Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Lantano/efectos adversos , Lantano/farmacocinética , Lantano/toxicidad , Fallo Renal Crónico/complicaciones , Hematemesis/tratamiento farmacológico , Hematemesis/cirugía , Endoscopía del Sistema Digestivo , Resultado del Tratamiento , Pacientes Internos , Examen Físico , Evaluación de Síntomas , GastroenterologíaRESUMEN
COVID-19, caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), is now a global pandemic with serious health consequences. Currently, many strict control measures are applied in health care settings, including endoscopy units, in order to limit virus spread. Several recommendations called to limit endoscopic procedures to emergent endoscopies; however, several uncertainties still exist concerning patient safety, protective measures, and infection control methods in emergency endoscopic settings. In this case report, we present a case of successful endoscopic band ligation for bleeding esophageal varices in man with COVID-19 disease who presented with an acute attack of hematemesis while on mechanical ventilation (MV). Esophago-gastroduodenoscopy was performed in the ICU room after preparing the setting, and revealed large, risky esophageal varices. Endoscopic band ligation was done with successful control of bleeding. Third-level measures of medical protection were applied for the participating medical personnel, and patient monitoring was maintained all through the procedure. After the procedure, the bleeding stopped, and the patient was vitally stable and conscious. We conclude that emergency endoscopic interventions could be performed safely with appropriate arrangements in patients with confirmed COVID-19 on MV.
Asunto(s)
Infecciones por Coronavirus/diagnóstico , Endoscopía del Sistema Digestivo/métodos , Várices Esofágicas y Gástricas/complicaciones , Várices Esofágicas y Gástricas/cirugía , Hematemesis/cirugía , Neumonía Viral/diagnóstico , COVID-19 , Prueba de COVID-19 , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/prevención & control , Urgencias Médicas , Hematemesis/etiología , Humanos , Control de Infecciones/métodos , Unidades de Cuidados Intensivos , Ligadura/métodos , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Neumonía Viral/prevención & control , Respiración Artificial/métodos , Medición de Riesgo , Resultado del TratamientoRESUMEN
Intussusception is defined as the invagination of one part of the gastrointestinal tract into another. Jejunogastric intussusception is a rare phenomenon following major upper abdominal surgery, where its aetiology is not well understood. We describe a 68-year-old woman who presented with abdominal pain and haematemesis on the background of a previous pancreaticoduodenectomy (Whipple procedure) for pancreatic cancer. Gastroscopy demonstrated retrograde jejunogastric intussusception, where part of the efferent jejunal limb had prolapsed into the remnant stomach. As a consequence, this intussuscepted segment had become oedematous and ischaemic. The patient subsequently underwent a laparotomy, where the original gastrojejunostomy was resected, which showed the intussuscepted jejunum. The non-viable portion was removed and a Roux-en-Y anastomosis was created. This case highlights the need to 'think outside the box' with respect to differential diagnoses when a patient presents with abdominal pain on the background of previous complex abdominal surgery.
Asunto(s)
Hematemesis/etiología , Intususcepción/etiología , Enfermedades del Yeyuno/etiología , Pancreaticoduodenectomía/efectos adversos , Gastropatías/etiología , Anciano , Diagnóstico Diferencial , Femenino , Hematemesis/cirugía , Humanos , Intususcepción/cirugía , Enfermedades del Yeyuno/cirugía , Neoplasias Pancreáticas/cirugía , Gastropatías/cirugíaRESUMEN
We report the clinical details, imaging findings, and management of a 74-year-old male who had recurrent episodes of massive hematemesis secondary to rupture of a cavernous internal carotid artery (ICA) aneurysm. Ruptured ICA aneurysms may present with epistaxis. However, intracranial aneurysmal rupture with hematemesis as the presenting complaint has not been described previously in the literature. In this case report we describe the pathophysiology of cerebral aneurysm as a cause of hematemesis and its management.
