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Pandit N, Bhattarai S, Nalbo D, Yadav S. Hookworm infestation as a rare cause of melaena in tropics: A case report. Trop Doct 2024; 54:191-192. [PMID: 38247308 DOI: 10.1177/00494755231226356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Melaena due to hookworm infestation is a rare clinical presentation. It usually presents with symptoms of iron-deficiency anaemia owing to slow blood loss. Here we present a case of 45-year male who presented with a one-year history of intermittent melena requiring multiple blood transfusions. Preliminary endoscopies at different centres were normal. The presence of hookworm in the duodenum was only detected on repeat upper endoscopy as the cause of blood loss, and treatment with albendazole was successful in curing the patient.
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Affiliation(s)
- Narendra Pandit
- Professor, Department of Surgical Gastroenterology, Birat Medical College Teaching Hospital, Biratnagar, Nepal
| | - Sameer Bhattarai
- Lecturer, Department of Surgical Gastroenterology, Birat Medical College Teaching Hospital, Biratnagar, Nepal
| | - Dinesh Nalbo
- Lecturer, Department of Surgical Gastroenterology, Birat Medical College Teaching Hospital, Biratnagar, Nepal
| | - Sanjay Yadav
- Assistant Professor, Department of Surgical Gastroenterology, Birat Medical College Teaching Hospital, Biratnagar, Nepal
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Toyama C, Mizushima H, Kinjo K, Masunaga Y, Fujisawa Y, Miyairi I, Tanahashi Y, Osawa S, Sawai T. Surgery for long tubular intestinal duplication with massive hemorrhage: a case report and literature review. Surg Case Rep 2024; 10:33. [PMID: 38302853 PMCID: PMC10834911 DOI: 10.1186/s40792-024-01829-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/23/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Long tubular duplication is a rare congenital intestinal disease, that can lead to emergency situations marked by massive hemorrhage. However, preoperative diagnosis and surgical treatment are challenging. This report presents preoperative images and details a surgical procedure for long tubular intestinal duplications with massive hemorrhage. CASE PRESENTATION A 3-year-old boy presented to the emergency department with melena. Despite undergoing a Tc-99m pertechnetate scintigraphy one year prior, which revealed nonspecific findings with enhancement of some parts of the intestine, enhanced abdominal CT revealed an edematous small intestine with luminal extravasation. The patient received a transfusion of red blood cells; however, his hemoglobin level did not improve. Arterial angiography and double-balloon endoscopy revealed no remarkable findings. Exploratory laparotomy revealed a long tubular duplication in half of the small intestine. Utilizing the Wrenn procedure, we successfully removed all duplicate mucosa. Pathological findings showed that almost all duplications contained gastric mucosa and revealed an ulcer with a ruptured arterial vessel. His symptoms were resolved, and the hemoglobin level stabilized. At 2 months postoperatively, no surgical complications were present. CONCLUSIONS Effective management of long tubular duplications with massive hemorrhage involves timely application of the Wrenn procedure. Recognition of specific imaging findings is crucial to prompt exploratory laparotomy, ensuring optimal outcomes and preventing delays in treatment.
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Affiliation(s)
- Chiyoshi Toyama
- Department of Pediatric Surgery, Hamamatsu University School of Medicine, University Hospital, Handayama, 1-20-1, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Hiroto Mizushima
- Department of Pediatrics, Hamamatsu University School of Medicine, University Hospital, Handayama, 1-20-1, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kenichi Kinjo
- Department of Pediatrics, Hamamatsu University School of Medicine, University Hospital, Handayama, 1-20-1, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yohei Masunaga
- Department of Pediatrics, Hamamatsu University School of Medicine, University Hospital, Handayama, 1-20-1, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yasuko Fujisawa
- Department of Pediatrics, Hamamatsu University School of Medicine, University Hospital, Handayama, 1-20-1, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Isao Miyairi
- Department of Pediatrics, Hamamatsu University School of Medicine, University Hospital, Handayama, 1-20-1, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yukichi Tanahashi
- Department of Radiology, Hamamatsu University School of Medicine, University Hospital, 1-20-1, HandayamaHamamatsu, Shizuoka, 431-3192, Japan
| | - Satoshi Osawa
- Department of Endoscopic and Photodynamic Medicine, Hamamatsu University School of Medicine, University Hospital, 1-20-1, HandayamaHamamatsu, Shizuoka, 431-3192, Japan
| | - Toshio Sawai
- Department of Pediatric Surgery, Hamamatsu University School of Medicine, University Hospital, Handayama, 1-20-1, Hamamatsu, Shizuoka, 431-3192, Japan
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Piccirillo M, Pucinischi V, Mennini M, Strisciuglio C, Iannicelli E, Giallorenzi MA, Furio S, Ferretti A, Parisi P, Di Nardo G. Gastrointestinal bleeding in children: diagnostic approach. Ital J Pediatr 2024; 50:13. [PMID: 38263189 PMCID: PMC10807079 DOI: 10.1186/s13052-024-01592-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024] Open
Abstract
Different conditions may underlie gastrointestinal bleeding (GIB) in children. The estimated prevalence of GIB in children is 6.4%, with spontaneous resolution in approximately 80% of cases. Nonetheless, the initial approach plays a pivotal role in determining the prognosis. The priority is the stabilization of hemodynamic status, followed by a systematic diagnostic approach. GIB can originate from either upper or lower gastrointestinal tract, leading to a broad differential diagnosis in infants and children. This includes benign and self-limiting disorders, alongside serious conditions necessitating immediate treatment. We performed a nonsystematic review of the literature, in order to describe the variety of conditions responsible for GIB in pediatric patients and to outline diagnostic pathways according to patients' age, suspected site of bleeding and type of bleeding which can help pediatricians in clinical practice. Diagnostic modalities may include esophagogastroduodenoscopy and colonoscopy, abdominal ultrasonography or computed tomography and, when necessary, magnetic resonance imaging. In this review, we critically assess these procedures, emphasizing their respective advantages and limitations concerning specific clinical scenarios.
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Affiliation(s)
- Marisa Piccirillo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy
| | - Valentina Pucinischi
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy
| | - Maurizio Mennini
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Elsa Iannicelli
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Radiology Unit, Rome, Italy
| | - Maria Agostina Giallorenzi
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Radiology Unit, Rome, Italy
| | - Silvia Furio
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy
| | - Alessandro Ferretti
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy
| | - Pasquale Parisi
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy.
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Raj A, Kaeley N, Prasad H, Patnaik I, Bahurupi Y, Joshi S, Shukla K, Galagali S, Patel S. Prospective observational study on clinical and epidemiological profile of adult patients presenting to the emergency department with suspected upper gastrointestinal bleed. BMC Emerg Med 2023; 23:107. [PMID: 37726688 PMCID: PMC10510119 DOI: 10.1186/s12873-023-00885-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 09/11/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Bleeding from the upper gastrointestinal (GI) tract is one of the common medical emergencies. In this study, we assessed patients' socio-demographic and clinical characteristics and the association of clinical characteristics with treatment outcomes among patients with suspected upper gastrointestinal bleed (UGIB) presenting to the emergency department (ED). At present, there is a scarcity of data on UGIB in Northern part of India. MATERIAL AND METHOD The study was a single-center, prospective observational study conducted at an urban tertiary care center. Consecutive patients with suspected UGIB were enrolled in the study from August 2020 to February 2022. A detailed history was obtained, including demographic data such as age and sex, presenting complaints, history of presenting illness, history related to co-morbidities, addiction, and drug history. Pre-endoscopic Rockall and Glasgow-Blatchford Score were calculated for each patient. The patients were subsequently followed up till discharge from the hospital. The final outcomes with regard to mortality, need for blood transfusion, length of emergency department stay, and discharge were noted. RESULT 141 patients were included in the study. The mean age of the patients with suspected UGIB was 48 ± 14 years. 115 (81.6%) patients were male. The most common co-morbidity was chronic liver disease (40;28.4%). The most frequent presenting complaint in this study was hematemesis (96; 68.1%), followed by melena (76;53.9%). The mean (Standard Deviation, SD) of the Rockall Score was 2.46 ± 1.75. The mean (SD) of the Glasgow Blatchford Score was 12.46 ± 3.15 in patients with UGIB. CONCLUSION In our study, hematemesis was the most prevalent symptom of suspected UGIB, followed by melena. Portal hypertension was the most common cause of UGIB. Most frequent comorbidities in patients suspected of UGIB were alcohol intake, Nonsteriodal Antiinflammatory Drugs (NSAIDs) abuse, and co-morbidities such as underlying chronic liver disease, hypertension, and diabetes. Early endoscopy can be of great utility to reduce morbidity and mortality.
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Affiliation(s)
- Alok Raj
- Department of Emergency Medicine, All India Institute of Medical Sciences Rishikesh, Rishikesh, 249203, Uttarakhand, India
| | - Nidhi Kaeley
- Department of Emergency Medicine, All India Institute of Medical Sciences Rishikesh, Rishikesh, 249203, Uttarakhand, India.
| | - Hari Prasad
- Department of Emergency Medicine, All India Institute of Medical Sciences Rishikesh, Rishikesh, 249203, Uttarakhand, India
| | - Itish Patnaik
- Department of Gastroenterology, All India Institute of Medical Sciences Rishikesh, Rishikesh, 249203, Uttarakhand, India
| | - Yogesh Bahurupi
- Department of Community and Family Medicine, All India Institute of Medical Sciences Rishikesh, Rishikesh, 249203, Uttarakhand, India
| | - Shrirang Joshi
- Department of Emergency Medicine, All India Institute of Medical Sciences Rishikesh, Rishikesh, 249203, Uttarakhand, India
| | - Krishna Shukla
- Department of Emergency Medicine, All India Institute of Medical Sciences Rishikesh, Rishikesh, 249203, Uttarakhand, India
| | - Santosh Galagali
- Department of Emergency Medicine, All India Institute of Medical Sciences Rishikesh, Rishikesh, 249203, Uttarakhand, India
| | - Sanket Patel
- Department of Emergency Medicine, Nootan Medical College, Gujarat, 384315, India
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Acharyya BC, Mukhopadhyay M, Chakraborty H. Changing trend in the spectrum of upper gastrointestinal bleeding in children-A multicentre experience. Indian J Gastroenterol 2023; 42:562-568. [PMID: 36757638 DOI: 10.1007/s12664-022-01306-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 10/27/2022] [Indexed: 02/10/2023]
Abstract
In children, upper gastrointestinal bleeding (UGIB) is an uncommon, but potentially serious, condition with diverse etiologies. A prospective study had been undertaken to find out any changing trend in the etiology and outcome of pediatric UGIB in Eastern India. This retrospective analysis of case records of children, presenting in outpatient or emergency with hematemesis and/or melena from 2 tertiary GI centers of Kolkata, was undertaken to find out the etiologies of bleed and the outcome of management. A total of 180 children were evaluated including 30 (16.7%) infants. The predominant cause of GGIB was gastroduodenal ulcer and erosions (60%) followed by variceal bleeding (19.4%). Vascular lesions were detected in 4 (2%). Hyperplastic antral polyp was an unusual etiology in 3 (1.7%) infants. Various endotherapies were needed in 28% of cases. No mortality was noted. Melena, hemoglobin below 8 gm%, the need for volume replacement, and packed red blood cells transfusion on admission were associated with significant endoscopic lesions, which needed endotherapies. This study, comprising the largest cohort among Indian published series, found an etiology of pediatric upper GI bleed, different from the one, previously depicted. This may be a reflection either of regional variations or a changing trend over time.
