Acute lower gastrointestinal bleeding in Sudanese patients: a study on 301 patients in a specialized centre.

BACKGROUND AND STUDY AIMS: Lower gastrointestinal bleeding originates from a site distal to the ligament of Treitz. It can present as an acute life-threatening or chronicbleeding. It is common among older patients and those with comorbidity. The common causes are diverticular disease, angiodysplasias, neoplasms, colitis, ischaemia and anorectal disorders. The aim of this study is to determine the prevalence and causes of acute lower gastrointestinal bleeding among Sudanese patients. PATIENTS AND METHODS: In a period of 2 years we studied 301 patients with fresh rectal bleeding out of 5625 patients with gastrointestinal bleeding in Ibn Sina Specialized Hospital, Khartoum, Sudan, This is a cross sectional observational hospital based study. All patients with fresh rectal bleeding within 24 h were included and consented. RESULT: Lower gastrointestinal bleeding constituted 5.37% of total cases of gastrointestinal bleeding. The mean age of patients was 55.43 ±â€¯17.779, male: female ratio was 2:1. The most common cause (if upper gastrointestinal bleeding is excluded) was diverticular disease 39.6% (n = 61) followed by piles 24.1% (n = 35), colonic tumours 12.34% (n = 19), ulcerative colitis 5.19% (n = 8), Crohn's 5.19% (n = 8), colonic polyps 3,89% (n = 6), angiodysplesia 4.5% (n = 7), colonic ulcer 2.59% (n = 4), ischaemic colitis 1.3%, nonspecific colitis 1.3% (n = 2), and small bowel source in 1.3% (n = 2). The majority of those patients with diverticular disease were male and with first presentation. The commonest cause in those patients younger than 20 years was polyps, and in those between 21 and 40 was piles followed by inflammatory bowel disease, and in those between 41 and 60 years old was piles followed by diverticular disease and tumours, and in those above 60 years was diverticular disease followed by piles and tumours. The correlation between positive colonoscopy finding and diabetes and the use of nonsteroidal anti-inflammatory drugs were statistically significant. The one-month mortality rate was 2.3% CONCLUSION: Acute lower gastrointestinal bleeding is common among elderly patients and the commonest cause is diverticular disease. Colonoscopy plays an important role in the diagnosis. Most patients respond to conservative therapy.

Primary gastric tuberculosis presenting as gastric outlet obstruction: a case report and review of the literature.

INTRODUCTION: Tuberculosis is a major health problem worldwide. Sudan has high burden of tuberculosis (TB) with a prevalence of 209 cases per 100,000 of the population and it is commonly presented with pulmonary disease but involvement of the gastrointestinal tract is not uncommon. Abdominal tuberculosis comprises about 1-3 % of all cases of tuberculosis and about 12% of extrapulmonary tuberculosis. It involves the ileocecal region, but involvement of stomach and duodenum are rare sites. Here we present an unusual case of gastric outlet obstruction due to gastric tuberculosis. CASE PRESENTATION: A 54-year-old Sudanese man presented with a non-bile stain persistent projectile vomiting, and epigastric pain for two years associated with marked loss of weight. There is no fever or cough. He was on antacid, physical examination showed BMI 18 and stable vital signs. He was not pale or jaundiced, there was no cervical lymphadenopathy and chest was clear. Abdominal examination was normal apart of positive succussion splash. The results of haematological tests were normal, ESR was 30 mm/hr, hepatitis B, C and HIV were negative. Upper gastrointestinal endoscopy showed that the stomach was full of fluid and food particles and ulcerated mass in the pylorus extended to the proximal part of the duodenum with severe narrowing of the pylorus. The lesion biopsied and the result revealed active inflammatory cells, cryptitis and multiple lymphoid follicles, no malignancy seen. Sonographic test showed hypodense pyloric mass, enlarged para-aortic and mesenteric lymph nodes and mild pelvic ascites. A computed tomography scan of the abdomen and pelvis showed antral hypodense lesions multiple mesenteric lymphadenopathies peritoneal thickening and ascites. Chest X-ray was normal. Intra-operative findings were dilated stomach and pylorus mass with multiple mesenteric lymph nodes, peritoneal and omental seedlings all over with small nodules on the surface of the liver, gastro-jejunostomy was done. Histopathology confirmed the diagnosis of abdominal tuberculosis. Postoperative event was uneventful. Patient received anti-tuberculous. CONCLUSIONS: Here we presented an unusual case of gastric outlet obstruction due to primary gastric tuberculosis, patient underwent surgery to relief his symptoms and received anti-tuberculous.

Primary extragastrointestinal stromal tumour of the whole abdominal cavity, omentum, peritoneum and mesentery: a case report and review of the literature.

INTRODUCTION: The gastrointestinal stromal tumour is one of the common mesenchymal tumours of the gastrointestinal tract. It originates from the interstitial cells of Cajal. Gastrointestinal stromal tumours that present outside the gastrointestinal tract are called extragastrointestinal stromal tumours; they share the same morphological and immunohistochemical characteristics. Here we describe an unusual case of extragastrointestinal stromal tumour that presented with gooseberry-like multiple nodules involving the whole abdominal cavity. CASE PRESENTATION: A 65-year-old Sudanese man presented with vague abdominal pain and progressive abdominal distension for 6 months. The pain was associated with mild loss of weight despite good appetite. A physical examination revealed distended abdomen with multiple firm nodules involving his whole abdomen. The results of haematological tests were within normal range. Ultrasound of his abdomen showed multiple nodules of varying sizes in the peritoneal cavity. A computed tomography scan of his abdomen showed numerous nodules of different sizes (1 to 3 cm in diameter) filling the whole peritoneal cavity with intense peripheral enhancement. Ultrasound-guided biopsy was not informative. Upper and lower gastrointestinal endoscopies were normal. Exploration of his abdomen revealed multiple firm gooseberry-like nodules of different sizes involving the greater omentum, peritoneal cavity and the mesentery. The liver, spleen and pancreas were normal. The result of the histopathology was conclusive for gastrointestinal stromal tumour. CONCLUSIONS: Here we present a rare case of extragastrointestinal stromal tumour in a patient who presented with vague abdominal pain and progressive abdominal distension. A laparotomy showed gooseberry-like multiple nodules of different sizes involving his whole abdominal cavity. He underwent debulking surgery and received imatinib.