RESUMO
INTRODUCTION: Upper gastrointestinal bleeding (UGIB) is a condition commonly seen in the emergency department (ED). Therefore, it is important for emergency clinicians to be aware of the current evidence regarding the diagnosis and management of this disease. OBJECTIVE: This paper evaluates key evidence-based updates concerning UGIB for the emergency clinician. DISCUSSION: UGIB most frequently presents with hematemesis. There are numerous causes, with the most common peptic ulcer disease, though variceal bleeding in particular can be severe. Nasogastric tube lavage for diagnosis is not recommended based on the current evidence. A hemoglobin transfusion threshold of 7 g/dL is recommended (8 g/dL in those with myocardial ischemia), but patients with severe bleeding and hemodynamic instability require emergent transfusion regardless of their level. Medications that may be used in UGIB include proton pump inhibitors, prokinetic agents, and vasoactive medications. Antibiotics are recommended for those with cirrhosis and suspected variceal bleeding. Endoscopy is the diagnostic and therapeutic modality of choice and should be performed within 24 h of presentation in non-variceal bleeding after resuscitation, though patients with variceal bleeding may require endoscopy within 12 h. Transcatheter arterial embolization or surgical intervention may be necessary. Intubation should be avoided if possible. If intubation is necessary, several considerations are required, including resuscitation prior to induction, utilizing preoxygenation and appropriate suction, and administering a prokinetic agent. There are a variety of tools available for risk stratification, including the Glasgow Blatchford Score. CONCLUSIONS: An understanding of literature updates can improve the ED care of patients with UGIB.
Assuntos
Hemorragia Gastrointestinal , Humanos , Hemorragia Gastrointestinal/terapia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Serviço Hospitalar de Emergência , Inibidores da Bomba de Prótons/uso terapêutico , Varizes Esofágicas e Gástricas/terapia , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/complicações , Hematemese/etiologia , Hematemese/terapia , Medicina de Emergência , Endoscopia GastrointestinalRESUMO
OBJECTIVES: Infantile acute upper gastrointestinal bleeding involves a decision for therapeutic intervention that most pediatricians first coming into contact with the patient are, not unreasonably, unable to objectively provide. Therefore, some objective tools of individual risk assessment would seem to be crucial. The principal aim of the present study was to investigate the anamnestic and clinical parameters of infants with hematemesis, together with laboratory and instrumental findings, to create a scoring system that may help identify those infants requiring an appropriate and timely application of upper gastrointestinal (GI) endoscopy. METHODS: Clinical data of infants admitted for hematemesis to the participating centers over the study period were systematically collected. According to the outcome dealing with rebleeding, need for blood transfusion, mortality, finding of GI bleeding lesions, or need for surgical intervention, patients were blindly divided into a group with major clinical severity and a group with minor clinical severity. Univariate and multivariate logistic regressions were conducted to investigate significant prognostic factors for clinical severity. RESULTS: According to our findings, we drafted a practical diagnostic algorithm and a clinical score able to predict the need for timely upper GI endoscopy (BLOVO infant score). Our clinical scoring system was created by incorporating anamnestic factors, clinical parameters, and laboratory findings that emerged as predictors of a worst outcome. CONCLUSIONS: We provided the first objective tool of individual risk assessment for infants with hematemesis, which could be very useful for pediatricians first coming into contact with the patient in the emergency department.