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Affiliation(s)
- Bhaswati C Acharyya
- Department of Paediatric Gastroenterology, AMRI Hospitals, 230 Barakhola Lane, Purba Jadavpur, Kolkata, 700 099, India.
| | - Meghdeep Mukhopadhyay
- Department of Paediatric Gastroenterology, AMRI Hospitals, 230 Barakhola Lane, Purba Jadavpur, Kolkata, 700 099, India
| | - Hema Chakraborty
- Department of Histopathology, AMRI Hospitals, 230 Barakhola Lane, Purba Jadavpur, Kolkata, 700 099, India
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Namavari N, Taheri L, Hooshmand F, Dousthaghi MH, Rahmanian V. Pure testicular choriocarcinoma with gastrointestinal metastasis and paraneoplastic symptoms: a case report. BMC Urol 2023; 23:102. [PMID: 37270552 DOI: 10.1186/s12894-023-01271-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/09/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Pure testicular choriocarcinoma is a rare type of non-seminomatous germ cell tumor extremely poor prognostic with the tendency to bleed at the metastatic site. At the time of the diagnosis, 70% of patients have metastatic lesions. Depending on the site of the metastasis, symptoms vary. Gastrointestinal involvement is seen in less than 5% of cases, mostly in the duodenum. CASE PRESENTATION We present a 47 years old male with testicular choriocarcinoma involving the jejunum, lung, liver, and kidney presenting with acute abdominal pain, melena, and dyspnea with some paraneoplastic symptoms. The patient had increased, severe and constant pain in the right lower quadrant for the previous four days. Additionally, he was complaining of nausea, vomiting, anorexia, and a history of melena for the last 10 days. Dyspnea on exertion, hemoptysis, and dry cough were the symptoms he was suffering from, for almost one year. The patient's general appearance was pale, ill, and thin with 10 kg of weight loss during the last some months. The computed tomography (CT) scan reported multiple metastatic lesions in both liver lobes and the left kidney. Pathologic study of the samples of small bowel lesions showed metastatic choriocarcinoma. Following the patient had been referred to an oncologist to start the chemotherapy regime. Finally, the patient has expired after 40 days of his first admission. CONCLUSIONS Testicular choriocarcinoma is a rare but fatal malignancy among young men. Gastrointestinal metastases are infrequent involvement represented by melena and acute abdominal pain, obstruction, and mass. Physicians should consider it as a differential diagnosis for acute abdomen and gastrointestinal bleeding causation.
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Affiliation(s)
- Negin Namavari
- School of Medicine, Peymaniye Hospital, Jahrom University of Medical Science, Jahrom, Iran.
| | - Lohrasb Taheri
- Department of Surgery, Jahrom University of Medical Science, Jahrom, Iran
| | - Farhang Hooshmand
- Department of pathology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | | | - Vahid Rahmanian
- Department of Public Health, Torbat Jam Faculty of Medical Sciences, Torbat Jam, Iran
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Vaze PG, Acharyya BC, Banerjee R, Biswas SK, Chattpopadhyay A, Saha S. Long Tubular Duplication of the Small Intestine - Lessons Learnt from a Common Presentation of a Rare Disease. J Indian Assoc Pediatr Surg 2023; 28:160-163. [PMID: 37197245 PMCID: PMC10185043 DOI: 10.4103/jiaps.jiaps_114_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/11/2022] [Accepted: 10/26/2022] [Indexed: 05/19/2023] Open
Abstract
Long tubular duplication of the small intestine is one of the most difficult surgical challenges. The presence of heterotopic gastric mucosa necessitates resection of the duplicated bowel, but shared vascularity with the normal adjoining bowel makes the task daunting. We present a case of long tubular small intestinal duplication with certain special surgical and perioperative challenges which were successfully managed.
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Affiliation(s)
- Poonam Guha Vaze
- Department of Pediatric Surgery, AMRI Hospitals, Kolkata, West Bengal, India
| | - Bhaswati C. Acharyya
- Department of Pediatric Gastroenterology, AMRI Hospitals, Kolkata, West Bengal, India
| | - Rupa Banerjee
- Department of Pediatric Surgery, Nilratan Sircar Medical College, Kolkata, West Bengal, India
| | - Somak Krishna Biswas
- Department of Pediatric Surgery, Institute of Child Health, Kolkata, West Bengal, India
| | | | - Subhasis Saha
- Department of Pediatric Surgery, AMRI Hospitals, Kolkata, West Bengal, India
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Reihani H, Ghanei-Shahmirzadi A, Salehi S, Ansari-Charsoughi N, Karbasian F, Imanieh MH. Manifestation of leech infestation as severe gastrointestinal bleeding in a 3-year-old boy: a case report and review of the literature. BMC Pediatr 2022; 22:704. [PMID: 36482427 DOI: 10.1186/s12887-022-03778-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 11/26/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Leeches are a class of hermaphroditic parasites that can attach to various body parts and start sucking blood. Gastrointestinal (GI) bleeding due to leeches is a rare phenomenon that is more common in less developed countries. Common symptoms include melena, hematemesis, pallor, weakness, and fatigue. Due to the similar symptoms of this issue to the main differential diagnoses of GI bleeding in pediatrics, such as diarrhea, constipation, diverticulitis, esophagitis, and anal fissures, it is challenging to differentiate it from the rest. CASE PRESENTATION We present a three-year-old boy who was transferred to our center with hematemesis, tarry stool, and a drop in hemoglobin level. He finally was diagnosed with a leech in his stomach. CONCLUSIONS In less developed counties, the inability to reach safe drinking water, swim in lakes or springs, and inadequate awareness of public health information among individuals can be risk factors for leech infestation.
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Kumagai H, Yaegashi M, Okutsu M, Otsuka K, Iwasa T, Sasaki A. Bleeding ileal schwannoma resulting in severe anemia requiring massive blood transfusion: A rare case report. Int J Surg Case Rep 2022; 102:107820. [PMID: 36463688 PMCID: PMC9720555 DOI: 10.1016/j.ijscr.2022.107820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 11/24/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Melena is a common symptom of schwannoma of the small intestine, a rare type of tumor. Even more rare is schwannoma of the small intestine that requires a massive blood transfusion due to hemorrhage. Herein, we report such a case successfully treated with surgical resection. PRESENTATION OF CASE A 72-year-old woman presented to the previous hospital with melena. The patient was taking antiplatelet drugs for a previous cerebral infarction. The patient had progressive anemia due to continuous melena. Thus, she needed a massive blood transfusion with 12 units of packed red blood cells within 1 week of admission. A diagnosis was not possible based on the esophagogastroduodenoscopy and colonoscopy findings. Therefore, the patient was referred to our hospital for further examination and treatment. Computed tomography (CT) showed a well-circumscribed tumor with hyperattenuation in the small intestine, and double-balloon endoscopy (DBE) revealed a submucosal tumor (SMT) in the ileum. The patient was diagnosed with a bleeding gastrointestinal stromal tumor (GIST) and underwent laparoscopic partial resection of the ileum. The histopathological findings revealed spindle-shaped cell growth and a peritumoral lymphoid cuff. Furthermore, immunohistochemistry demonstrated that the tumor cells were negative for c-kit and CD34 but positive for S100 staining. Finally, the patient was diagnosed with ileal schwannoma. The postoperative course was uneventful, and the patient was discharged on postoperative day 10. CONCLUSION This report describes an extremely rare case of ileal schwannoma requiring massive blood transfusion. Furthermore, it highlights that schwannomas of the small intestine can cause severe anemia, especially in patients receiving antiplatelet drugs.
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Su JZ, Fan SF, Song X, Cao LJ, Su DY. Wandering small intestinal stromal tumor: A case report. World J Clin Cases 2022; 10:10622-10628. [PMID: 36312500 PMCID: PMC9602228 DOI: 10.12998/wjcc.v10.i29.10622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/16/2022] [Accepted: 09/07/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The occurrence of gastrointestinal stromal tumors (GISTs) in the small intestine is rare, and a case of wandering small intestinal stromal tumor has been rarely reported to date. Dissemination of this case can help inform future diagnosis and effective treatment.
CASE SUMMARY A 68-year-old patient presented to us with tarry stools. Computed tomography showed a mobile tumor moving widely within the abdominal cavity. As the laboratory data showed a low range of red blood cells and an immediate surgery was not indicated, we performed digital subtraction angiography and embolization to achieve hemostasis. Surgical resection was performed after the patient’s condition improved. The tumor was successfully removed laparoscopically. Histological examination revealed submucosal GIST with infarction, which was of intermediate-risk, with mitotic count < 1 per 10 high-power field. Immunohistochemical studies revealed the following: CD117+, Dog1+, CD34+, SMA+, S100-, CK-, Des-, SOX-11-, STAT6-, Ki67 Hotspots 10%+. The patient was ultimately diagnosed with wandering small intestinal stromal tumor.
CONCLUSION When a highly vascularized tumor is clinically encountered in the small intestine, the possibility of stromal tumors should be considered. However, when the tumor cannot be visualized at its original location, the possibility of tumor migration is considered.
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Affiliation(s)
- Jin-Zhan Su
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
| | - Shu-Feng Fan
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
| | - Xia Song
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
| | - Lu-Jun Cao
- Department of Radiology, The Hospital of the Zhejiang University, Hangzhou 310058, Zhejiang Province, China
| | - Dong-Ying Su
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
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Kweun JA, Kang HM, Kim JE, Park SJ. Annular Pancreas: A Rare Cause of Upper Gastrointestinal Bleeding in Adults. Korean J Gastroenterol 2022; 79:182-186. [PMID: 35473777 DOI: 10.4166/kjg.2022.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/25/2022] [Accepted: 03/14/2022] [Indexed: 11/03/2022]
Abstract
Annular pancreas is a rare congenital anomaly in which a thin band of pancreatic tissue partially or completely surrounds the duodenum. It is challenging to diagnose due to its variable clinical presentation. Approximately two-thirds of patients have no symptoms in their lifetime, and most symptomatic cases are seen in neonates and infants. Symptomatic adult patients present with upper gastrointestinal symptoms, such as epigastric pain, vomiting, and postprandial fullness associated with gastric outlet obstruction. Complications associated with annular pancreas include peptic ulcer disease, pancreatitis, pancreatic head carcinoma, and biliary obstruction. Annular pancreas is also a rare cause of upper gastrointestinal bleeding in adults, but it should be considered as one of the differential diagnoses in patients presenting with a peptic ulcer and duodenal stricture. Here, we report the case of a 60-year-old man who presented with melena and was subsequently diagnosed with an annular pancreas.