Asunto(s)
Aneurisma Roto , Arteria Carótida Interna/diagnóstico por imagen , Epistaxis/etiología , Hematemesis/etiología , Aneurisma Intracraneal/complicaciones , Anciano , Angiografía por Tomografía Computarizada , Embolización Terapéutica , Epistaxis/diagnóstico por imagen , Hematemesis/cirugía , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/terapia , Resultado del TratamientoRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Anciano de 80 o más Años , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/cirugía , Hematemesis/cirugía , Perforación Intestinal/diagnóstico por imagen , Instrumentos Quirúrgicos , Hemostáticos , Abdomen/diagnóstico por imagen , Abdomen/patología , Gastroscopía , Perforación Intestinal/cirugíaRESUMEN
Pica is a serious condition that is characterized by ingesting inedible things which can prove to be fatal (glass, pebbles, etc.) We present the case of a 64-year-old male patient who is admitted to the emergency room with the following complaints: upper GI tract bleeding manifested through hematemesis and melena, epigastric pain, lack of bowel movements. A contrast computed tomograohy is performed showing the presence of a hyper-dense stomach content, gastric wall thickening, abdominal fluid but with no signs of intestinal occlusion. A laparotomy is performed and ollowing an anterior gastrotomy a large quantity of pebbles is found along with a hemorrhagic and stenotic tumor of the lesser curvature. Taking into account the intraoperative aspect the decision was made to perform an end-to-side stapled esophago-jejunal anastomosis on an omega loop with a Braun entero-entero anastomosis following total gastric resection and D1 lymphadenectomy. Postoperative course is uneventful. A barium swallow carried out on the 10th day following surgery shows a functional anastomosis without leakage. On day 11, the patient is discharged. Pica is usually discovered by accident, most frequently on the operating table which is why thorough preoperative examination and investigations are required.
Asunto(s)
Esófago/cirugía , Hemorragia Gastrointestinal/etiología , Yeyuno/cirugía , Pica/complicaciones , Anastomosis Quirúrgica , Gastrectomía , Hemorragia Gastrointestinal/cirugía , Hematemesis/etiología , Hematemesis/cirugía , Humanos , Masculino , Melena/etiología , Melena/cirugía , Persona de Mediana Edad , Pica/diagnóstico por imagen , Pica/cirugía , Estómago/diagnóstico por imagen , Estómago/cirugíaRESUMEN
BACKGROUND/PURPOSE OF THE STUDY: Acute upper gastrointestinal (UGI) bleed is a life-threatening emergency carrying risks of rebleed and mortality despite standard pharmacological and endoscopic management. We aimed to determine etiologies of acute UGI bleed in hospitalized patients and outcomes (rebleed rates, 5-day mortality, in-hospital mortality, 6-week mortality, need for surgery) and to determine predictors of rebleed and mortality. METHODS: Clinical and endoscopic findings were recorded in patients aged > 12 years who presented within 72 h of onset of UGI bleed. Outcomes were recorded during the hospital stay and 6 weeks after discharge. RESULTS: A total of 305 patients were included in this study, mean age being 44 ± 17 years. Most common etiology of UGI bleed was portal hypertension (62.3%) followed by peptic ulcer disease (PUD) (16.7%). Rebleed rate within 6 weeks was 37.4% (portal hypertension 47.9%, PUD 21.6%, malignancy 71.4%). Five-day mortality was 2.3% (malignancy 14.3%, portal hypertension 3.2%); the in-hospital mortality rate was 3.0% (malignancy 14.3%, portal hypertension 3.2%, PUD 0.0%) and 4.9% at 6 weeks (malignancy 28.6%, portal hypertension 5.8%, PUD 0.0%). Surgery was required in 4.59% patients. On multivariate analysis, post-endoscopy Rockall score was significantly predictive of rebleed in both portal hypertension- and PUD-related rebleed. No factors were found predictive of mortality in multivariate analysis. CONCLUSION: Portal hypertension remains the commonest cause of UGI bleed in India and carries a higher risk of rebleed and mortality as compared to PUD-related bleed. Post-endoscopy Rockall score is a useful tool for clinicians to assess risk of rebleed.
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Hematemesis/etiología , Hematemesis/mortalidad , Hipertensión Portal/complicaciones , Melena/etiología , Melena/mortalidad , Neoplasias/complicaciones , Enfermedad Aguda , Adolescente , Adulto , Anciano , Endoscopía Gastrointestinal , Várices Esofágicas y Gástricas/complicaciones , Femenino , Ectasia Vascular Antral Gástrica/complicaciones , Hematemesis/diagnóstico por imagen , Hematemesis/cirugía , Mortalidad Hospitalaria , Humanos , India/epidemiología , Cirrosis Hepática/complicaciones , Masculino , Melena/diagnóstico , Melena/cirugía , Persona de Mediana Edad , Úlcera Péptica Hemorrágica/diagnóstico por imagen , Úlcera Péptica Hemorrágica/mortalidad , Úlcera Péptica Hemorrágica/cirugía , Recurrencia , Centros de Atención Terciaria , Adulto JovenRESUMEN
This study aimed to report the case of a patient diagnosed with pulmonary sequestration accompanied by an intermittent haematemesis as the initial and life-threatening symptom. Emergent surgical intervention finally confirmed a rare direct fistula formation between the arterial blood supply of pulmonary sequestration and the oesophagus, which led to intermittent upper gastrointestinal haemorrhage. To our knowledge, this is the first case reported with this kind of fistula formation.