Assuntos
Endoscopia Gastrointestinal , Hematemese , Transfusão de Sangue , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Hematemese/diagnóstico , Hematemese/etiologia , Hematemese/terapia , Humanos , Lactente , Medição de RiscoAssuntos
Embolia/diagnóstico por imagem , Varizes Esofágicas e Gástricas/terapia , Hematemese/terapia , Fígado/diagnóstico por imagem , Adesivos Teciduais , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/diagnóstico , Feminino , Hematemese/etiologia , Humanos , Fígado/irrigação sanguínea , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Pessoa de Meia-Idade , Estômago/irrigação sanguínea , Estômago/diagnóstico por imagem , Adesivos Teciduais/administração & dosagem , Adesivos Teciduais/efeitos adversosRESUMO
BACKGROUND: Hemobilia due to rupture of hepatic artery pseudoaneurysm and recurrent hemorrhage caused by hepatic artery collateral circulation are both rare complications after liver trauma. There have been a number of separate reports of both complications, but no cases have been reported in which the two events occurred in the same patient. Here we report a recurrent hemorrhage in the bile duct due to hepatic artery pseudoaneurysm secondary to collateral circulation formation after hepatic artery ligation in a patient with liver trauma. CASE PRESENTATION: A 52-year-old male patient was admitted to our hospital for liver trauma (Grade IV according to the American Association for the Surgery of Trauma (AAST) grading system) with active bleeding after a traffic accident. Hepatic artery ligation was performed for hemostasis. Three months after the surgery, the patient was readmitted for melena and subsequent hematemesis. Selective angiography examination revealed the formation of collateral circulation between the superior mesenteric artery and right hepatic artery. Moreover, a ruptured hepatic artery pseudoaneurysm was observed and transcatheter arterial embolization (TAE) was performed for hemostasis at the same time. After the treatment, the patient recovered very well and had an uneventful prognosis until the last follow-up. CONCLUSION: For patients with hepatic trauma, the selection of the site of hepatic artery ligation and the diagnosis and treatment methods of postoperative biliary hemorrhage are crucial for the prognosis of the disease.
Assuntos
Falso Aneurisma , Aneurisma Roto , Hemobilia , Artéria Hepática , Ligadura/efeitos adversos , Fígado , Traumatismos Abdominais/complicações , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Aneurisma Roto/etiologia , Aneurisma Roto/terapia , Angiografia/métodos , Ductos Biliares/diagnóstico por imagem , Ductos Biliares/lesões , Circulação Colateral , Embolização Terapêutica , Hematemese/etiologia , Hematemese/terapia , Hemobilia/etiologia , Hemobilia/terapia , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/lesões , Artéria Hepática/cirurgia , Humanos , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Fígado/lesões , Masculino , Melena/etiologia , Melena/terapia , Pessoa de Meia-Idade , Recidiva , Circulação EsplâncnicaRESUMO
INTRODUCTION: Upper gastrointestinal bleeding (UGIB) is a feared complication of acute coronary syndrome (ACS) and has been shown to increase morbidity and mortality. Our aim was to assess the incidence of non-variceal UGIB in patients with ACS in a national cohort and its impact on in-hospital mortality, length of stay (LOS), and cost of hospitalization. METHODS: This was a retrospective cohort study analyzing the 2016 Nationwide Inpatient Sample (NIS) utilizing ICD 10 CM codes. Principal discharge diagnoses of ACS (STEMI, NSTEMI, and UA) in patients over 18 years old were included. Non-variceal UGIB with interventions including endoscopy, angiography, and embolization were also evaluated. Primary outcome was the national incidence of concomitant non-variceal UGIB in the setting of ACS. Secondary outcomes included in-hospital mortality, length of stay, and cost of stay. RESULTS: A total of 661,404 discharges with principal discharge diagnosis of ACS in 2016 were analyzed. Of the included cohort, 0.80% (n = 5324) were complicated with non-variceal UGIB with increased frequency in older patients (OR 1.03, 95% CI 1.03-1.04; p = 0.0001). Despite endoscopic evaluation, 17.35% (n = 744) underwent angiography. After adjustment of confounders, inpatient mortality was significantly higher in patients with UGIB (OR 2.07, 95% CI 1.63-2.63, p = 0.0001). Non-variceal UGIB also led to significantly longer LOS (10.38 days vs 4.37 days, p = 0.0001) and cost of stay ($177,324 vs $88,468, p = 0.0001). DISCUSSION: Our study shows that the national incidence of non-variceal UGIB complicating ACS is low at less than 1%, but resulted in significantly higher inpatient mortality, LOS, and hospitalization charges.
