RESUMO
Ectopic variceal bleeding is an uncommonâ¯cause of gastrointestinal bleeding and carries a high mortality. Management depends on provider comfort and resource availability asâ¯treatment guidelines are lackingâ¯due to the infrequent occurrence of bleeding ectopic varices. We present a case of a middle-aged woman who presented with melena and anemia requiring transfusion. She was diagnosed with cirrhosis, and computed tomography of the abdomen revealed active bleeding at the proximal duodenum. She underwent emergent esophagogastroduodenoscopy, which showed actively bleeding duodenal varices secondary to portosystemic shunt from portal hypertension. Endoscopic hemostasis was achieved with variceal band ligation, a useful modality when alternative methods of emergent variceal management are unavailable. Given the risk of recurrent bleeding, the patient underwent embolization of varices by interventional radiology.
RESUMO
Intra-abdominal and intramural hematomas are well-known complications of pseudoaneurysms. We present a case of small bowel obstruction as a result of external mechanical compression from hematoma. Bleeding was localized to the pseudoaneurysm of the gastroduodenal artery and inferior pancreaticoduodenal artery. Angiography was used to control the bleeding with coil embolization. This rare clinical manifestation represents just one of the symptoms associated with pseudoaneurysms of the gastrointestinal tract. Therapeutic options are discussed along with a review of the literature.
RESUMO
The altered anatomy of patients after Roux-en-Y gastric bypass (RYGB) surgery creates technical challenges for endoscopic and surgical treatment of gallstones. We present a unique case of a post-RYGB patient with complicated gallbladder surgery requiring coiling and embolization of the cystic duct for bile leak. The cystic duct coils migrated out into the bile duct forming a nidus for infection and biliary obstruction, which was resolved using the novel endoscopic ultrasound-directed transgastric routine endoscopic retrograde cholangiopancreatography technique, with successful transpapillary removal of cystic duct coils in RYGB anatomy.
RESUMO
Video capsule endoscopy (VCE) is a safe innovative tool for investigating obscure gastrointestinal bleeding, Crohn's disease and other small bowel pathologies. The capsule is usually excreted with faeces within 24-48 h. Retention of capsule rarely occurs, and it usually depends on the indication of VCE. The longest reported case of capsule retention in the literature is 2.5 years. Surgical approach is considered effective to retrieve the retained capsule. We present a case of asymptomatic retention of capsule for four and half years in a 49-year-old man who underwent VCE to explore the cause of obscure gastrointestinal bleeding. It was successfully retrieved endoscopically. We will also briefly review the literature regarding the causes, different presentations and management of capsule retention.
RESUMO
Patients with head and neck cancers need a percutaneous endoscopic gastrosotomy (PEG) before start of treatment to ensure adequate nutrition because worsening dysphagia during chemo radiation [Nicholson FB, Korman MG, Richardson MA. Percutaneous endoscopic gastrostomy: a review of indications, complications and outcome. J. Gastroenterol Hepatol 2000; 15: 21-5; Beer KT, Krause KB, Zuercher T, Stanga Z. Early percutaneous endoscopic gastrostomy insertion maintains nutritional state in patients with aerodigestive tract cancer. Nutr Cancer 2005; 52: 29-34.]. However implantation of original tumor to the gastrostomy exit site is rare but serious complication of this procedure and here we report a case of PEG site metastasis along with relevant review of literature.