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Affiliation(s)
- Joung Ah Kweun
- Division of Gastroenterology, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Hyung Mook Kang
- Division of Gastroenterology, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Jang Eon Kim
- Division of Gastroenterology, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Sung Jae Park
- Division of Gastroenterology, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
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Ashktorab H, Russo T, Oskrochi G, Latella G, Massironi S, Luca M, Chirumamilla LG, Laiyemo AO, Brim H. Clinical and Endoscopic Outcomes in Coronavirus Disease-2019 Patients With Gastrointestinal Bleeding. Gastro Hep Adv 2022; 1:487-499. [PMID: 35287301 PMCID: PMC8907011 DOI: 10.1016/j.gastha.2022.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/17/2022] [Indexed: 01/11/2023]
Abstract
Background and Aims Over 404 million people worldwide have been infected with coronavirus disease-2019 (COVID-19), 145 million in the United States (77 million) and Europe (151 million) alone (as of February 10, 2022). This paper aims to analyze data from studies reporting gastrointestinal bleeding (GIB) and/or endoscopic findings in COVID-19 patients in Western countries. Methods We conducted a systematic review of articles on confirmed COVID-19 cases with GIB in Western countries published in PubMed and Google Scholar databases from June 20, 2020, to July 10, 2021. Results A total of 12 studies reporting GIB and/or endoscopic findings in 808 COVID-19 patients in Western countries were collected and analyzed. Outcomes and comorbidities were compared with 18,179 non-GIB COVID-19 patients from Italy and the United States. As per our study findings, the overall incidence of GIB in COVID-19 patients was found to be 0.06%. When compared to the non-GIB cohort, the death rate was significantly high in COVID-19 patients with GIB (16.4% vs 25.4%, P < .001, respectively). Endoscopic treatment was rarely necessary, and blood transfusion was the most common GIB treatment. The most common presentation in GIB patients is melena (n = 117, 47.5%). Peptic, esophageal, and rectal ulcers were the most common endoscopic findings in upper (48.4%) and lower (36.4%) endoscopies. The GIB cohort had worse outcomes and higher incidence of hypertension (61.1%), liver disease (11.2%), and cancer (13.6%) than the non-GIB cohort. Death was strongly associated with hypertension (P < .001, r = 0.814), hematochezia (P < .001, r = 0.646), and esophagogastroduodenoscopy (P < .001, r = 0.591) in COVID-19 patients with GIB. Conclusions Overall, the incidence of GIB in COVID-19 patients is similar to that estimated in the overall population, with melena being the most common presentation. The common endoscopic findings in GIB COVID-19 patients were ulcers, esophagitis, gastritis, and colitis. Patients with GIB were more prone to death than non-GIB COVID-19 patients.
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Affiliation(s)
- Hassan Ashktorab
- Department of Medicine, Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, District of Columbia
| | - Tiziano Russo
- Department of Medicine, Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, District of Columbia
| | - Gholamreza Oskrochi
- College of Engineering and Technology, American University of the Middle East, Egaila, Kuwait
| | - Giovanni Latella
- Gastroenterology, Hepatology and Nutrition Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Sara Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Martina Luca
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Lakshmi G. Chirumamilla
- Department of Medicine, Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, District of Columbia
| | - Adeyinka O. Laiyemo
- Department of Medicine, Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, District of Columbia
| | - Hassan Brim
- Department of Medicine, Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, District of Columbia
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Sekiguchi H, Shinozaki S, Takezawa T, Osawa H, Miura Y, Lefor AK, Yamamoto H. Long-Term Outcomes in Patients with Post-Bulbar Ulcer Bleeding Compared to Bulbar Ulcer Bleeding in the Duodenum. Digestion 2022; 103:126-132. [PMID: 34551417 DOI: 10.1159/000519293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/27/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Duodenal ulcers are classified into bulbar and post-bulbar ulcers. The aim of this study is to compare the long-term outcomes of patients with post-bulbar ulcer bleeding and those with bulbar ulcer bleeding. METHODS A total of 272 patients with hemorrhagic duodenal ulcers requiring hospitalization were included. Their medical records were retrospectively reviewed. RESULTS All patients were categorized as bulbar or post-bulbar bleeding ulcer groups. The post-bulbar ulcer group had more patients of advanced age, concurrent malignancy, diabetes mellitus, hypertension, cirrhosis, and chronic kidney disease undergoing hemodialysis. We performed long-term follow-up for an average of 2.6 years. The mortality rate during the follow-up period in the post-bulbar ulcer group was significantly higher than that in the bulbar ulcer group (p < 0.001). The PNED score was a better predictor of 30-day mortality compared to the complete Rockall score and the Glasgow-Blatchford Score. Predictors of mortality were evaluated using a Cox proportional hazards regression model. In multivariate analysis, post-bulbar ulcer, concurrent malignancy, cirrhosis, antiplatelet/anticoagulant use, and transfusion were significant predictors of mortality. CONCLUSIONS Patients with post-bulbar ulcers have a poorer prognosis than those with bulbar ulcers. After the diagnosis of hemorrhagic post-bulbar duodenal ulcer, close follow-up is necessary.
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Affiliation(s)
- Hiromi Sekiguchi
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Satoshi Shinozaki
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.,Shinozaki Medical Clinic, Utsunomiya, Japan
| | - Takahito Takezawa
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Hiroyuki Osawa
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Yoshimasa Miura
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | | | - Hironori Yamamoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
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Alhasan AS, Daqqaq TS. Extensive abdominal lymphangiomatosis involving the small bowel mesentery: A case report. World J Clin Cases 2021; 9:9990-9996. [PMID: 34877341 PMCID: PMC8610896 DOI: 10.12998/wjcc.v9.i32.9990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/16/2021] [Accepted: 07/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Abdominal lymphangiomatosis is a rare benign condition accounting for less than 1% of all the cases of lymphangiomatosis. Management usually involves radical surgical excision; however, depending upon the extent of involvement, patient condition, and absence of complications, conservative management can be also considered.
CASE SUMMARY We present the case of a 32-year-old male who presented with short onset abdominal pain and melena. Physical examination findings were within normal limits, except for left lower abdominal tenderness. Upper gastrointestinal endoscopy was within normal limits. Abdominal and pelvic ultrasound and computed tomography (CT) scan revealed numerous, variably-sized cystic lesions within the abdominal cavity, exclusively and extensively affecting the small bowel mesentery with sparing of the retroperitoneum. The diagnosis was confirmed by CT and cytological examination. Radical surgical excision was technically impossible in this patient because of the extensive involvement of the mesentery; therefore, the patient was managed conservatively.
CONCLUSION Extensive and exclusive small bowel mesentery involvement in abdominal lymphangiomatosis is rare. Imaging modalities play an important role in establishing the diagnosis and conservative management can be considered when surgery is technically impossible.
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Affiliation(s)
- Ayman S Alhasan
- Department of Radiology and Medical Imaging, College of Medicine Taibah University, Madinah 42353, Saudi Arabia
| | - Tareef S Daqqaq
- Department of Radiology and Medical Imaging, College of Medicine Taibah University, Madinah 42353, Saudi Arabia
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Melki G, Mohamed H, Kapoor A, Ha J, Mohamed A, Patel V, Baddoura WJ. A Case of Treated Penile Melanoma with Gastric Recurrence. Middle East J Dig Dis 2021; 13:259-263. [PMID: 36606222 PMCID: PMC9489467 DOI: 10.34172/mejdd.2021.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/11/2021] [Indexed: 01/07/2023] Open
Abstract
Melanoma is a very aggressive skin cancer that could metastasize to any organ in the body. The treatment of melanomas includes surgical resection, chemotherapy, and immunotherapy. After resections, melanomas could recur at the previous site or present as a distant metastatic lesion. The symptoms of melanoma are vague and primarily occur because of the local disruption of the tissue architecture. Presented here is a case of gastric melanoma that presented with abdominal discomfort and melena in a patient with a history of penile melanoma that was completely resected 3 years earlier. This case illustrates the importance of having metastatic lesions to the intestinal tract as a differential for a patient with gastrointestinal hemorrhage.
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Affiliation(s)
- Gabriel Melki
- Department of Internal Medicine, St. Joseph’s University Medical Center, Paterson, NJ, USA
,Corresponding Author: Gabriel Melki, MD 703 Main Street, Paterson, New Jersey 07503, United States of America Tel: + 973 754 2439 Fax: + 973 2243-2570
| | - Hadir Mohamed
- Department of Internal Medicine, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Ashima Kapoor
- Department of Internal Medicine, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Jewook Ha
- Department of Internal Medicine, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Abdalla Mohamed
- Department of Gastroenterology, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Varun Patel
- Department of Gastroenterology, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Walid J. Baddoura
- Department of Gastroenterology, St. Joseph’s University Medical Center, Paterson, NJ, USA
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Scherdin Y, Halldestam I, Redeen S. Incidence and Mortality Related to Gastrointestinal Bleeding, and the Effect of Tranexamic Acid on Gastrointestinal Bleeding. Gastroenterology Res 2021; 14:165-172. [PMID: 34267831 PMCID: PMC8256901 DOI: 10.14740/gr1383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/28/2021] [Indexed: 12/29/2022] Open
Abstract
Background Gastrointestinal bleeding is a common and potentially life-threatening condition. The incidence of gastrointestinal bleeding has not decreased despite new prophylaxis and treatments. Ulcer is still one of the most common etiologies for upper gastrointestinal bleeding. It is routinely treated with proton pump inhibitors (PPIs) and endoscopic interventions, sometimes endovascular procedures, and rarely today, open surgery with suture to stop the bleeding. The fibrinolytic tranexamic acid (TXA) has a role in bleeding treatment, and is routinely used for example within trauma care, postpartum bleeding and orthopedic surgery. The aim of this study is to assess the incidence of gastrointestinal bleeding. A further aim was to investigate if TXA has any role in medical treatment of gastrointestinal bleeding today. Methods We performed a retrospective cohort study with a review of medical records, involving patients with clinical signs of gastrointestinal bleeding and endoscopically verified ulcers between the years of 2010 and 2016 at the University Hospital of Linkoping, Sweden. The cities of Motala and Linkoping have the primary acute admissions at this Hospital. Results We found in total 1,331 patients with gastrointestinal bleeding. The overall incidence for patients with gastrointestinal bleeding was 98.6 (98.6/100,000 inhabitants and year). For those with endoscopically verified ulcer (386 patients), the incidence for peptic ulcer was 28.6/100,000/year. In the group with endoscopically verified ulcer, 25 patients died, giving the 30-day mortality of 6.4%. TXA is still used for treatment of bleeding ulcers. We had two groups, those with and without TXA treatment. They were equal in age, gender and comorbidity. Clinically we saw no major differences in respect to hemodynamic stability. There were more patients with overt bleeding symptoms in the TXA group. We also saw more patients in need of intensive care in the TXA group. Conclusions The incidence of gastrointestinal bleeding has not significantly decreased during the last years. There was no significant positive effect of TXA in patients with upper gastrointestinal bleeding in this study. The difference between the two groups is probably more a question of whom we treat with TXA (e.g., the patients in worse condition or at higher risk) than a difference in drug effect. It is time to quit with TXA treatment in all patients with gastrointestinal bleeding, even those at intensive care unit (ICU).
