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1.
BMJ Case Rep ; 14(9)2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34518182

RESUMO

An 84-year-old woman presented acutely with dizziness, fatigue and a total of 800 mL of fresh per rectum (PR) bleeding. The significant history of abdominal aortic aneurysm repair 5 years ago included multiple episodes of endovascular leak around the stent associated with abscess of left psoas major, left abdominal wall abscess with sinus formation, appendicitis with abscess formation, and acute pancreatic and chronic cholecystitis with multiple gallstones in the 7 months prior to this presentation. During the preceding 7 months, the patient was stabilised with an intravenous proton pump inhibitor, blood transfusions and Intensive Care Unit (ICU) management for the assumed diagnosis of stress ulcers over multiple hospital admissions. Imaging with CT scan of the abdomen made the more accurate diagnosis of acute gastrointestinal haemorrhage caused by a fistula between the distal duodenum and aorta, which was later surgically confirmed. Removal of infected stents and axillobifemoral bypass were performed with a successful recovery.


Assuntos
Aneurisma da Aorta Abdominal , Doenças da Aorta , Duodenopatias , Fístula Intestinal , Fístula Vascular , Idoso de 80 Anos ou mais , Aorta , Duodenopatias/diagnóstico por imagem , Duodenopatias/etiologia , Duodenopatias/cirurgia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/etiologia , Fístula Intestinal/cirurgia , Stents/efeitos adversos , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia , Fístula Vascular/cirurgia
2.
Arch Argent Pediatr ; 119(5): e513-e517, 2021 10.
Artigo em Espanhol | MEDLINE | ID: mdl-34569753

RESUMO

Graft versus host disease is a serious complication that occurs following bone marrow transplant with significant morbidity and mortality. The gold standard to diagnose gastrointestinal graft versus host disease is upper and lower gastrointestinal endoscopy with histological validation. The development of intramural duodenal hematoma is a rare complication associated with this procedure. We present two cases of intramural duodenal haematoma after duodenal biopsies in bone marrow transplant patients that presented clinically with severe abdominal pain and intestinal bleeding. In both cases, CT scans confirmed the diagnosis and they were treated conservatively with favorable outcomes. Final diagnosis of gastrointestinal graft versus host disease was based on the colonic samples with normal duodenal histoarchitecture, which could lead to avoiding duodenal samples in future patients in order to prevent this serious complication and thus diminish morbidity.


Assuntos
Duodenopatias , Doença Enxerto-Hospedeiro , Criança , Duodenopatias/diagnóstico , Duodenopatias/etiologia , Endoscopia Gastrointestinal , Hemorragia Gastrointestinal , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/etiologia , Hematoma/diagnóstico , Hematoma/etiologia , Humanos
4.
Arch. argent. pediatr ; 119(5): e513-e517, oct. 2021. tab, ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1292683

RESUMO

La enfermedad de injerto contra huésped es una complicación grave que se presenta después del trasplante de médula ósea, con morbilidad y mortalidad elevadas. El patrón de oro para evaluar su compromiso gastrointestinal es la endoscopia digestiva alta y baja con toma de biopsia. El desarrollo de hematoma duodenal intramural es una complicación poco frecuente asociada con este procedimiento .Se presentan dos casos de hematoma duodenal intramural posendoscopia en pacientes con trasplante y sospecha de enfermedad injerto contra huésped que presentaron un cuadro agudo de dolor abdominal y sangrado intestinal. El diagnóstico se realizó por tomografía y recibieron tratamiento conservador, con un resultado favorable. En ambos casos, el diagnóstico de enfermedad injerto contra huésped gastrointestinal se hizo a través de las biopsias colónicas con histología duodenal normal, lo que sugiere evitar la toma de muestras duodenales para prevenir esta grave complicación en pacientes de alto riesgo y, de este modo, disminuir la morbilidad.


Graft versus host disease is a serious complication that occurs following bone marrow transplant with significant morbidity and mortality. The gold standard to diagnose gastrointestinal graft versus host disease is upper and lower gastrointestinal endoscopy with histological validation. The development of intramural duodenal hematoma is a rare complication associated with this procedure. We present two cases of intramural duodenal haematoma after duodenal biopsies in bone marrow transplant patients that presented clinically with severe abdominal pain and intestinal bleeding. In both cases, CT scans confirmed the diagnosis and they were treated conservatively with favorable outcomes.Final diagnosis of gastrointestinal graft versus host disease was based on the colonic samples with normal duodenal histoarchitecture, which could lead to avoiding duodenal samples in future patients in order to prevent this serious complication and thus diminish morbidity.