Assuntos
Síndrome Coronariana Aguda , Hematemese , Infarto do Miocárdio sem Supradesnível do Segmento ST , Trato Gastrointestinal Superior , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/terapia , Idoso , Embolização Terapêutica/estatística & dados numéricos , Endoscopia do Sistema Digestório/estatística & dados numéricos , Feminino , Hematemese/epidemiologia , Hematemese/etiologia , Hematemese/terapia , Mortalidade Hospitalar , Hospitalização/economia , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Masculino , Infarto do Miocárdio sem Supradesnível do Segmento ST/complicações , Infarto do Miocárdio sem Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Estudos Retrospectivos , Medição de Risco/métodos , Estados Unidos/epidemiologia , Trato Gastrointestinal Superior/irrigação sanguínea , Trato Gastrointestinal Superior/diagnóstico por imagemRESUMO
Although sequelae of chronic liver disease are the most common causes of altered pressure dynamics in the portal and splanchnic circulations, there are other mechanisms resulting in increased venous pressures with subsequent development of splenic and gastric varices. We report a case of a patient without portal hypertension, but with bleeding gastric varices with a presumed splenorenal shunt (SRS) on CT. Venography revealed flow reversal through the shunt (directed from the renal vein, into the splenic vein and out the portal vein; a renal-splent shunt (RSR)) and thus an anatomically similar but functionally distinct systemic to mesenteric variant. While being anatomically similar to the well-known SRS, the different flow dynamics necessitate a different approach for treatment and important considerations for the use of any liquid embolic.
Assuntos
Embolização Terapêutica/métodos , Varizes Esofágicas e Gástricas/complicações , Hematemese/terapia , Veia Porta/cirurgia , Veias Renais/cirurgia , Veia Esplênica/cirurgia , Derivação Esplenorrenal Cirúrgica/efeitos adversos , Adulto , Varizes Esofágicas e Gástricas/terapia , Feminino , Hematemese/diagnóstico , Hematemese/etiologia , Humanos , Flebografia , Tomografia Computadorizada por Raios XRESUMO
Endotipsitis is a vegetative endovascular infection of a transjugular intrahepatic portosystemic shunt (TIPS). There is currently no uniformly accepted diagnostic criterion, and most cases are diagnosed by clinical diagnosis of recurrent bacteraemia in patients with TIPS and no identifiable source after appropriate investigation. We present a case of 62-year-old man in whom endotipsitis was suspected clinically after emergent TIPS placement complicated by TIPS thrombosis, need for TIPS revision and recurrent bacteraemia. The diagnosis was confirmed using an Indium-111-labelled leucocyte scan (tagged white blood cell scan). This case highlights the potential risks of endotipsitis with TIPS procedures and provides insight into the utilisation of an old diagnostic tool in a new diagnostic role.