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Affiliation(s)
- Ylva Scherdin
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linkoping University, Linkoping, Sweden
| | - Ingvar Halldestam
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linkoping University, Linkoping, Sweden
| | - Stefan Redeen
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linkoping University, Linkoping, Sweden
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Heo TG. Solitary jejunal cavernous hemangioma causing intermittent melena: A case report. Int J Surg Case Rep 2021; 84:106121. [PMID: 34175681 PMCID: PMC8253942 DOI: 10.1016/j.ijscr.2021.106121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Hemangioma of the small intestine is a rare disease that causes acute and chronic intestinal bleeding and is difficult to diagnose before surgery. This report presents a case of a cavernous hemangioma confined to the jejunum of a man with intermittent melena. CASE PRESENTATION A 38-year-old man presented with an episode of melena one and a half month ago. He had similar symptoms a year ago and had undergone esophagogastroduodenoscopy, colonoscopy, and abdominopelvic computed tomography, but the results were normal. Abdominopelvic computed tomography performed after hospitalization showed a small intraluminal protruding mass in the jejunum. A jejunal hemangioma was found during laparoscopy and was successfully treated with intestinal resection. CLINICAL DISCUSSION It is difficult to identify the cause of gastrointestinal bleeding preoperatively in patients with normal esophagogastroduodenoscopy, colonoscopy, and abdominopelvic computed tomography results. Small bowel tumors, especially small hemangiomas, should be considered as a cause. Laparoscopy may be one option for finding and treating lesions of the small intestine in hospitals where capsule endoscopy or double-balloon intestinal enteroscopy is not available. CONCLUSION This report presents a case of a cavernous hemangioma localized in the jejunum of a 38-year-old man with intermittent melena that was successfully treated with laparoscopy and intestinal resection, thereby emphasizing the usefulness of laparoscopy in hospitals where capsule endoscopy or double-balloon intestinal enteroscopy is not available.
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Affiliation(s)
- Tae Gil Heo
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea.
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18
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Kim BY, Kim KB. Primary Aortoduodenal Fistula Causes Massive Melena: A Case Report. Korean J Gastroenterol 2021; 77:132-135. [PMID: 33758109 DOI: 10.4166/kjg.2021.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 11/03/2022]
Abstract
A primary aortoenteric fistula is defined as the spontaneous development of communication between the gastrointestinal tract and the native aorta. This is unlike a secondary aortoenteric fistula that occurs after surgery, such as a vascular graft. A primary aortoenteric fistula is an extremely rare cause of upper gastrointestinal bleeding. The condition is often overlooked because of its extremely low incidence. This paper reports a case of a 75-year-old man who presented with massive melena. Esophagogastroduodenoscopy revealed an ulcer measuring approximately 1.3 cm with a huge pulsating vessel in the third portion of the duodenum. Later, the diagnosis of primary aortoduodenal fistula was confirmed. The patient died in the preoperative stage due to massive bleeding. The findings of this case suggest that the endoscopists should recognize aortoenteric fistula as a potential cause of gastrointestinal bleeding.
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Affiliation(s)
- Byung Yen Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ki Bae Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
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Maglangit SACA, Macalindong SS, Dofitas RB, Cabaluna ND. Indocyanine Green (ICG) fluorescence angiography of gastric conduit after transhiatal thoracic esophagectomy with proximal gastrectomy for esophagogastric junction adenocarcinoma: A case report and initial experience at a tertiary government hospital in the Philippines. Int J Surg Case Rep 2021; 80:105653. [PMID: 33611079 PMCID: PMC7905447 DOI: 10.1016/j.ijscr.2021.105653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/06/2021] [Accepted: 02/07/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE We documented the initial experience in our institution where we used indocyanine green (ICG) fluorescence angiography as adjunct in the evaluation of the vascular supply of a reconstructed gastric conduit for esophageal replacement for esophagogastric junction (EGJ) cancer surgery. CASE PRESENTATION A 62-year-old patient consulted with a two-month history of melena and weight loss and unremarkable chest and abdominal physical examinations. CLINICAL FINDINGS AND INVESTIGATIONS Upper endoscopy and contrast-enhanced computed tomography scans of the chest and abdomen demonstrated an EGJ tumor with no nodal and distant metastases, which revealed adenocarcinoma on biopsy. INTERVENTION AND OUTCOME The patient underwent combined thoracoscopic-assisted and transhiatal thoracic esophagectomy with proximal gastrectomy. Esophageal reconstruction was done via a retrosternal gastric pull-up. The perfusion and viability of the gastric conduit were confirmed as per usual methods of inspection and palpation. ICG fluorescence angiography further demonstrated and confirmed the vascular perfusion of the gastric conduit and the optimal site of anastomosis. The patient had an unremarkable postoperative course with no reported anastomotic leakage and stricture formation at 12 months follow-up. RELEVANCE AND IMPACT ICG fluorescence angiography represents a feasible and promising tool in assessing viability of esophageal replacement and choosing the optimal site for anastomosis with the proximal esophagus. It can aid in choosing the most appropriate site of anastomosis to prevent ischemia-related complications such as leakage or stricture. This particular case can serve as an initial learning experience to guide surgeons in our institution in the use of ICG fluorescence angiography for esophageal replacements after esophagectomy.
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Affiliation(s)
- Sittie Aneza Camille A Maglangit
- Division of Surgical Oncology, Head & Neck, Breast, Skin & Soft Tissue, and Esophagogastric Surgery, Department of Surgery, Philippine General Hospital, University of the Philippines Manila, Philippines.
| | - Shiela S Macalindong
- Division of Surgical Oncology, Head & Neck, Breast, Skin & Soft Tissue, and Esophagogastric Surgery, Department of Surgery, Philippine General Hospital, University of the Philippines Manila, Philippines
| | - Rodney B Dofitas
- Division of Surgical Oncology, Head & Neck, Breast, Skin & Soft Tissue, and Esophagogastric Surgery, Department of Surgery, Philippine General Hospital, University of the Philippines Manila, Philippines
| | - Nelson D Cabaluna
- Division of Surgical Oncology, Head & Neck, Breast, Skin & Soft Tissue, and Esophagogastric Surgery, Department of Surgery, Philippine General Hospital, University of the Philippines Manila, Philippines
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Abstract
Upper gastrointestinal (GI) bleeding is a common reason for hospital admission in older adult patients and carries a high morbidity and mortality if not properly managed. Risk factors include advanced age, Helicobacter pylori infection, medication use, smoking, and history of liver disease. Patients with known or suspected liver disease and suspected variceal bleeding should also receive antibiotics and somatostatin analogues. Risk stratification scores should be used to determine patients at highest risk for further decompensation. Upper endoscopy is both a diagnostic and therapeutic tool used in the management of upper GI bleeding. Endoscopy should be performed within 24 hours of presentation after appropriate resuscitation. Management of anticoagulation in upper GI bleeding largely depends on the indication for anticoagulation, the risk of continued bleeding with continuing the medication, and the risk of thrombosis with discontinuing the medication. A multidisciplinary approach to the decision of anticoagulation continuation is preferred when possible.
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Affiliation(s)
- Nicholas J Costable
- Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustav L Levy Place, New York, NY 10029, USA
| | - David A Greenwald
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 11th Floor, New York, NY 10029, USA.
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21
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Arieira C, Magalhães R, Dias de Castro F, Boal Carvalho P, Rosa B, Moreira MJ, Cotter J. Small Bowel Angioectasias Rebleeding and the Identification of Higher Risk Patients. Dig Dis Sci 2021; 66:175-80. [PMID: 32072436 DOI: 10.1007/s10620-020-06137-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 02/07/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Small bowel capsule endoscopy (SBCE) is the gold standard for suspected small bowel bleeding (SBB). Angioectasias are the most common vascular anomalies in the gastrointestinal tract and have been reported as the source of SBB in up to 80% of patients. Considering their frequency, their usual intermittent bleeding nature, and their risk of rebleeding, the aim of this study was to identify some features and possible predictors of rebleeding in the presence of these lesions. METHODS This is a retrospective study, which included consecutive SBCE with angioectasias between April 2008 and December 2017 with a minimum follow-up of 12 months. Rebleeding was defined as a drop of hemoglobin ≥ 2 g/dl and/or in the presence of hematochezia or melenas with negative esophagogastroduodenoscopy and ileocolonoscopy. Data were collected from medical records, and angioectasias were classified by number, location, size, and type. Univariate and multivariable statistical analysis was performed to identify possible predictors of rebleeding. RESULTS From a total of 630 patients submitted to SBCE for suspected SBB, 129 with angioectasias were included; 59.7% were female, with a median age of 72 (19-91) years old and a mean follow-up of 44.0 ± 31.9 months. In 32.6% (n = 42) of the patients, at least one episode of rebleeding was documented. The presence of heart failure (OR 3.41; IC95% 1.18-9.89; p = 0.024), the size of the angioectasias (OR 5.41; IC95% 2.15-13.6; p < 0.001), and smoking status (OR 3.15; IC95% 1.07-9.27; p = 0.038) were independent predictor factors of rebleeding. CONCLUSION Heart failure, smoking status, and angioectasias with a size superior to 5 mm are independent predictor factors of rebleeding in a population with angioectasias diagnosed by SBCE.
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Affiliation(s)
- Steve S Qian
- Department of Internal Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Mohamad Mouchli
- Department of Gastroenterology, Carilion Clinic, Roanoke, Virginia
| | - Douglas J Grider
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
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Affiliation(s)
- Lisa F. Barrett
- Department of Internal Medicine, Einstein Healthcare Network, 19141 Philadelphia, USA,Corresponding author
| | - Kevin Bryan Lo
- Department of Internal Medicine, Einstein Healthcare Network, 19141 Philadelphia, USA
| | - Steven R. Stanek
- Department of Gastroenterology, Einstein Healthcare Network, 19141 Philadelphia, USA
| | - James W. Walter
- Department of Gastroenterology, Einstein Healthcare Network, 19141 Philadelphia, USA
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Ogasawara O, Kojima T, Miyazu M, Sobue K. Impact of the stress ulcer prophylactic protocol on reducing the unnecessary administration of stress ulcer medications and gastrointestinal bleeding: a single-center, retrospective pre-post study. J Intensive Care 2020; 8:10. [PMID: 31988751 PMCID: PMC6966877 DOI: 10.1186/s40560-020-0427-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/09/2020] [Indexed: 12/11/2022] Open
Abstract
Background Clinically significant gastrointestinal bleeding from stress ulcers increases patient mortality in intensive care, and histamine type 2 receptor blockers and proton pump inhibitors as stress ulcer prophylaxes were reported to decrease the incidence of that. Although medical checklists are widely used to maintain high compliance with medications and interventions to improve patient outcome in the intensive care field, the efficacy of medical checklists regarding the incidence of gastrointestinal bleeding and the reduction of unnecessary administration of stress ulcer prophylaxis medications has not been sufficiently explored to date. This study aimed to investigate the incidence of gastrointestinal bleeding and the rate of administering stress ulcer prophylaxis medication before and after setting administration criteria for stress ulcer prophylaxis and introducing a medical checklist for critically ill adults. Methods This was a retrospective pre-post study at a single-center, tertiary adult and pediatric mixed ICU. Adult patients (≥ 18 years) who were admitted to the ICU for reasons other than gastrectomy, esophagectomy, pancreatoduodenectomy, and gastrointestinal bleeding were analyzed. A medical checklist and stress ulcer prophylaxis criteria were introduced on December 22, 2014, and the patients were classified into the preintervention group (from September to December 21, 2014) and the postintervention group (from December 22, 2014, to April 2015). The primary outcome was the incidence of upper gastrointestinal bleeding, and the secondary outcome was the proportion administered stress ulcer prophylaxis medications. Results One hundred adult patients were analyzed. The incidence of upper gastrointestinal bleeding in the pre- and postintervention groups was both 4.0% [95% confidence interval, 0.5–13.7%]. The proportion administered stress ulcer prophylaxis medications decreased from 100 to 38% between the pre- and post-intervention groups. Conclusions After the checklist and the criteria were introduced, the administration of stress ulcer prophylaxis medications decreased without an increase in upper gastrointestinal bleeding in critically ill adults. Prospective studies are necessary to evaluate the causal relationship between the introduction of them and gastrointestinal adverse events in critically ill adults.