Assuntos
Humanos , Masculino , Lactente , Criança , Duodenopatias/diagnóstico , Duodenopatias/etiologia , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/etiologia , Endoscopia Gastrointestinal , Hematoma/diagnóstico , Hematoma/etiologia , Hemorragia Gastrointestinal
7.
J Vet Diagn Invest ; 33(4): 782-787, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34027760

RESUMO

Choledochal cysts, congenital segmental dilations of the common bile duct, have been reported in few cats, and histologic characterization is lacking. A 20-mo-old spayed female domestic shorthair cat was presented because of vomiting and weight loss. There was progressive elevation of liver enzyme activity (ALT > ALP, GGT) and hyperbilirubinemia. Diagnostic imaging identified focal cystic dilation of the common bile duct, dilation and tortuosity of adjacent hepatic ducts, and a prominent duodenal papilla. A choledochal cyst was suspected, and the animal was euthanized. On postmortem examination, there was a 2-cm, firm, thickened, cystic dilation of the common bile duct, patent with adjacent ducts. Histologically, the cyst wall was expanded by fibroblasts, collagen, and lymphoplasmacytic inflammation. Adjacent bile ducts were markedly dilated and tortuous, with lymphoplasmacytic inflammation and papillary mucosal hyperplasia that extended to the major duodenal papilla. There was chronic neutrophilic cholangitis, suggesting bacterial infection and/or disturbed bile drainage, extrahepatic obstruction, and lymphoplasmacytic pancreatitis with ductular metaplasia. Prominent lymphoid follicles within biliary ducts and duodenum suggested chronic antigenic stimulation. Choledochal cysts can be associated with chronic neutrophilic cholangitis, extrahepatic obstruction, choledochitis, duodenal papillitis, and pancreatitis, and should be a differential for increased hepatic enzymes and hyperbilirubinemia in young cats.


Assuntos
Doenças do Gato/diagnóstico , Colangite/veterinária , Cisto do Colédoco/veterinária , Duodenopatias/veterinária , Pancreatite/veterinária , Animais , Doenças do Gato/patologia , Gatos , Colangite/diagnóstico , Colangite/etiologia , Cisto do Colédoco/complicações , Duodenopatias/diagnóstico , Duodenopatias/etiologia , Feminino , Pancreatite/diagnóstico , Pancreatite/etiologia
8.
Vasc Endovascular Surg ; 55(7): 752-755, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33779400

RESUMO

Primary aortoenteric fistula (AEF) is an uncommon but life-threatening condition. We present a case of primary AEF in an octogenarian with previous endovascular aortic repair, type II endoleak and end stage liver and renal disease. He was successfully treated with accessory renal artery ligation, duodenojejunostomy, aneurysm sac debridement and irrigation and closure of the aneurysm sac over a drain. The patient made an excellent recovery and was discharged on POD #7, with no complications noted after over a year of follow up. This approach may represent a valuable option to manage primary AEF versus open endograft explant, particularly in severely ill patients.


Assuntos
Duodenopatias/terapia , Duodenostomia , Embolização Terapêutica , Doença Hepática Terminal/complicações , Endoleak/terapia , Fístula Intestinal/terapia , Jejunostomia , Falência Renal Crônica/complicações , Artéria Renal/cirurgia , Fístula Vascular/terapia , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Desbridamento , Duodenopatias/diagnóstico por imagem , Duodenopatias/etiologia , Doença Hepática Terminal/diagnóstico , Endoleak/diagnóstico por imagem , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/etiologia , Falência Renal Crônica/diagnóstico , Ligadura , Masculino , Artéria Renal/diagnóstico por imagem , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia
9.
J Vasc Surg ; 74(3): 711-719.e1, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33684467