Assuntos
Antibacterianos/uso terapêutico , Varizes Esofágicas e Gástricas/terapia , Hematemese/terapia , Infecções por Klebsiella/tratamento farmacológico , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Bacteriemia/microbiologia , Colangite Esclerosante/complicações , Varizes Esofágicas e Gástricas/etiologia , Fígado Gorduroso/complicações , Hematemese/etiologia , Humanos , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-IdadeAssuntos
Aneurisma da Aorta Abdominal/diagnóstico , Fístula Esofágica/diagnóstico , Hematemese/etiologia , Aneurisma da Aorta Abdominal/complicações , Aortografia , Angiografia por Tomografia Computadorizada , Endoscopia do Sistema Digestório , Fístula Esofágica/etiologia , Esôfago/diagnóstico por imagem , Hidratação , Hematemese/terapia , Humanos , Masculino , Adulto JovemRESUMO
OBJECTIVES: To retrospectively evaluate the safety and efficacy of transcatheter arterial embolization (TAE) for delayed arterial bleeding secondary to percutaneous self-expandable metallic stent (SEMS) placement in patients with malignant biliary obstruction (MBO). METHODS: From January 1997 to September 2017, 1858 patients underwent percutaneous SEMS placement for MBO at a single tertiary referral center. Among them, 19 patients (mean age, 70.2 [range, 52-82] years; 13 men) presented with delayed SEMS-associated arterial bleeding and underwent TAE. RESULTS: The incidence of delayed arterial bleeding was 1.0% (19/1858) after SEMS placement, with a median time interval of 225 days (range, 22-2296). Digital subtraction angiography (DSA) showed pseudoaneurysm alone close to the stent mesh (n = 10), pseudoaneurysm close to the stent mesh with contrast extravasation to the duodenum (n = 3), pseudoaneurysm close to the stent mesh with arteriobiliary fistula (n = 1), in-stent pseudoaneurysm alone (n = 4) and in-stent pseudoaneurysm with arteriobiliary fistula (n = 1). Bleeding was stopped after the embolization in all patients. Overall clinical success rate was 94.7% (18/19). One patient with recurrent bleeding was successfully treated with a second embolization. Overall 30-day mortality rate was 26.3% (5/19). A major procedure-related complication was acute hepatic failure in one hilar bile duct cancer patient (5.3%), which was associated with an obliterated portal vein. CONCLUSION: TAE is safe and effective for the treatment of delayed arterial bleeding after percutaneous SEMS placement for MBO. ADVANCES IN KNOWLEDGE: This study demonstrated TAE is safe and effective for arterial bleeding after SEMS placement after MBO through the largest case series so far.
Assuntos
Falso Aneurisma/terapia , Colestase/cirurgia , Embolização Terapêutica/métodos , Hemorragia Pós-Operatória/terapia , Stents Metálicos Autoexpansíveis/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Angiografia Digital , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/terapia , Colestase/etiologia , Embolização Terapêutica/efeitos adversos , Feminino , Hemorragia Gastrointestinal , Hematemese/diagnóstico por imagem , Hematemese/terapia , Hemobilia/diagnóstico por imagem , Hemobilia/terapia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Implantação de Prótese/efeitos adversos , Estudos Retrospectivos , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/terapiaRESUMO
Despite many years of published medical society guidelines for red blood cell (RBC) transfusion therapy, along with clinical trials that provide Level 1 evidence that restrictive transfusion practices can be used safely and are equivalent to transfusions given more liberally, annualized blood transfusion activity did not begin to decline in the United States until 2010. Adoption of electronic medical records has subsequently allowed implementation of clinical decision support (CDS): best practice alerts that can be initiated to improve the use of blood components. We describe our own institutional experience using a targeted CDS to promote restrictive blood transfusion practice and to improve RBC use. A 42% reduction in RBC transfusions was demonstrated at our institution from a baseline in 2008 through 2015, and the rate remained stable through 2018. Although the data cannot be used to infer causality, this decreased RBC use was accompanied by improved clinical outcomes.