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Affiliation(s)
- Osamu Ogasawara
- 1Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Science, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601 Japan
| | - Taiki Kojima
- Department of Anesthesiology, Aichi Children's Health and Medical Center, 7-426, Morioka-cho, Obu, Aichi 474-0031 Japan
| | - Mitsunori Miyazu
- Department of Anesthesiology, Aichi Children's Health and Medical Center, 7-426, Morioka-cho, Obu, Aichi 474-0031 Japan
| | - Kazuya Sobue
- 1Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Science, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601 Japan
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Haddad FG, El Imad T, Nassani N, Kwok R, Al Moussawi H, Polavarapu A, Ahmed M, El Douaihy Y, Deeb L. In-hospital acute upper gastrointestinal bleeding: What is the scope of the problem? World J Gastrointest Endosc 2019; 11:561-572. [PMID: 31839875 PMCID: PMC6885731 DOI: 10.4253/wjge.v11.i12.561] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/29/2019] [Accepted: 10/02/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute upper gastrointestinal bleeding (AUGIB) is a frequently encountered condition in the Gastroenterology field with a mortality rate of 10-14%. Despite recent newer innovations and advancements in endoscopic techniques and available medications, the mortality rate associated with AUGIB remained persistently elevated.
AIM To explore mortality, characteristics and outcome differences between hospitalized patients who develop AUGIB while in-hospital, and patients who initially present with AUGIB.
METHODS This is a retrospective of patients who presented to Northwell Health Staten Island University Hospital from October 2012 to October 2016 with AUGIB that was confirmed endoscopically. Patients were divided in two groups: Group 1 comprised patients who developed AUGIB during their hospital stay; group 2 consisted of patients who initially presented with AUGIB as their main complaint. Patient characteristics, time to endoscopy, endoscopy findings and interventions, and clinical outcomes were collected and compared between groups.
RESULTS A total of 336 patients were included. Group 1 consisted of 139 patients and group 2 of 196 patients. Mortality was significantly higher in the 1st group compared to the 2nd (20% vs 3.1%, P ≤ 0.05). Increased length of stay (LOS) was noted in the 1st group (13 vs 6, P ≤ 0.05). LOS post-endoscopy, vasopressor use, number of packed red blood cell units and patients requiring fresh frozen plasma were higher in group 1. Inpatients were more likely to be on corticosteroids, antiplatelets and anticoagulants. Conversely, the mean time from bleeding to undergoing upper endoscopy was significantly lower in group 1 compared to group 2.
CONCLUSION In-hospital AUGIB is associated with high mortality and morbidity despite a shorter time to endoscopy. Larger scale studies assessing the role of increased comorbidities and antithrombotic use in this setting are warranted.
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Affiliation(s)
- Fady G Haddad
- Department of Gastroenterology and Hepatology, Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Talal El Imad
- Department of Gastroenterology and Hepatology, Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Najib Nassani
- Department of Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, IL 60607, United States
| | - Raymond Kwok
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Hassan Al Moussawi
- Department of Gastroenterology and Hepatology, Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Abhishek Polavarapu
- Department of Gastroenterology and Hepatology, Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Moiz Ahmed
- Department of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai Elmhurst Hospital Center, Elmhurst, NY 11373, United States
| | - Youssef El Douaihy
- Department of Gastroenterology and Hepatology, Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Liliane Deeb
- Department of Gastroenterology and Hepatology, Staten Island University Hospital, Staten Island, NY 10305, United States
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Chan WYS, Kwan KEL, Teo LT. A rare case of retroperitoneal and mesenteric lymphangiomatosis. Radiol Case Rep 2020; 15:11-4. [PMID: 31762861 DOI: 10.1016/j.radcr.2019.09.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 12/15/2022] Open
Abstract
Lymphagiomatosis are rare benign malformations of the lymphatic system. They are more commonly seen during childhood and are frequently asymptomatic and incidentally found in the adult patient. We report a case of a 31-year-old male who presented initially with melena. Computer tomography scan revealed multiple confluent, fluid-density lesions encasing the retroperitoneum and mesentery. A laparotomy and incisional biopsy of the mesenteric lesion was performed. Histologic examination demonstrated fibrofatty tissue with prominent, thick-walled endothelial-lined vessels. The histologic and computer tomography findings were consistent with a diagnosis of retroperitoneal and mesenteric lymphangiomatosis. The patient was subsequently discharged home well.
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Ghoneim S, Shah A, Calderon A. Esophageal Nikolsky's Sign: A Rare Finding in a Patient with Bullous Pemphigoid. Case Rep Gastroenterol 2019; 13:445-449. [PMID: 31762733 PMCID: PMC6873001 DOI: 10.1159/000503898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 10/03/2019] [Indexed: 01/30/2023] Open
Abstract
Bullous pemphigoid (BP) is a chronic relapsing autoimmune blistering disease that typically affects middle-age and elderly patients. It can manifest with varying degrees of mucosal involvement in addition to characteristic skin findings. However, esophageal involvement is very rare. We report a case of a 57-year-old female with BP who presented with epigastric pain and melena. She underwent an esophagogastroduodenoscopy which induced bullae seen only upon withdrawal of the endoscope. This finding is analogous to the dermatological finding of Nikolsky's sign. Gentle insertion and withdrawal of the endoscope is recommended to reduce the risk of bullae formation and mucosal injury.
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Affiliation(s)
- Sara Ghoneim
- Department of Internal Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Aun Shah
- Department of Internal Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Amy Calderon
- Division of Gastroenterology and Hepatology, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio, USA
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Chen J, Zhang B, Yan Z, Zhao H, Yang K, Yin Y, Jiang L. Exploratory laparoscopy combined with pathological examination in the diagnosis of obscure gastrointestinal bleeding in a child: a case report. BMC Pediatr 2018; 18:371. [PMID: 30482204 PMCID: PMC6260701 DOI: 10.1186/s12887-018-1339-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 11/12/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The diagnosis of obscure gastrointestinal bleeding (OGIB) which is defined as bleeding of unknown origin of the small bowel by routine evaluation in childhood is a challenge. CASE PRESENTATION Here we report a one-year-old Chinese girl who was suspected with idiopathic pulmonary haemosiderosis (IPH) and referred to our department for further diagnosis. Finally she was diagnosed with vascular malformations (VM) by exploratory laparoscopy combined with pathological examination. CONCLUSIONS Children OGIB could be easily misdiagnosed in the beginning, and OGIB children with active ongoing bleeding may benefit from proceeding directly to exploratory laparoscopy, followed by pathological confirmation of the diagnosis.
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Affiliation(s)
- Jiande Chen
- Department of Respiratory Medicine, Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, No.1678 Dongfang Road, Pudong, 200127 Shanghai China
| | - Bin Zhang
- Department of Gastroenterology, Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, No.1678 Dongfang Road, Pudong, 200127 Shanghai China
| | - Zhilong Yan
- Department of General Surgery, Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, No.1678 Dongfang Road, Pudong, 200127 Shanghai China
| | - Huaying Zhao
- Department of General Surgery, Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, No.1678 Dongfang Road, Pudong, 200127 Shanghai China
| | - Kaihua Yang
- Department of Gastroenterology, Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, No.1678 Dongfang Road, Pudong, 200127 Shanghai China
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, No.1678 Dongfang Road, Pudong, 200127 Shanghai China
| | - Lirong Jiang
- Department of Gastroenterology, Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, No.1678 Dongfang Road, Pudong, 200127 Shanghai China
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Sadhale A, Adike A, Lam-Himlin D. Metastatic renal cell carcinoma presenting with melena. Clin Case Rep 2018; 6:961-962. [PMID: 29744101 PMCID: PMC5930209 DOI: 10.1002/ccr3.1492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/16/2018] [Accepted: 02/24/2018] [Indexed: 11/09/2022] Open
Abstract
Renal cell carcinoma is a highly malignant neoplasm. Metastasis to the pancreas and gastrointestinal tract is rare. In this case report, we show images of metastatic renal cell carcinoma to the upper gastrointestinal tract in a patient who presented with melena.
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Affiliation(s)
- Ashwini Sadhale
- Department of Gastroenterology and Hepatology Mayo Clinic Scottsdale Arizona
| | - Abimbola Adike
- Department of Gastroenterology and Hepatology Mayo Clinic Scottsdale Arizona
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Abstract
BACKGROUND AND AIMS Melena is a symptom of upper gastrointestinal bleeding and usually indicates bleeding proximal to the ligament of Treitz. However, whether melena predicts bleeding in the proximal small intestine in patients with obscure gastrointestinal bleeding (OGIB) is unknown and the objective of this study. METHODS A retrospective cohort study of consecutive patients undergoing capsule endoscopy for OGIB between July 2009 and May 2016 was conducted. Subjects were categorized based on the presence of melena, and the primary outcome was identification of a bleeding source within the proximal 2/3 of the small intestine. Multi-variable regression was performed to control for confounders. RESULTS During the study, 288 patients met the eligibility criteria. Subjects with melena accounted for 37.1% of the cohort and were more likely to be older (mean age 66.9 vs. 63.9, p = 0.0457), take warfarin (15.1 vs. 9.4%, p = 0.0122), and have a lower 12-month hemoglobin nadir (7.3 vs. 8.3 g/dL, p = 0.0002). On crude analysis, 56.1% of patients with melena had a bleeding source within the proximal small intestine compared to 34.8% for those without (RR 1.61, 95% CI 1.24-2.09, p = 0.0004). On multi-variable analysis, the presence of melena doubled the odds of finding a bleeding site within the proximal small intestine (OR 1.97, 95% CI 1.17-3.33, p = 0.010). CONCLUSIONS The presence of melena doubles the odds of finding a bleeding site within the proximal small intestine among patients with OGIB, and deep enteroscopy, if performed before a capsule study, should begin with an antegrade approach in these patients.
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Affiliation(s)
- Cindy Ningfu Zhu
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Joshua Friedland
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Brian Yan
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Aze Wilson
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Jamie Gregor
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Vipul Jairath
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
- Robarts Clinical Trials, London, Canada
| | - Michael Sey
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada.
- London Health Sciences Centre-Victoria Hospital, 800 Commissioners Rd. E., London, ON, N6A 5W9, Canada.
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Mulkerrin G, Hogan NM, Sheehan M, Joyce MR. Melena as an unusual presentation of gastrointestinal stromal tumour, a case report. Int J Surg Case Rep 2018; 44:172-175. [PMID: 29524855 PMCID: PMC5927812 DOI: 10.1016/j.ijscr.2018.02.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/18/2018] [Accepted: 02/26/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Gastrointestinal Stromal Tumors (GISTs) are a rare slow growing malignancy, accounting for less than 1% of all gastrointestinal (GI) tract tumors. These tumors are usually discovered incidentally by endoscopy, surgery or radiology. However on occasions they may present with significant symptoms including GI blood loss. This case report discusses an atypical presentation of a GIST in a 57-year-old female. CASE PRESENTATION A 57-year-old woman presented to the emergency department following one episode of melena. This occurred on a background of two previous presentations with melena over a 10-year period. She had a preceding surgery for a Meckel's Diverticulum. She was admitted for monitoring and investigation. An emergency upper endoscopy showed no upper gastrointestinal pathology to account for the bleeding. Her condition deteriorated with development of hypovolemic shock, requiring blood transfusion. An urgent CT angiogram identified a large mass in the distal ileum. The patient underwent an emergency laparotomy, where a 9.1 cm tumor located on the distal one-third of the ileum was resected. Histopathology confirmed the mass was a GIST. The patient had a successful post-operative period and subsequent treatment with Imatinib. DISCUSSION The majority of GISTs are found incidentally. This case report describes an unusual presentation of a GIST in which the tumor bled into the intestinal lumen causing significant melena and life threatening hemorrhage. CONCLUSION We conclude that GIST should be considered as a possible differential in rare cases of GI bleeding where more common causes have been ruled out.
