The role of labelled red blood cell scintigraphy in the detention of acute gastrointestinal bleeding

This paper describes the experience with 99m Technetium labelled red blood cell (99mTc RBC) scintigraphy in twenty-two patients presenting with acute gastrointestinal (GI) tract bleeding. Studies were postitive in thirteen cases - eight from the lower GI tract and five from the upper. The data from surgical intervention were available in ten cases. Scintigraphy cannot diagnose the cause of GI bleeding, as it is a nonspecific study. Its usefulness lies in its ability to accurately diagnose the bleeding site, as was shown in this study where there was good surgical correlation. The simplicity, reproducibility and reliability of the technique, particularly when bleeding rates are low and intermittent, make it, in our view, the first line of investigation in any patient with suspected bleeding from the colon or upper GI tract if endoscopic evaluation is not possible in the latter. Its current under-utilisation in the Caribbean may be a reflection of the lack of nuclear imaging facilities.(Au)

Primary aortoenteric fistula

One hundred and thirty-eight patients with abdominal aortic aneurysms were treated by aneurysmorrhaphy over an eleven-year period. Six patients, all male and aged 60 - 74 years, were found to have developed primary aorteonteric fistulae. Four patients presented with bleeding into the gastrointestinal tract in association with a tender abdominal swelling. In the other two cases, the aneurysm was discovered at emergency laparatomy for gastrointestinal haemorrhage. The presence of the fistula was confirmed at operation in five patients and at autopsy in one. Two patients died, one from a massive gastrointestinal haemorrhage to surgery, the other from sepsis complicated by adult respiratory distress syndrome and renal failure following operation (AU)

Necrotizing haemorrhagic colitis caused by resistant shigella flexneri. Report of a case

A case of fatal infection with shigella flexneri is reported. The 19-year-old male patient who presented with fulminating haemorrhagic colitis died nine days after the onset of symptoms. The infecting strain of shigella flexneri was resistant to multiple antimicrobial agents, including amoxycillin, co-trimoxazole and chloramphenicol (AU)

Cavernous haemangioma of the duodenum: a rare case of gastrointestinal bleeding

Vascular malformations (VMs), including haemangioma, of the upper gastrointestinal tract, are rare causes of bleeding. Bleeding from these lesions is often recurrent and diagnosis is often delayed for months to years. A patient with severe, recurrent upper gastrointestinal bleeding requiring repeated hospitalization and blood transfusions is presented. Upper endoscopy, barium meal and small bowel enteroclysis were negative. Selective mesenteric angiography revealed a VM in the second part of the duodenum. Segmental resection of the duodenum was performed and microscopial examination showed cavernous haemangioma. VM should be considered in patients with recurrent gastrointestinal bleeding and negative conventional investigations. Mesenteric angiography may be the only investigation which will identify these leisons. Results after excision are excellent. (AU)

Aorta-oesophageal fistula: a rare cause of gastrointestinal haemorrhage

Primary aorto-oesophageal fistula is a rare cause of massive and usually fatal gastrointestinal haemorrhage. We herein present a case of a 62-year-old chronic alcohol abuser who had a small haematemesis after a week of persistent vomiting. He succumbed to an exsanguinating bleed 36 hours after admission. An aorto-oesophageal fistula was found at autopsy. We emphasize the need for a high index of suspicion and recognition of premonitory signs for accurate diagnosis and management of this condition. (AU)

Endoscopic sclerotherapy of bleeding oesophageal varices in Jamaica

The results of oesophageal sclerotherapy (OS) in 18 patients with recurrent bleeding varices are compared with 15 patients treated medically. The total transfusion requirement pre-sclerotherapy was 112 units of blood (mean 6/patient) which decreased to 46 units (mean 2.5) after sclerotherapy treatment was started (p=0.005). In the medically treated group, total transfusion was 74 units (mean 5 units/patient). One hundred and forty-three injection sclerotherapy sesions were given, and all but one patient had significant reduction or eradication of varices. Three patients died of recurrent bleeding (17 percent) and one other required surgery. In the medically treated group, 3 patients died of bleeding (20 percent). Complications of sclerotherapy included mild bleeding (39 percent), chest pain (28 percent) and oesophageal ulcer (5.5 percent). OS reduces transfusion requirements in patients with recurrent variceal bleeding. (AU)

