A rare cause of acute massive lower gastrointestinal bleeding.

Even if lower gastrointestinal bleeding (LGIB) can present as trivial haematochezia, massive hemorrhage with shock may occur. Acute massive LGIB is defined as bleeding of recent duration that originates beyond the ligament of Treitz and encompasses: passage of a large volume of red or maroon blood through the rectum, haemodynamic instability and shock, initial decrease in haematocrit level of 6 g/dL or less, transfusion of at least 2 U of packed red blood cells, bleeding that continues for 3 days or significant rebleeding in 1 week. This report presents the case of a 58-year-old man with massive LGI bleeding. Colonoscopy was performed in emergency with a poor colonic preparation, but the examiner fortunately and with difficulty managed to identify the source of the haemorrhage- a Dieulafoy's lesion of the right colon. The bleeding was successfully stopped permanently by injecting sclerosing agents into the spurting vessel. We have preferred colonoscopy as our first choice of investigation due to the facile availability and the opportunity of endoscopic haemostasis in case of finding the source of bleeding. Angiography was planned in case of failure of the first method. The definition, clinical presentation, and treatment of Dieulafoy's lesion are further discussed.

[The role of multimodal analgesia in the decrease of postoperative surgical stress response in major neoplastic thoraco-abdominal surgery]. / Rolul analgeziei multimodale in diminuarea raspunsului postoperator la stressul chirurgical in chirurgia toraco-abdominala neoplazica majora.

A major issue of the surgical anesthetic team is the surgical stress response, with its organ disfunctions, and the postoperative pain with consequences regarding the physiopathologic and socio-economical impact associated with its inadequate therapy. According to the "fast-track" approach, multimodal analgesia has a central place, together with minimal invasive procedures. Opioid-local anesthetic association via thoracic epidural catheter, has become the "anesthetic golden standard", in major thoraco-abdominal surgery. Co-administration of i.v. non-steroid anti-inflammatory drugs, seriously decreases the inflammatory response to the surgical stress, allowing a faster recovery, an early social rehabilitation, and a decrease in morbidity and mortality associated with major neoplasic surgery.