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Affiliation(s)
- G Mulkerrin
- Department of Colorectal Surgery, University Hospital Galway, Ireland.
| | - N M Hogan
- Department of Colorectal Surgery, University Hospital Galway, Ireland
| | - M Sheehan
- Department of Pathology, University Hospital Galway, Ireland
| | - M R Joyce
- Department of Colorectal Surgery, University Hospital Galway, Ireland
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Thiebaud PC, Yordanov Y, Galimard JE, Raynal PA, Beaune S, Jacquin L, Ageron FX, Pateron D; Initiatives de Recherche aux Urgences Group. Management of upper gastrointestinal bleeding in emergency departments, from bleeding symptoms to diagnosis: a prospective, multicenter, observational study. Scand J Trauma Resusc Emerg Med 2017; 25:78. [PMID: 28807040 DOI: 10.1186/s13049-017-0425-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 08/02/2017] [Indexed: 12/16/2022] Open
Abstract
Background Upper gastrointestinal bleeding (UGB) is common in emergency departments (EDs) and can be caused by many eso-gastro-duodenal lesions. Most available epidemiological data and data on the management of UGB comes from specialized departments (intensive care units or gastroenterology departments), but little is known from the ED perspective. We aimed to determine the distribution of symptoms revealing UGB in EDs and the hemorrhagic lesions identified by endoscopy. We also describe the characteristics of patients consulting for UGB, UGB management in the ED and patients outcomes. Method This was a prospective, observational, multicenter study covering 4 consecutive days in November 2013. Participating EDs were part of the Initiatives de Recherche aux Urgences network coordinated by the French Society of Emergency Medicine. All patients with suspected UGB in these EDs were included. Results In total, 110 EDs participated, including 194 patients with suspected UGB (median age 66 years [Q1-Q3: 51-81]). Overall, 104 patients (54%) had hematemesis and 75 (39%) melena. Endoscopy revealed lesions in 121 patients, mainly gastroduodenal ulcer or ulcerations (41%) or bleeding lesions due to portal hypertension (20%). The final diagnosis of UGB was reversed by endoscopy in only 3% of cases. Overall, 67 patients (35%) had at least one severity sign. Twenty-one patients died (11%); 40 (21%) were hospitalized in intensive care units and 126 (65%) in medicine departments; 28 (14%) were outpatients. Mortality was higher among patients with clinical and biological severity signs. Conclusion Most of the UGB cases in EDs are revealed by hematemesis. The emergency physician diagnosis of UGB is rarely challenged by the endoscopic findings. Electronic supplementary material The online version of this article (doi:10.1186/s13049-017-0425-6) contains supplementary material, which is available to authorized users.
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Cappell MS, Stevens CE, Amin M. Systematic review of giant gastric lipomas reported since 1980 and report of two new cases in a review of 117110 esophagogastroduodenoscopies. World J Gastroenterol 2017; 23:5619-5633. [PMID: 28852321 PMCID: PMC5558125 DOI: 10.3748/wjg.v23.i30.5619] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/04/2017] [Accepted: 06/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To systematically review the syndrome of giant gastric lipomas, report 2 new illustrative cases.
METHODS Literature systematically reviewed using PubMed for publications since 1980 with following medical subject heading/keywords: (“giant lipoma”) AND (“gastric”) OR [(“lipoma”) and (“gastric”) and (“bleeding”)]. Two authors independently reviewed literature, and decided by consensus which articles to incorporate. Computerized review of pathology/endoscopy records at William Beaumont Hospitals, Royal Oak and Troy, Michigan, January 2005-December 2015, revealed 2 giant gastric lipomas among 117110 consecutive esophagogastroduodenoscopies (EGDs), which were thoroughly reviewed, including re-review of original endoscopic photographs, radiologic images, and pathologic slides.
RESULTS Giant gastric lipomas are extremely rare: 32 cases reported since 1980, and 2 diagnosed among 117110 consecutive EGDs. Average patient age = 54.5 ± 17.0 years old (males = 22, females = 10). Maximal lipoma dimension averaged 7.9 cm ± 4.1 cm. Ulcerated mass occurred in 21 patients. Lipoma locations: antrum-17, body-and-antrum-4, antrum-intussuscepting-into-small-intestine-3, body-2, fundus-1, and unspecified-5. Intramural locations included submucosal-22, subserosal-2, and unspecified-8. Presentations included: acute upper gastrointestinal (UGI) bleeding-19, abdominal pain-5, nausea/vomiting-5, and asymptomatic-3. Symptoms among patients with UGI bleeding included: weakness/fatigue-6, abdominal pain-4, nausea/vomiting-4, early-satiety-3, dizziness-2, and other-1. Their hemoglobin on admission averaged 7.5 g/dL ± 2.8 g/dL. Patients with GI bleeding had significantly more frequently ulcers than other patients. EGD was extremely helpful diagnostically (n = 31 patients), based on characteristic endoscopic findings, including yellowish hue, well-demarcated margins, smooth overlying mucosa, and endoscopic cushion, tenting, or naked-fat signs. However, endoscopic mucosal biopsies were mostly non-diagnostic (11 of 12 non-diagnostic). Twenty (95%) of 21 abdominal CTs demonstrated characteristic findings of lipomas, including: well-circumscribed, submucosal, and homogeneous mass with attenuation of fat. Endoscopic-ultrasound showed characteristic findings in 4 (80%) of 5 cases: hyperechoic, well-localized, mass in gastric-wall-layer-3. Transabdominal ultrasound and UGI series were generally less helpful. All 32 patients underwent successful therapy without major complications or mortality, including: laparotomy and full-thickness gastric wall resection of tumor using various surgical reconstructions-26; laparotomy-and-enucleation-2; laparoscopic-transgastric-resection-2; endoscopic-mucosal-resection-1, and other-1. Two new illustrative patients are reported who presented with severe UGI bleeding from giant, ulcerated, gastric lipomas.
CONCLUSION This systematic review may help standardize the endoscopic and radiologic evaluation and therapy of patients with this syndrome.
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Abstract
BACKGROUND Bleeding ulcer is a common condition, especially among the elderly population. Tranexamic acid (TXA) has been successfully used for many bleeding conditions. Its use in patients with bleeding ulcer is inclusive yet. The aim of this study was to provide an overview of the prescription of TXA. METHODS This retrospective cohort study was performed as a review of medical records at the Surgery Department, University Hospital in Linkoping. Patients with complete esophagogastroduodenoscopy and ulcer disease were included and divided on the basis of treatment with TXA or not. Differences between the groups were statistically analyzed. RESULTS The main part of the prescription of TXA, 65%, occurred during 2010 and 2011, and 35% between 2012 and 2013 (P < 0.05). In the group treated with TXA, 84% needed blood transfusion, compared to 64% in the control group (P = 0.039). Of the patients treated with TXA, 18% were re-bleeding compared to 14% of the controls (P = 0.594). Median value for days at hospital was 5 in the tranexamic group and 3 in the control group (P = 0.005). CONCLUSION The prescription of TXA has declined between 2010 and 2013. TXA was more often prescribed to patients with more severe gastrointestinal (GI) bleeding ulcer disease. Further investigation is needed to conclude the significance of tranexamic acid in patients with GI bleeding ulcer disease.
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Affiliation(s)
- Stefan Redeen
- Department of Surgery and Department of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden.
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Fernandez-Moure JS, Kim K, Zubair MH, Rosenberg WR. Case report on the non-operative management of a retrievable inferior vena cava filter perforating the duodenum. Int J Surg Case Rep 2017; 39:60-63. [PMID: 28806622 PMCID: PMC5554988 DOI: 10.1016/j.ijscr.2017.06.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/23/2017] [Accepted: 06/25/2017] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Deep vein thrombosis (DVT) continues to be a significant source of morbidity for surgical patients. Placement of a retrievable inferior vena cava (IVC) filter is used when patients have contraindications to anticoagulation or recurrent pulmonary embolism despite therapeutic anticoagulation. Although retrievable IVC filters are often used, they carry a unique set of risks. PRESENTATION OF CASE A 67-year-old man presents to the Emergency Room (ER) following large volume melena and complaining of syncope. One year prior, the patient had been diagnosed with Glioblastoma multiforme, for which he underwent a craniotomy with near-total resection of the mass. He subsequently developed a deep vein thrombosis and underwent placement of a retrievable inferior vena cava (IVC) filter. Computerized tomography (CT) and esophagogastroduodenoscopy showed duodenal perforation by the retrievable IVC filter. The filter was successfully retrieved through an endovascular approach. DISCUSSION Retrievable IVC filter placement is the preferred method of pulmonary embolism prevention in patients with significant risk for bleeding. Duodenal perforation by a retrievable IVC filter is a rare and serious complication. It is usually managed surgically, but can also be managed non-operatively. CONCLUSION For patients with significant comorbidities or patients who are poor surgical candidates, non-operative management with close monitoring can serve as an initial approach to the patient with a caval enteric perforation secondary to a retrievable IVC filter.
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Affiliation(s)
- Joseph S Fernandez-Moure
- Houston Methodist Hospital, Dept. of Surgery, 6550 Fannin Street, Houston, TX 77030, United States; Department of Regenerative and Biomimetic Medicine, Houston Methodist Research Institute, 6670 Bertner Ave., Houston, TX 77030, United States
| | - Keemberly Kim
- Texas A&M College of Medicine, 8447 TX-47, Bryan, TX 77807, United States
| | - M Haseeb Zubair
- Houston Methodist Hospital, Dept. of Surgery, 6550 Fannin Street, Houston, TX 77030, United States
| | - Wade R Rosenberg
- Houston Methodist Hospital, Dept. of Surgery, 6550 Fannin Street, Houston, TX 77030, United States.
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Abstract
There is a broad clinical spectrum of gastrointestinal bleeding in children, ranging from subtle laboratory findings to dramatic clinical presentations. This review provides a framework for the evaluation and management of gastrointestinal hemorrhage for pediatricians. It outlines strategies for obtaining a tailored patient history and conducting a thorough physical examination that can shed light on the location, severity, and likely etiology of bleeding. It appraises blood tests, radiologic tools, and endoscopic modalities frequently used to identify and control a source of bleeding.