Upper gastrointestinal endoscopy for gastrointestinal haemorrhage in Jamaica - abstract

Upper gastrointestinal endoscopy has been carried out at the University Hospital of the West Indies, Jamaica routinely in the management of patients with acute upper gastrointestinal bleeding. Between 1975 and 1979, 206 of 648 upper gastrointestinal endoscopies were performed for presumed gastrointestinal haemorrhage. Two hundred and thirty one bleeding lesions were identified, the commonest being pyloroduodenal ulcer in 72, 28 had peptic duodenitis. Gastritis, (54), was commoner that gastric ulcer, (33), whilst gastric neoplasm was seen in 12. Twelve patients had bleeding varices, 9 oesophagitis and 5 Mallory Weiss tears. Diffuse duodenitis secondary to strongyloidiasis was seen in 3 patients. There were 3 miscellaneous lesions. In these 206 patients 68 non-bleeding lesions were identified including 17 gastric or oesophageal varices and 20 gastric or duodenal ulcers. Eighteen patients (8.7 percent) showed bleeding from 2 or 3 different lesions, 9 of the patients referred were bleeding from lesions outside the gastroduodenal tract. Three patients had no lesion seen at endoscopy, they refused further investigations. Although no mortality nor serious morbitity followed endoscopy in any patient, disadvantages relate to the delicacy, sophistication and expense of maintenance of the instruments, and also the specialised medical and paramedical personnel required. Endoscopy enabled the differentation of bleeding lesions from coincidental non-bleeding lesions (33.0 percent). Appreciation of multiple bleeding lesions, size and aetiology of the lesions, presence of arterial and/or continued bleeding was facilitated. Mild bleeding lesions where bleeding had stopped enabled early discharge from hospital. By providing accurate diagnosis, endoscopy will give surgeons and physicians the opportunity to employ rational modalities and thus the chance to decrease mortality (AU)

An approach to the management of upper gastronintestinal haemorrhage - abstract

Examination of the records for 161 patients, who together had 195 admissions to the University Hospital of the West Indies during 1966-1970, revealed considerable variation both in terms of diagnostic procedures and treatment. Variceal haemorrhage accounted for 43 admissions, whereas gastric or duodenal ulcers were thought responsible for 127. Aspirin gastritis was the persumptive diagnosis in 6 cases, alcoholic gastritis in 4, and no diagnosis was made in 14. Aspirin consumption within 48 hours of the haemorrhage, was noted in 35 of 116 cases of non-variceal haemorrhage. Where peptic ulceration or gastritis was the presumptive diagnosis, there was no in-patient mortality as opposed to variceal haemorrhage where 17 of 33 patients died. A review of measusres currently available for the management of upper gastrointestinal haemorrhage is given, and in the light of factors present in the Eastern Caribbean, an approach to the management of upper gastrointestinal haemorrahage is presented. Emphasis is placed on a vigorous diagnostic approach as a prerequisite for rational treatment , and the importance of endoscopy plus joint management by physicians and surgeons is stressed (AU)

Veno-occlusive disease of the liver: surgical aspects

Veno-occlusive disease of the liver is a recently established disease entity. Its etiology, pathology, and symptomatology, and natural history are discussed on the basis of 99 cases of this disease so far authenticated at the University College of the West Indies. In the surgical literature the disease is added to the list of causes of intra-hepatic portal hypertension, and the cases of 4 patients are presented in detail in whom portacaval anastomoses were performed for the decompression of esophageal varices. The surgical implications of this disease have been stated and some of the difficulties enountered in the treatment of portal hypertension in infants and children outlined (Summary)

Massive gastro-duodenal haemorrhage

The etiology and management of massive gastro-duodenal haemorrage is discussed, on the basis of findings in 225 cases. (AU)