RESUMO

OBJECTIVE: In the present study, we have reported and compared aortoduodenal fistulas (ADFs) after endovascular abdominal aortic aneurysm repair (EVAR) vs after open aortic repair (OAR). METHODS: We retrospectively analyzed the data from patients treated for ADFs from January 2015 to May 2020 in our hospital. The clinical data, diagnostic procedures, and surgical options were evaluated. The primary endpoints of the present study were 30-day and 1-year mortality. The secondary endpoints were major postoperative complications. RESULTS: A total of 24 patients (20 men; median age, 69 years; range, 53-82 years) were admitted with ADFs after EVAR (n = 9) or OAR (n = 15). These patients accounted for ∼4.3% of all abdominal aortic aneurysm repairs in our hospital. The median interval from the initial aortic repair and the diagnosis of ADF was 68 months (range, 6-83 months) for the ADF-EVAR group and 80 months (range, 1-479 months) for the ADF-OAR group. Three patients in the ADF-EVAR group had refused surgical treatment owing to their high surgical risk. One patient in the ADF-OAR group had undergone removal of the aortic prosthesis without replacement. Of the remaining 20 patients, 12 (ADF-EVAR group, n = 4; ADF-OAR group, n = 8) had undergone in situ replacement of the aorta and 8 (ADF-EVAR group, n = 2; ADF-OAR group, n = 6) had undergone extra-anatomic reconstruction with aortic ligation. After a mean follow-up of 26 months, no patient had experienced early limb loss. However, one case of rupture of the venous graft (ADF-EVAR), one case of aortic stump blowout (ADF-OAR), and one case of a ureteroarterial fistula with a homograft (ADF-OAR) had occurred. Overall, the incidence of postoperative complications was significantly greater after ADF-OAR (93% vs 33%; P = .036). The most frequent bacteria involved in the blood cultures were Escherichia coli (25% of patients), and Candida spp. (61%) were the predominant pathogens found on intra-abdominal smears. The in-hospital mortality rates for the ADF-EVAR and ADF-OAR group were 22% and 13%, respectively. The corresponding 1 -year mortality rates were 22% and 33%. CONCLUSIONS: Patients with ADFs after EVAR or OAR have limited overall survival. In addition to the similar therapeutic approaches, we found no significant differences in postoperative mortality between these two uncommon pathologic entities. In our study, the overall postoperative morbidity seemed greater for the ADF-OAR group.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Duodenopatias/etiologia , Procedimentos Endovasculares/efeitos adversos , Fístula Intestinal/etiologia , Fístula Vascular/etiologia , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Implante de Prótese Vascular/mortalidade , Bases de Dados Factuais , Remoção de Dispositivo , Duodenopatias/diagnóstico por imagem , Duodenopatias/mortalidade , Duodenopatias/cirurgia , Procedimentos Endovasculares/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/mortalidade , Fístula Intestinal/cirurgia , Ligadura , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/mortalidade , Fístula Vascular/cirurgia
10.
BMC Gastroenterol ; 21(1): 45, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526013

RESUMO

BACKGROUND: Upper gastrointestinal (GI) bleeding is the most important presentation of an aorto-duodenal fistula (ADF). Early diagnosis is difficult, and the disease is associated with high mortality. The present study aimed to examine the clinical and the endoscopic characteristics of ADF in eight patients who presented to our hospital. We also sought to clarify the diagnostic approach towards the disease. METHODS: The present study examined the clinical and the endoscopic/computed tomography (CT) characteristics of ADF in eight patients who were definitively diagnosed with this condition in a 12-year period at our hospital. RESULTS: The patients comprised of five men and three women, with a mean age of 69.8 years. Upper gastrointestinal bleeding was the chief complaint for all the patients. Out of these, two patients presented with shock. The patients' mean haemoglobin at presentation was 7.09 g/dL, and the mean number of blood transfusions was 7.5. All patients had undergone intervention to manage an aortic pathology in the past. As the first investigation, an upper GI endoscopy in 5 and a CT scan in 3 patients were performed. In cases where CT scan was performed first, no definitive diagnosis was obtained, and the diagnosis was confirmed by performing an upper GI endoscopy. In cases where endoscopy was performed first, definitive diagnosis was made in only one case, and the other cases were confirmed by the CT scan. In some cases, tip attachments, converting to long endoscopes, and marking clips were found useful. CONCLUSIONS: In patients who have undergone intervention to manage an aortic pathology and have episodes of upper gastrointestinal bleeding, ADF cannot be definitively diagnosed with only one investigation. In addition, when performing upper GI endoscopy in cases where an ADF is suspected, tip attachment, converting to a long endoscope, and using marking clips can be helpful.


