RESUMEN
BACKGROUND: This case report presents the rare occurrence of hematochezia due to an internal iliac artery aneurysm leading to an arterioenteric fistula, expanding the differential diagnosis for gastrointestinal bleeding. It emphasizes the importance of considering vascular origins in cases of atypical hematochezia, particularly in the absence of common gastrointestinal causes, and highlights the role of imaging and multidisciplinary management in diagnosing and treating such unusual presentations. CASE SUMMARY: A 75-year-old man with a history of hypertension presented with 12 d of hematochezia, experiencing bloody stools 7-8 times per day. Initial computed tomography (CT) scans revealed an aneurysmal rupture near the right internal iliac artery with suspected hematoma development. Hemoglobin levels progressively decreased to 7 g/dL. Emergency arterial angiography and iliac artery-covered stent placement were performed, followed by balloon angioplasty. Despite initial stabilization, minor rectal bleeding and abdominal pain persisted, leading to further diagnostic colonoscopy. This identified a neoplasm and potential perforation at the proximal rectum. An exploratory laparotomy confirmed the presence of a hematoma and an aneurysm invading the rectal wall, necessitating partial rectal resection, intestinal anastomosis, and ileostomy. Postoperative recovery was successful, with no further bleeding incidents and normal follow-up CT and colonoscopy results after six months. CONCLUSION: In cases of unusual gastrointestinal bleeding, it is necessary to consider vascular causes for effective diagnosis and intervention.
RESUMEN
OBJECTIVE: Apparent diffusion coefficient (ADC) value measurement of nodes in diffusion-weighted imaging was widely used in differentiating different types of human tumors. The aim of this meta-analysis was to evaluate the clinical value of ADC measurement through diffusion-weighted magnetic resonance imaging (DW-MRI) in the differential diagnosis of benign and malignant breast tumors. METHODS: Relevant studies were identified through computer-based search of databases, which were supplemented through manual search strategies. Case-control studies were selected in adherence with our strict inclusion and exclusion criteria. Statistical analysis was conducted using Stata 12.0 statistical software (StataCorp, College Station, Tex). RESULTS: Our database searches initially retrieved 602 studies (320 studies in Chinese and 282 studies in English), and 31 studies (18 studies in English and 13 studies in Chinese) were eventually selected for meta-analysis. These 31 case-control studies included a total of 926 normal breast tissues and 2323 breast tumors (911 benign tumors and 1412 malignant tumors). Our meta-analysis showed that ADC values measured through DW-MRI were higher in benign breast tumors compared with malignant breast tumors, and this difference was statistically significant. In addition, the ADC values in the normal breast tissues were markedly higher than the benign breast tumors, which were also at a statistically significant level. Consistent with these observations, the ADC values in the normal breast tissues were significantly higher when compared with the values found in the malignant breast tumors. CONCLUSIONS: Our data strongly support the conclusion that the ADC value measured through DW-MRI is an important radiographic index for differential diagnosis of benign and malignant breast tumors and is critical to our assessment of the internal structure of tumors.
