominal apoplexy with 2 synchronous bleeding sites in GDA and IPDA. The awareness of abdominal apoplexy was still the key point in the management of this disease. Quick diagnosis by the imaging and immediate embolization were very important for the treatment.

Spontaneous mesenteric haematoma; diagnosis and management

Spontaneous mesenteric haematomas are rare. They have been reported to be associated with coagulopathies, connective tissue disorders, past trauma, arteriopathy and pancreatitis. However, some cases have been reported in which there is no apparent underlying aetiology. Here we report such a case and we review the literature that discusses optimal diagnosis and management. In this case, spontaneous haemostasis occurred by intra-abdominal tamponade and the regression of the haematoma was monitored with regular imaging.

Spontaneous colonic mesenteric hemorrhage: report of an unusual case of abdominal apoplexy

We describe a case of idiopathic abdominal apoplexy secondary to a spontaneous mesocolic bleed. Preoperative computed tomography of the abdomen suggested a ruptured colonic mass at the splenic flexure. The diagnosis was made when exploratory laparotomy revealed hemoperitoneum and an extensive hematoma in the transverse mesocolon, with no apparent source. Idiopathic abdominal apoplexy is rare, the reported mortality has historically been high, and a short hospital stay and rapid, complete recovery are uncommon, although outcomes may be improving in recent years. We present such a case and examine the clinical presentation, management, and prognosis through literature review.

Profiling genes related to mitochondrial function in mice treated with N-methyl-4-phenyl-1,2,3,6-tetrahydropyridine

Since mitochondrial dysfunction plays an important role in the pathogenesis of dopaminergic neurodegeneration in Parkinson's disease, we determined the expression of genes related to mitochondrial function in the substantia nigra of mice treated with N-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) using a cDNA array. MPTP treatment significantly depleted striatal dopamine, but did not result in apparent neuronal loss in the substantia nigra at 3 and 18 days post-treatment. We also examined changes in genes in the hypothalamus, a region containing dopaminergic neurons that are relatively resistant to MPTP. Finally, we confirmed those genes identified by microarrays as differentially expressed in the substantia nigra but not in the hypothalamus using in situ hybridization. Our results demonstrated that MPTP significantly changed the expressions of six genes in nigral neurons, four of which were related to the mitochondrial electron transport chain: the NADH-ubiquinone oxidoreductase 13 kDa B subunit, the NADH-ubiquinone oxidoreductase MNLL subunit, cytochrome c, and the cytochrome c oxidase Va subunit. Two other differentially expressed genes were the dihydropyridine-sensitive L-type calcium channel alpha-2 subunit precursor and type III alpha-1 procollagen. None of these six genes are encoded by mitochondrial DNA. The potential significance of these gene alterations in the context of Parkinson's disease is discussed.