Assuntos
Doenças da Aorta , Duodenopatias , Fístula Intestinal , Idoso , Aorta , Doenças da Aorta/diagnóstico por imagem , Duodenopatias/diagnóstico por imagem , Duodenopatias/etiologia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/etiologia , Fístula Intestinal/cirurgia , Masculino
17.
Vasc Endovascular Surg ; 55(3): 282-285, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33047669

RESUMO

An 80 year-old gentleman presented with aortoduodenal fistula 2 months after uncomplicated endovascular aneurysm repair (EVAR). Upon laparotomy and fistula takedown, there was no active hemorrhage from the excluded aneurysm. It was theorized the fistula had originated from an occult type II endoleak which had since thrombosed. The duodenum was repaired primarily; the anterior defect in the aneurysm sac was packed and covered with omentum. The patient recovered uneventfully and remains well after 9 months. This is the first case, to our knowledge, of a post-EVAR aortoduodenal fistula successfully treated without endograft excision.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Duodenopatias/cirurgia , Endoleak/cirurgia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Fístula Intestinal/cirurgia , Fístula Vascular/cirurgia , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Duodenopatias/diagnóstico por imagem , Duodenopatias/etiologia , Endoleak/diagnóstico por imagem , Endoleak/etiologia , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/etiologia , Masculino , Reoperação , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia
19.
Korean J Gastroenterol ; 76(6): 331-336, 2020 12 25.
Artigo em Inglês | MEDLINE | ID: mdl-33361709

RESUMO

Duodenal varices are a serious complication of portal hypertension. Bleeding from duodenal varices is rare, but when bleeding does occur, it is massive and can be fatal. Unfortunately, the optimal therapeutic modality for duodenal variceal bleeding is unclear. This paper presents a patient with duodenal variceal bleeding that was managed successfully using percutaneous trans-splenic variceal obliteration (PTVO). A 56-year-old man with a history of alcoholic cirrhosis presented with a 6-day history of melena. Emergency esophagogastroduodenoscopy revealed a large, bluish mass with a nipple sign in the second portion of the duodenum. Coil embolization of the duodenal varix was performed via a trans-splenic approach (i.e., PTVO). The patient no longer complained of melena after treatment. The duodenal varix was no longer visible at the follow-up esophagogastroduodenoscopy performed three months after PTVO. The use of PTVO might be a viable option for the treatment of duodenal variceal bleeding.


Assuntos
Duodenopatias , Hemorragia Gastrointestinal , Varizes , Duodenopatias/diagnóstico , Duodenopatias/etiologia , Duodenopatias/terapia , Duodeno , Embolização Terapêutica , Varizes Esofágicas e Gástricas/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Baço , Varizes/complicações , Varizes/diagnóstico
20.
Saudi Med J ; 41(8): 874-877, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32789429

RESUMO

A duodenal hematoma secondary to blunt-abdominal trauma is a relatively rare condition and is usually managed conservatively. We report a case of a post-traumatic duodenal hematoma after a road trafficc accident in a 10-year-old boy, who presented with progressive vomiting 3 weeks after the accident. The case was managed using serial esophagogastroduodenoscopy (EGD) with dilatation. Controlled radial expansion (CRE) balloon dilatation was performed 4 times over a period of 11 weeks. The patient recovered uneventfully and remained asymptomatic at the 3-month follow-up after the last endoscopic dilatation. This case highlights the applicability of EGD with CRE balloon dilatation as an alternative to surgical treatment in patients with symptomatic post-traumatic duodenal hematomas.


Assuntos
Dilatação/métodos , Duodenopatias/terapia , Endoscopia do Sistema Digestório/métodos , Hematoma/terapia , Traumatismos Abdominais/complicações , Acidentes de Trânsito , Criança , Duodenopatias/diagnóstico por imagem , Duodenopatias/etiologia , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Humanos , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Vômito/etiologia , Ferimentos não Penetrantes/complicações
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