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Affiliation(s)
- Anita K Pai
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Victor L Fox
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Schatz RA, Rockey DC. Gastrointestinal Bleeding Due to Gastrointestinal Tract Malignancy: Natural History, Management, and Outcomes. Dig Dis Sci 2017; 62:491-501. [PMID: 28032204 DOI: 10.1007/s10620-016-4368-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 10/27/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gastrointestinal (GI) tumor bleeding can vary from occult bleeding to massive hemorrhage and can be the presenting sign of malignancy. AIMS Our primary aims were to: (1) characterize the natural history, treatment, and outcomes in patients with GI tumor bleeding and (2) compare and contrast bleeding in upper GI (UGI)/small bowel (SB) and lower GI malignancies. METHODS Patients with endoscopically confirmed tumor bleeding were identified through search of consecutive electronic medical records: Bleeding was determined by the presence of melena, hematochezia, hematemesis, or fecal occult blood. Comprehensive clinical and management data were abstracted. RESULTS A total of 354 patients with GI tumors were identified: 71 had tumor bleeding (42 UGI/SB and 29 colonic). GI bleeding was the initial presenting symptom of malignancy in 55/71 (77%) of patients; 26/71 patients had widely metastatic disease at presentation. Further, 15 of 26 patients with metastatic disease presented with GI bleeding. Visible bleeding was present in 14/42 (33%) and 4/29 (14%) of UGI/SB and colonic tumors, respectively. Endoscopic hemostasis was attempted in 10 patients, and although initial control was successful in all, bleeding recurred in all of these patients. The most common endoscopic lesion was clean-based tumor ulceration. Overall mortality at 1 year was 57% for esophageal/gastric, 14% for SB, and 33% for colonic tumors. CONCLUSIONS When patients with GI malignancy present with GI bleeding, it is often the index symptom. Initial endoscopic hemostasis is often successful, but rebleeding is typical. Esophageal and gastric tumors carry the poorest prognosis, with a high 1-year mortality rate.
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Omranipour R, Mahmoud Zadeh H, Ensani F, Yadegari S, Miri SR. Duodenal Metastases From Renal Cell Carcinoma Presented With Melena: Review and Case Report. Iran J Pathol 2017. [PMID: 29531553 PMCID: PMC5835376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Renal cell carcinoma (RCC) metastasis to duodenum is very rare and only a few case reports are available in the literature. We here reported a patient with solitary duodenal metastasis presented with melena six years after right nephrectomy. The patient underwent upper gastrointestinal endoscopy showing ulcerative mass at the second portion of duodenum and biopsy of this mass was consistent with metastatic RCC. Metastasis work up did not find any other site of malignancy, thus Whipple's operation (Pancreaticoduodenectomy) was performed. In conclusion metastasis from RCC should be considered in mind in patients with history of nephrectomy presenting with gastrointestinal symptoms and a complete evaluation, especially endoscopic examination followed by biopsy, is suggested.
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Affiliation(s)
- Ramesh Omranipour
- Cancer Institute of Tehran University of Medical Science, Tehran, Iran
| | | | - Fershteh Ensani
- Research Center of Cancer, Tehran University of Medical Science, Tehran, Iran
| | - Samira Yadegari
- Cancer Institute of Tehran University of Medical Science, Tehran, Iran
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Baldwin CL, Wilsey M. Three Year Old Male with Multiple Dieulafoy Lesions Treated with Epinephrine Injections via Therapeutic Endoscopy. Pediatr Gastroenterol Hepatol Nutr 2016; 19:276-280. [PMID: 28090473 PMCID: PMC5234423 DOI: 10.5223/pghn.2016.19.4.276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/05/2016] [Accepted: 09/12/2016] [Indexed: 12/29/2022] Open
Abstract
Dieulafoy lesions, vascular anomalies typically found along the gastrointestinal tract, have been viewed as rare and obscure causes of sudden intestinal bleeding, especially in pediatric patients. Since their discovery in the late 19th century, the reported incidence has increased. This is due to an increased awareness of, and knowledge about, their presentation and to advanced endoscopic diagnosis and therapy. Our patient was a three-year-old male, without a complex medical history. He presented to the emergency department with acute hematemesis with blood clots and acute anemia requiring blood transfusion. Endoscopy revealed four isolated Dieulafoy lesions along the lesser curvature of the stomach, which were treated with an epinephrine injection. The Dieulafoy lesion, although thought to be rare, should be considered when investigating an acute gastrointestinal bleed. These lesions have been successfully treated endoscopically. Appropriate anticipation and preparation for diagnosis and therapy can lead to optimal outcomes for the pediatric patient.
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Affiliation(s)
| | - Michael Wilsey
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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Hulstaert E, Smith V, Mielants H, Van Praet L, De Kock J, Lambrecht V, Rasschaert G, Van Belle S. Rapidly growing gastric metastasis of Merkel cell carcinoma, an unusual cause of melena. Acta Clin Belg 2016; 71:263-6. [PMID: 27075789 DOI: 10.1080/17843286.2015.1105612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Merkel cell carcinoma (MCC) is an uncommon, highly aggressive neuroendocrine skin carcinoma that has a tendency for local recurrence and metastatic disease. We report a rare case of recurrent melena in a 77-year-old Caucasian male. Three years earlier, the patient had undergone a radical resection of a para-umbilical MCC. A repeat esophagogastroduodenoscopy proved necessary to identify rapidly proliferating gastric metastasis of MCC as the cause of bleeding.
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Srinivasan PH, Maliekal JI, Reddy CS, Suda S. GIST Jinx - A Rare Case of Acute Massive Life Threatening Bleed from a Jejunal Gastro-Intestinal Stromal Tumour. J Clin Diagn Res 2016; 10:PJ03-4. [PMID: 27134942 DOI: 10.7860/jcdr/2016/16828.7391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/09/2016] [Indexed: 11/24/2022]
Affiliation(s)
| | - Joji I Maliekal
- Professor and Head, Department of General Surgery, Government Medical College , Kozhikode, Kerala, India
| | - Chaganty Saikiran Reddy
- Post Graduate Student, Department of Pathology, Government Medical College , Kozhikode, Kerala, India
| | - Sriharsha Suda
- Senior resident, Department of General Surgery, Government Medical College , Kozhikode, Kerala, India
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Zirpe D, Wani M, Tiwari P, Ramaswamy PK, Kumar RP. Duodenal Lipomatosis as a Curious Cause of Upper Gastrointestinal Bleed: A Report with Review of Literature. J Clin Diagn Res 2016; 10:PE01-4. [PMID: 27437304 DOI: 10.7860/jcdr/2016/19851.7881] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/15/2016] [Indexed: 12/17/2022]
Abstract
Lipomas of the gastrointestinal tract are rare. Duodenal lipomas are incidental and mostly asymptomatic. Tumours may produce symptoms of abdominal pain and discomfort or cause bleeding due to ulceration or intestinal obstruction due to intussusception. We describe a 45-year-old man presenting in emergency with 3 days history of melena with normal gastroduodenoscopy and contrast enhanced computed tomography revealing multiple polypoid lesion in duodenum and proximal jejunum suggestive of lipoma. Due to ongoing bleed, he underwent laparotomy with duodenectomy and uneventful postoperative recovery. Our review of cases published in last 67 years indicate that duodenal lipomas are rare to occur but commonly found in second part, they may be seen in third and fourth part of duodenum which may be missed on endoscopy. They can be multiple and may present as severe UGI bleeding which could be managed surgically. Though CT is diagnostic, histopathology confirms the diagnosis which shows lipomatous lesion composed of mature adipose arranged in lobules.
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Affiliation(s)
- Dinesh Zirpe
- Senior Registrar, Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospitals (Main) , Greams Road, Chennai, Tamilnadu, India
| | - Majid Wani
- Senior Registrar, Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospitals (Main) , Greams Road, Chennai, Tamilnadu, India
| | - Priyanka Tiwari
- Senior Registrar, Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospitals (Main) , Greams Road, Chennai, Tamilnadu, India
| | | | - Reddy Prasanna Kumar
- Senior Consultant, Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospitals (Main) , Greams Road, Chennai, Tamilnadu, India
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Sawant AD, Shah R, Shah N, Gupta T. A Rare Cause of Chronic Life Threatening Bleeding in a Girl: The Ulcerated Blind Loops. APSP J Case Rep 2016; 7:13. [PMID: 27170918 PMCID: PMC4852056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 01/18/2016] [Indexed: 11/26/2022] Open
Abstract
Ulceration in a blind loop can lead to massive gastrointestinal tract (GIT) bleeding. A 13-year old girl presented with symptomatic melena requiring repeated blood transfusion since childhood. She was an operated case of small bowel atresia in neonatal life. Her upper and lower gastrointestinal endoscopies were normal. Operation showed presence of multiple ulcers in two blind loops (parts of previous side to side anastomosis) and at the anastomotic site. She underwent resection and end-to-end anastomosis of the small bowel leading to complete resolution of melena and anemia.
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Affiliation(s)
- Abhijeet D Sawant
- Department of Paediatric Surgery, P.D. Hinduja National Hospital and MRC, Mahim, Mumbai
| | - Rasik Shah
- Department of Paediatric Surgery, P.D. Hinduja National Hospital and MRC, Mahim, Mumbai
| | - Nitin Shah
- Department of Paediatrics, P.D. Hinduja National Hospital and MRC, Mahim, Mumbai
| | - Tarun Gupta
- Department of Gastroenterology, P.D. Hinduja National Hospital and MRC, Mahim, Mumbai
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Khalid F, Kaiyasah H, Binfadil W, Majid M, Hazim W, ElTayeb Y. Pneumatosis intestinalis due to gastrointestinal amyloidosis: A case report & review of literature. Int J Surg Case Rep 2016; 23:29-32. [PMID: 27085104 PMCID: PMC4855412 DOI: 10.1016/j.ijscr.2016.03.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 03/28/2016] [Indexed: 12/17/2022] Open
Abstract
Pneumatosis intestinalis is a poorly understood phenomenon with a multitude of causes. It may mimic other gastrointestinal conditions ranging from benign to life threatening ones. A high index of suspicion is required to reach the correct diagnosis in order to provide optimal care for the patient. G.I amyloidosis is among the rare causes for secondary pneumatosis intestinalis.
Introduction Pneumatosis intestinalis (PI) is not a disease but a radiological finding with a poorly understood pathogenesis. It can be divided into primary/idiopathic (15%) or secondary (85%) Kim et al. 2007, based on the factors thought to play a role in its development. Amongst the rare causes of secondary PI is gastrointestinal (GI) amyloidosis. Presentation of the case We report a case of a 46-year-old gentleman who presented with a one month history of acute on chronic abdominal pain, associated with one episode of melena. Upon further investigation, he was found to have pneumoperitoneum. He was taken to the operating theatre, where he was noted to have features of pneumatosis intestinalis of the small bowel with no evidence of bowel perforation. Postoperatively, he underwent an upper GI endoscopy with biopsies that revealed GI amyloidosis. Discussion One of the rare causes that can lead to secondary PI is GI amyloidosis as proven in our case. Patients with symptomatic gastrointestinal amyloidosis usually present with one of four syndromes: gastrointestinal bleeding, malabsorption, protein-losing gastroenteropathy, and, less often, gastrointestinal dysmotility. Conclusion GI amyloidosis is a rare cause of secondary pneumatosis intestinalis. The presentation of the disease varies from patient to patient, therefore, the management should be tailored accordingly.
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Affiliation(s)
- Filza Khalid
- General surgery department, Rashid hospital, Dubai Health Authority, Dubai, UAE.
| | - Hadiel Kaiyasah
- General surgery department, Rashid hospital, Dubai Health Authority, Dubai, UAE
| | - Wafa Binfadil
- General surgery department, Rashid hospital, Dubai Health Authority, Dubai, UAE
| | - Maiyasa Majid
- General surgery department, Rashid hospital, Dubai Health Authority, Dubai, UAE
| | - Wessam Hazim
- General surgery department, Rashid hospital, Dubai Health Authority, Dubai, UAE
| | - Yousif ElTayeb
- General surgery department, Rashid hospital, Dubai Health Authority, Dubai, UAE
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Cardile S, Martinelli M, Barabino A, Gandullia P, Oliva S, Di Nardo G, Dall'Oglio L, Rea F, de' Angelis GL, Bizzarri B, Guariso G, Masci E, Staiano A, Miele E, Romano C. Italian survey on non-steroidal anti-inflammatory drugs and gastrointestinal bleeding in children. World J Gastroenterol 2016; 22:1877-1883. [PMID: 26855547 PMCID: PMC4724619 DOI: 10.3748/wjg.v22.i5.1877] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/13/2015] [Accepted: 11/13/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate gastrointestinal complications associated with non-steroidal anti-inflammatory drug (NSAIDs) use in children.