Assuntos
Sistemas de Apoio a Decisões Clínicas , Registros Eletrônicos de Saúde , Transfusão de Eritrócitos , Hematemese/terapia , Feminino , Humanos , Pessoa de Meia-IdadeAssuntos
Doença de Crohn/patologia , Esofagite/patologia , Hemorragia Gastrointestinal/etiologia , Adalimumab/uso terapêutico , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Budesonida/uso terapêutico , Colonoscopia , Colostomia , Constrição Patológica , Doença de Crohn/complicações , Doença de Crohn/diagnóstico por imagem , Doença de Crohn/terapia , Gerenciamento Clínico , Embolização Terapêutica , Endoscopia do Sistema Digestório , Doenças do Esôfago/etiologia , Esofagite/complicações , Esofagite/diagnóstico por imagem , Esofagite/tratamento farmacológico , Feminino , Artéria Gástrica , Hemorragia Gastrointestinal/terapia , Hematemese/etiologia , Hematemese/terapia , Humanos , Infliximab/uso terapêutico , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Omeprazol/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Fístula Retovaginal/etiologia , Fístula Retovaginal/terapia , Recidiva , Doenças do Colo Sigmoide/terapia , Inibidores do Fator de Necrose Tumoral/uso terapêuticoRESUMO
OBJECTIVES: Patients with acute upper gastrointestinal bleeding (AUGIB) often manifest as hematemesis and melena. Theoretically, hematemesis will carry worse outcomes of AUGIB. However, there is little real-world evidence. We aimed to compare the outcomes of hematemesis versus no hematemesis as a clinical manifestation of AUGIB at admission in cirrhotic patients. METHODS: All cirrhotic patients with AUGIB who were consecutively admitted to our hospital from January 2010 to June 2014 were considered in this retrospective study. Patients were divided into hematemesis with or without melena and melena alone without hematemesis at admission. A 1:1 propensity score matching analysis was performed. Subgroup analyses were performed based on systemic hemodynamics (stable and unstable) and Child-Pugh class (A and B+C). Sensitivity analyses were conducted in patients with moderate and severe esophageal varices confirmed on endoscopy. Primary outcomes included five-day rebleeding and in-hospital death. RESULTS: Overall, 793 patients were included. Patients with hematemesis at admission had significantly higher five-day rebleeding rate (17.4 versus 10.1%, P = 0.004) and in-hospital mortality (7.9 versus 2.4%, P = 0.001) than those without hematemesis. In the propensity score matching analyses, 358 patients were included with similar Child-Pugh score (P = 0.227) and MELD score (P = 0.881) between the two groups; five-day rebleeding rate (19.0 versus 10.6%, P = 0.026) and in-hospital mortality (8.4 versus 2.8%, P = 0.021) remained significantly higher in patients with hematemesis. In the subgroup and sensitivity analyses, the statistical results were also similar. CONCLUSIONS: Hematemesis at admission indicates worse outcomes of cirrhotic patients with AUGIB, which is useful for the risk stratification of AUGIB.
Assuntos
Varizes Esofágicas e Gástricas/fisiopatologia , Hematemese/fisiopatologia , Cirrose Hepática/fisiopatologia , Melena/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue , Causas de Morte , Criança , Doença Hepática Terminal/mortalidade , Endoscopia Gastrointestinal , Varizes Esofágicas e Gástricas/etiologia , Feminino , Fármacos Gastrointestinais/uso terapêutico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/fisiopatologia , Hemorragia Gastrointestinal/terapia , Hematemese/etiologia , Hematemese/terapia , Encefalopatia Hepática/mortalidade , Hormônios/uso terapêutico , Mortalidade Hospitalar , Humanos , Cirrose Hepática/complicações , Falência Hepática/mortalidade , Masculino , Melena/etiologia , Melena/terapia , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/mortalidade , Octreotida/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Recidiva , Índice de Gravidade de Doença , Somatostatina/uso terapêutico , Adulto JovemAssuntos
Digoxina/farmacologia , Overdose de Drogas/etiologia , Hematemese/induzido quimicamente , Fenindiona/análogos & derivados , Feniltioidantoína/análogos & derivados , Idoso , Fibrilação Atrial/sangue , Fibrilação Atrial/tratamento farmacológico , Benzamidas , Digoxina/uso terapêutico , Interações Medicamentosas , Overdose de Drogas/terapia , Substituição de Medicamentos , Hematemese/terapia , Humanos , Coeficiente Internacional Normatizado , Masculino , Nitrilas , Fenindiona/farmacologia , Fenindiona/uso terapêutico , Feniltioidantoína/farmacologia , Feniltioidantoína/uso terapêutico , Polimedicação , Neoplasias da Próstata/tratamento farmacológico , Tinzaparina/uso terapêuticoRESUMO