Asunto(s)
Secuestro Broncopulmonar/complicaciones , Fístula Esofágica/complicaciones , Hematemesis/etiología , Fístula Vascular/complicaciones , Secuestro Broncopulmonar/diagnóstico , Secuestro Broncopulmonar/cirugía , Fístula Esofágica/diagnóstico , Fístula Esofágica/cirugía , Esófago/diagnóstico por imagen , Esófago/cirugía , Hematemesis/diagnóstico , Hematemesis/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neumonectomía , Tomografía Computarizada por Rayos X , Fístula Vascular/diagnóstico , Fístula Vascular/cirugía , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
Schwannomas are benign tumors derived from Schwann cells and their typical site of origin is the subcutaneous tissue of the extremities. Gastrointestinal localization of Schwannomas is extremely rare and the stomach is the prevalent site. Gastric schwannomas primarily occur in the gastric submucosa and are usually asymptomatic.We present a rare case of a solitary gastric schwannoma in a 51-year old male, which initially manifested with hematemesis by acute upper gastrointestinal (GI) bleeding. The upper GI-Endoscopy revealed a gastric submucosal tumor, 7âcm in size, located in the proximal corpus and fundus. In the endoscopical Ultrasound (EUS-Examination), the lesion appeared to arise from the fourth proper muscle layer (Muscularis propria). The fourth layer origin and the isoechogenicity, as compared to the normal muscle layer, are endoscopic ultrasonographic characteristics of gastric schwannomas and help in distinguishing them from gastrointestinal tumors (GIST). Because of the unclear histological identity, the patient underwent a "rendezvous" endoscopic-laparoscopic surgical resection of the tumor in toto. The histomorphological features of the lesion and the strong expression of S100 in combination with absence of DOG1 expression indicated the diagnosis of gastric schwannoma. There was no evidence of malignancy. The postoperative course was uncomplicated.This is a very rare manifestation of gastric schwannoma, representing a rare differenzial diagnosis in a case of acute upper GI-Bleeding. Only 14â% of gastric schwanommas are presented with gastrointestinal bleeding, including mainly melena rather than hematemesis. This case is considered to be worthy of presentation owing to the rare and unusual cause of upper GI bleeding implied in it.
Asunto(s)
Hematemesis/etiología , Neurilemoma/diagnóstico , Neoplasias Gástricas/diagnóstico , Diagnóstico Diferencial , Endoscopía Gastrointestinal , Endosonografía , Gastrectomía , Hematemesis/patología , Hematemesis/cirugía , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad , Neurilemoma/patología , Neurilemoma/cirugía , Estómago/patología , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugíaRESUMEN
Gastric duplication cyst is a very rare congenital anomaly accounting up to 4% of all gastrointestinal tract duplications. It is a quite rare anomaly in adults, the majority of the cases are diagnosed in the neonatal period. Gastric duplication cysts are usually asymptomatic or they do present with non-specific symptoms. They are usually discovered incidentally during endoscopy or laparotomy or very rarely after getting complicated. We describe herein, along with literature review, a case of an adult patient who presented with abdominal pain and bloody vomiting and turned out to have a gastric duplication cyst complicated by internal bleeding.