METHODS: A retrospective, multicenter study was conducted between January 2005 and January 2013, with the participation of 8 Italian pediatric gastroenterology centers. We collected all the cases of patients who refer to emergency room for suspected gastrointestinal bleeding following NSAIDs consumption, and underwent endoscopic evaluation. Previous medical history, associated risk factors, symptoms and signs at presentation, diagnostic procedures, severity of bleeding and management of gastrointestinal bleeding were collected. In addition, data regarding type of drug used, indication, dose, duration of treatment and prescriber (physician or self-medication) were examined.
RESULTS: Fifty-one patients, including 34 males, were enrolled (median age: 7.8 years). Ibuprofen was the most used NSAID [35/51 patients (68.6%)]. Pain was the most frequent indication for NSAIDs use [29/51 patients (56.9%)]. Seven patients had positive family history of Helicobacter pylori (H. pylori) infection or peptic ulcer, and 12 had associated comorbidities. Twenty-four (47%) out of 51 patients used medication inappropriately. Hematemesis was the most frequent symptom (33.3%). Upper gastrointestinal endoscopy revealed gastric lesions in 32/51 (62%) patients, duodenal lesions in 17 (33%) and esophageal lesions in 8 (15%). In 10/51 (19.6%) patients, a diagnosis of H. pylori gastritis was made. Forty-eight (94%) patients underwent medical therapy, with spontaneous bleeding resolution, while in 3/51 (6%) patients, an endoscopic hemostasis was needed.
CONCLUSION: The data collected in this study confirms that adverse events with the involvement of the gastrointestinal tract secondary to NSAID use are also common in children
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AlSaeed EF, Tunio MA, AlSayari K, AlDandan S, Riaz K. Duodenal metastasis from lung adenocarcinoma: A rare cause of melena. Int J Surg Case Rep 2015; 13:91-4. [PMID: 26177377 PMCID: PMC4529650 DOI: 10.1016/j.ijscr.2015.06.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/20/2015] [Indexed: 12/20/2022] Open
Abstract
Duodenal metastasis. Melena and microcytic anemia. Lung carcinoma.
Introduction We report a rare case of duodenal metastasis from primary lung adenocarcinoma presented with history of melena and weight loss. Presentation of case A 52-year-old smoker man presented with six months history of epigastric pain, melena and weight loss. Esophago-gastroduodenoscopy revealed a 10 mm ulcerative lesion in the fourth part of duodenum. Histopathology of resected lesion showed poorly differentiated adenocarcinoma. Tumor cells showed immunopositivity for cytokeratin-7 (CK7), thyroid transcription factor 1 (TTF-1), and immunonegativity for CK20, Villin, CDX2 and thyroglobulin, supporting the diagnosis of metastatic adenocarcinoma of the lung origin. Computed tomography (CT) of chest revealed left hilar mass encasing the main pulmonary artery associated with ipsilateral hilar and contralateral mediastinal lymphadenopathy. Bronchoscopy assisted biopsy of lung mass confirmed the diagnosis of primary adenocarcinoma. Patient was staged as T4N3M1. After the resection of duodenal metastasis followed by three cycles of cisplatinum based chemotherapy with Bevacizumab, melena resolved completely. Discussion Duodenal metastases from lung adenocarcinoma are extremely uncommon, and rarely produce symptoms. Most of cases require duodenectomy or pancreatico-duodenectomy for symptomatic relief. For smaller duodenal metastatic lesions (≤1 cm) endoscopic resection is a feasible therapeutic option. Conclusion Although rare, duodenal metastasis from lung adenocarcinoma should also be included in the differential diagnosis of melena. Smaller lesions (≤1 cm) can safely be managed with endoscopic resection.
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Affiliation(s)
| | | | | | - Sadiq AlDandan
- King Fahad Medical City, Riyadh, Saudi Arabia; Comprehensive Cancer Center, King Fahad Medical City, Riyadh 59046, Saudi Arabia.
| | - Khalid Riaz
- King Fahad Medical City, Riyadh, Saudi Arabia; Comprehensive Cancer Center, King Fahad Medical City, Riyadh 59046, Saudi Arabia.
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Kim KS, Kang CH, Kim JY. Availability of blood urea nitrogen/creatinine ratio in gastrointestinal bleeding with melena in children. Pediatr Gastroenterol Hepatol Nutr 2015; 18:30-8. [PMID: 25866731 PMCID: PMC4391998 DOI: 10.5223/pghn.2015.18.1.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/23/2014] [Accepted: 01/13/2015] [Indexed: 12/02/2022] Open
Abstract
PURPOSE The aims of our study were to evaluate the blood urea nitrogen to creatinine ratio (BUN/Cr ratio) for distinguishing between an upper and lower gastrointestinal bleeding (GIB), and differentiating between the two most common causes of upper gastrointestinal bleeding (UGIB) presenting with melena in children. METHODS Retrospective data of patients with GIB presenting with melena were analyzed. The data from 60 cases were reviewed including demographics, laboratory findings, diagnostic modalities and results, treatments, and transfusions. RESULTS Among the 60 cases, UGIB and lower gastrointestinal bleeding (LGIB) were found in 35 cases (58.3%) and 14 cases (23.3%), respectively. The two common causes of UGIB were varices (37.1%), and peptic ulcer diseases (PUD) (31.4%). The BUN/Cr ratio of 30 or greater was higher in UGIB than LGIB (odds ratio [OR], 6.9; 95% confidence interval [95% CI], 1.3-37.2). In UGIB, the BUN/Cr ratio of the varices group was higher than that of the PUD group (p=0.015). The OR for the BUN/Cr ratio appeared as 1.2 per unit increase in the varices group than the PUD group (95% CI, 1.03-1.3). There was no difference between the PUD group and Meckel's diverticulum group. CONCLUSION The BUN/Cr ratio was not uneven in differentiating UGIB from LGIB of children with melena in our study. This suggests that BUN/Cr ratio should be interpreted carefully.
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Affiliation(s)
- Kyu Seon Kim
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea
| | - Chan Ho Kang
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae Young Kim
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea
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Jin T, Fei BY, Zheng WH, Wang YX. Successful treatment of refractory gastric antral vascular ectasia by distal gastrectomy: A case report. World J Gastroenterol 2014; 20:14073-14075. [PMID: 25320549 PMCID: PMC4194595 DOI: 10.3748/wjg.v20.i38.14073] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/06/2014] [Accepted: 07/25/2014] [Indexed: 02/06/2023] Open
Abstract
Gastric antral vascular ectasia (GAVE) is an uncommon and often neglected cause of gastric hemorrhage. The treatments for GAVE include surgery, endoscopy and medical therapies. Here, we report an unusual case of GAVE. A 72-year-old man with a three-month history of recurrent melena was diagnosed with GAVE. Endoscopy revealed the classical “watermelon stomach” appearance of GAVE and complete pyloric involvement. Melena reoccurred three days after argon plasma coagulation treatment, and the level of hemoglobin dropped to 47 g/L. The patient was then successfully treated with distal gastrectomy with Billroth II anastomosis. We propose that surgery should be considered as an effective option for GAVE patients with extensive and severe lesions upon deterioration of general conditions and hemodynamic instability.
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Ogasawara N, Mizuno M, Masui R, Kondo Y, Yamaguchi Y, Yanamoto K, Noda H, Okaniwa N, Sasaki M, Kasugai K. Predictive factors for intractability to endoscopic hemostasis in the treatment of bleeding gastroduodenal peptic ulcers in Japanese patients. Clin Endosc 2014; 47:162-73. [PMID: 24765599 PMCID: PMC3994259 DOI: 10.5946/ce.2014.47.2.162] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 07/31/2013] [Accepted: 08/15/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND/AIMS Despite improvements in endoscopic hemostasis and pharmacological therapies, upper gastrointestinal (UGI) ulcers repeatedly bleed in 10% to 20% of patients, and those without early endoscopic reintervention or definitive surgery might be at a high risk for mortality. This study aimed to identify the risk factors for intractability to initial endoscopic hemostasis. METHODS We analyzed intractability among 428 patients who underwent emergency endoscopy for bleeding UGI ulcers within 24 hours of arrival at the hospital. RESULTS Durable hemostasis was achieved in 354 patients by using initial endoscopic procedures. Sixty-nine patients with Forrest types Ia, Ib, IIa, and IIb at the second-look endoscopy were considered intractable to the initial endoscopic hemostasis. Multivariate analysis indicated that age ≥70 years (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.07 to 4.03), shock on admission (OR, 5.26; 95% CI, 2.43 to 11.6), hemoglobin <8.0 mg/dL (OR, 2.80; 95% CI, 1.39 to 5.91), serum albumin <3.3 g/dL (OR, 2.23; 95% CI, 1.07 to 4.89), exposed vessels with a diameter of ≥2 mm on the bottom of ulcers (OR, 4.38; 95% CI, 1.25 to 7.01), and Forrest type Ia and Ib (OR, 2.21; 95% CI, 1.33 to 3.00) predicted intractable endoscopic hemostasis. CONCLUSIONS Various factors contribute to intractable endoscopic hemostasis. Careful observation after endoscopic hemostasis is important for patients at a high risk for incomplete hemostasis.
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Affiliation(s)
- Naotaka Ogasawara
- Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan
| | - Mari Mizuno
- Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan
| | - Ryuta Masui
- Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan
| | - Yoshihiro Kondo
- Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan
| | - Yoshiharu Yamaguchi
- Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan
| | - Kenichiro Yanamoto
- Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan
| | - Hisatsugu Noda
- Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan
| | - Noriko Okaniwa
- Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan
| | - Makoto Sasaki
- Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan
| | - Kunio Kasugai
- Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan
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El Koraichi A, Ayoubi A, Benjelloun MY, Bentalha A, El Kettani SE. Melena revealing a nasopharyngeal leech: a paediatric case. Arab J Gastroenterol 2014; 15:36-7. [PMID: 24630513 DOI: 10.1016/j.ajg.2014.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 08/01/2013] [Indexed: 11/30/2022]
Abstract
Leech infestation occurs after swimming or ingestion of freshwater, especially in rural areas. Symptoms are different depending on the binding site of the leech. At the nasopharynx, it is mainly responsible for epistaxis. We report a case of an unknown pharyngeal location of a leech in a three year-old girl responsible for melena and leading to a severe anaemia.
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Affiliation(s)
- Alae El Koraichi
- Pediatric ICU, Children Hospital of Rabat, Morocco; Mohamed V University, School of Medicine of Rabat, Morocco.
| | - Ali Ayoubi
- Mohamed V University, School of Medicine of Rabat, Morocco
| | | | - A Bentalha
- Mohamed V University, School of Medicine of Rabat, Morocco
| | - Salma E El Kettani
- Pediatric ICU, Children Hospital of Rabat, Morocco; Mohamed V University, School of Medicine of Rabat, Morocco
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