RESUMEN El hematoma disecante del esófago es poco frecuente y solo existen pocos casos registrados en la literatura. Generalmente, se presenta después de un trauma asociado a procedimientos endoscópicos o de forma espontánea. Se describe clínicamente con la triada clásica de dolor torácico, odinofagia, disfagia o hematemesis. Se ha relacionado con un aumento rápido de la presión intraesofágica o un mecanismo de deglución anómala particularmente en presencia de trastornos de la hemostasia. La mayoría de los pacientes tienen un buen pronóstico pues resuelven con tratamiento conservador. Presentamos el caso clínico de un paciente con diagnóstico de hematoma disecante de esófago con ruptura a cavidad abdominal que causó hemoperitoneo importante. Se realiza una revisión del tema(AU)
ABSTRACT Dissecting hematoma of the esophagus is a rare condition and there are only few cases reported by the literature. Generally, it occurs after trauma associated with endoscopic procedures or spontaneously. It is described clinically with the classic triad of chest pain, odynophagia, dysphagia or hematemesis. It has been associated with a rapid increase in intra-esophageal pressure or an abnormal swallowing mechanism particularly in the presence of haemostasis disorders. Most patients have a good prognosis because they obtain a solution by means of a conservative treatment. We present the clinical case of a patient with a diagnosis of dissecting hematoma of the esophagus with rupture to the abdominal cavity causing significant hemoperitoneum. A review of the subject is carried out(AU)
Assuntos
Humanos , Masculino , Adulto , Esofagoscópios/efeitos adversos , Hematoma/diagnóstico por imagem , Abdome Agudo/diagnóstico por imagem , Transtornos de Deglutição/tratamento farmacológico , Hematemese/terapiaAssuntos
Transtornos de Deglutição/etiologia , Estenose Esofágica/etiologia , Hematemese/etiologia , Úlcera/etiologia , Divertículo de Zenker/complicações , Idoso , Deglutição , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/fisiopatologia , Transtornos de Deglutição/terapia , Endoscopia do Sistema Digestório , Estenose Esofágica/diagnóstico , Estenose Esofágica/fisiopatologia , Estenose Esofágica/terapia , Hematemese/diagnóstico , Hematemese/fisiopatologia , Hematemese/terapia , Humanos , Masculino , Recuperação de Função Fisiológica , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Úlcera/diagnóstico , Úlcera/fisiopatologia , Úlcera/terapia , Divertículo de Zenker/diagnóstico , Divertículo de Zenker/fisiopatologia , Divertículo de Zenker/terapiaRESUMO
Major aortopulmonary collateral arteries (MAPCAs) are unique vessels associated with hypoxia induced by congenital heart disease (CHD). Although MAPCAs are essential to supply blood to the lungs, their development and proliferation can induce life-threatening complications, such as rupture into the lung. Here, we describe a rare case of esophageal bleeding from MAPCAs in a CHD patient, which was successfully treated by transcatheter arterial embolization (TAE). A 16-year-old male with CHD experienced a hematemesis and melena after the Bentall procedure to treat valvular heart disease. Emergent esophagogastroduodenoscopy revealed spurting bleeding from the middle esophageal vessels; accordingly, endoscopic variceal ligation (EVL) was performed. However, he had a hematemesis again after 2 weeks of EVL. The arterial phase of dynamic computed tomography indicated that a MAPCA associated with CHD was the origin of bleeding. Hence, TAE of this MAPCA with a mixture of n-butyl-2-cyanoacrylate and ethiodized oil was performed to prevent re-bleeding. Color Doppler mode in endoscopic ultrasonography via the esophagus revealed mosaic-like signals in MAPCAs located in the esophageal wall. This finding was consistent with tortuous MAPCAs accompanied by turbulent blood flow. When clinicians encounter CHD patients with unexpected massive esophageal bleeding, bleeding related to MAPCAs should be considered.