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Quistes/diagnóstico por imagen , Anomalías del Sistema Digestivo/diagnóstico por imagen , Estómago/diagnóstico por imagen , Dolor Abdominal/etiología , Adulto , Quistes/congénito , Quistes/patología , Quistes/cirugía , Anomalías del Sistema Digestivo/complicaciones , Anomalías del Sistema Digestivo/patología , Anomalías del Sistema Digestivo/cirugía , Femenino , Hematemesis/etiología , Hematemesis/cirugía , Humanos , Estómago/anomalías , Estómago/patología , Estómago/cirugíaAsunto(s)
Endoscopía Gastrointestinal , Hematemesis/cirugía , Hemostasis Endoscópica , Hemorragia Posoperatoria/cirugía , Anastomosis Quirúrgica/efectos adversos , Femenino , Gastrectomía/efectos adversos , Hematemesis/etiología , Hemostasis Endoscópica/instrumentación , Humanos , Persona de Mediana Edad , Pancreaticoduodenectomía/efectos adversos , Hemorragia Posoperatoria/etiologíaAsunto(s)
Endoscopía Gastrointestinal/métodos , Várices Esofágicas y Gástricas/complicaciones , Várices Esofágicas y Gástricas/cirugía , Hematemesis/cirugía , Cirrosis Hepática/complicaciones , Rotura Espontánea/complicaciones , Abdomen Agudo , Plaquetas , Várices Esofágicas y Gástricas/etiología , Fibrina , Hematemesis/etiología , Humanos , Hipertensión Portal/complicaciones , Hipertensión Portal/etiología , Ligadura , Masculino , Persona de Mediana Edad , Presión , Rotura Espontánea/cirugía , Resultado del Tratamiento , Várices/patología , Várices/cirugíaAsunto(s)
Várices Esofágicas y Gástricas/cirugía , Hematemesis/etiología , Hematemesis/cirugía , Falla de Equipo , Várices Esofágicas y Gástricas/complicaciones , Gastroscopía , Humanos , Ligadura/efectos adversos , Ligadura/instrumentación , Masculino , Persona de Mediana Edad , Succión/efectos adversosRESUMEN
BACKGROUND: Haematemesis is an alarming symptom in children, even if the proportion of normal endoscopies ranges from 10 to 21% and the causes are often benign. The purpose of the study was to identify clinical predictors of endoscopic lesions with high risk of bleeding and to establish a score that predict the presence of these lesions. METHODS: Retrospective study carried in Children's Hospital of Tunis between 1997 and 2006 involved children with haematemesis who underwent Upper gastrointestinal endoscopy. Several clinical parameters were analyzed. Univariate analysis and multivariate logistic regression were performed to identify predictive parameters of endoscopic lesions with high risk of bleeding. A score was developed from the parameters derived from the multivariate analysis. The sensitivity and specificity of the score were determined. RESULTS: Among 2814 endoscopies, 814 were conducted for haematemesis and 489 were selected for the study. 140/489 had lesions with high risk of bleeding. Multivariate logistic regression analysis identified six factors independently associated with high risk bleeding lesions: endoscopy performed within 48 hours (OR=2.2; 95% CI 0.7-6.9), re-bleeding (OR=1.4; 95% CI 0.7-2.5), the importance of the bleeding, mild to severe (OR=1.8; 95% CI 1.1-3), bright red haematemesis (OR=1; 95% CI 0.2-5.8), history of gastrointestinal and liver disease (OR=1.6; 95% CI 1.1-3) and intake of gastro toxic drugs (OR=1.3; 95% CI 0.8-2.3). Then, we established a score. The sensitivity, specificity, positive predictive value and negative predictive value of this score were respectively 79.6%, 32.9%, 34.9% and 78% for a cut off value>0.22. CONCLUSION: The clinical predictive parameters of high risk bleeding lesions identified have not yielded a score with significant sensitivity and specificity. A prospective study should be performed to improve the score.
Asunto(s)
Endoscopía Gastrointestinal/efectos adversos , Hemorragia Gastrointestinal/etiología , Hematemesis/cirugía , Adolescente , Niño , Preescolar , Estudios de Cohortes , Humanos , Lactante , Recién Nacido , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Endograft infections present a potentially lethal complication of thoracic endovascular aortic repair (TEVAR). We report a case of a young male patient who was referred to our institution because of a stent graft infection that occurred 10 months after TEVAR. Contained distal aortic arch rupture and hematemesis were associated with the endograft infection. Emergent open surgical repair was undertaken with deep hypothermic circulatory arrest. After the removal of the infected endograft, the distal aortic arch and proximal descending thoracic aorta were replaced with a cryopreserved aortic homograft. Fifteen-month follow-up was uneventful. We discuss techniques and materials for replacement of the infected endograft. The article provides an outline of the potential benefit of cryopreserved aortic homografts within the setting of a complex thoracic aortic infection.