Assuntos
Ruptura Aórtica/complicações , Circulação Colateral , Embolização Terapêutica/métodos , Doenças do Esôfago/terapia , Cardiopatias Congênitas/fisiopatologia , Hematemese/terapia , Artéria Pulmonar/fisiopatologia , Adolescente , Ruptura Aórtica/fisiopatologia , Cateterismo , Endoscopia do Sistema Digestório , Doenças do Esôfago/etiologia , Cardiopatias Congênitas/complicações , Hematemese/etiologia , Síndrome de Heterotaxia/complicações , Humanos , Masculino , Melena/etiologia , Ruptura Espontânea , Prevenção SecundáriaAssuntos
Aneurisma/diagnóstico , Hematemese/etiologia , Estômago/irrigação sanguínea , Aneurisma/complicações , Aneurisma/terapia , Pré-Escolar , Diagnóstico Diferencial , Eletrocoagulação/métodos , Endoscopia do Sistema Digestório/métodos , Epinefrina/administração & dosagem , Hematemese/terapia , Humanos , Masculino , Estômago/patologiaAssuntos
Falso Aneurisma/diagnóstico , Artéria Gástrica/diagnóstico por imagem , Hematemese/diagnóstico , Úlcera Péptica Hemorrágica/diagnóstico , Úlcera Gástrica/complicações , Idoso , Falso Aneurisma/complicações , Falso Aneurisma/terapia , Angiografia , Embolização Terapêutica , Endoscopia do Sistema Digestório , Artéria Gástrica/patologia , Hematemese/etiologia , Hematemese/terapia , Humanos , Masculino , Úlcera Péptica Hemorrágica/etiologia , Úlcera Péptica Hemorrágica/terapia , Estômago/irrigação sanguínea , Estômago/diagnóstico por imagem , Úlcera Gástrica/diagnóstico por imagem , Resultado do TratamentoRESUMO
Hemorrhagic complications are the most common major complications that occur after radiofrequency ablation, but hematemesis as a complication after radiofrequency ablation for hepatic tumor has not been mentioned before. A hepatogastric fistula as a delayed complication is also rare. We present the case of a 77-year-old man with severe hematemesis that occurred 2â¯months after radiofrequency ablation of a liver metastasis of gastric cancer. A ruptured hepatic artery pseudoaneurysm and a hepatogastric fistula were confirmed through serial imaging examinations. The current case is reported in combination with 2 rare major complications after radiofrequency ablation of a liver tumor.
Assuntos
Falso Aneurisma/etiologia , Ablação por Cateter/efeitos adversos , Fístula/etiologia , Hematemese/etiologia , Artéria Hepática/patologia , Neoplasias Hepáticas/terapia , Estômago/patologia , Idoso , Falso Aneurisma/terapia , Ablação por Cateter/métodos , Embolização Terapêutica , Fístula/terapia , Fístula Gástrica/etiologia , Fístula Gástrica/terapia , Hematemese/terapia , Hemostasia , Humanos , Fígado/patologia , Neoplasias Hepáticas/secundário , Masculino , Neoplasias Gástricas/patologia , Procedimentos Cirúrgicos VascularesRESUMO
Background and Aim: The outcome of cirrhotic patients with main portal vein occlusion and portal cavernoma after the first episode of acute variceal bleeding (AVB) is unknown. We compared short-term outcomes after AVB in cirrhotic patients with and without portal cavernoma. Methods: Between January 2009 and September 2014, 28 patients with cirrhosis and portal cavernoma presenting with the first occurrence of AVB and 56 age-, sex-, and Child-Pugh score-matched cirrhotic patients without portal cavernoma were included. The primary endpoints were 5-day treatment failure and 6-week mortality. Results: The 5-day treatment failure rate was higher in the cavernoma group than in the control group (32.1% versus 12.5%; p = 0.031). The 6-week mortality rate did not differ between the cavernoma and control group (25% versus 12.5%, p = 0.137). Multivariable Cox proportional hazard regression analyses revealed that 5-day treatment failure (HR = 1.223, 95% CI = 1.082 to 1.384; p = 0.001) independently predicted 6-week mortality. Conclusions: Cirrhotic patients with AVB and portal cavernoma have worse short-term prognosis than patients without portal cavernoma. The 5-day treatment failure was an independent risk factor for 6-week mortality in patients with cirrhosis and portal cavernoma.