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1.
Medicine (Baltimore) ; 101(35): e30098, 2022 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-36107510

RESUMO

BACKGROUND: A jejunal gastrointestinal stromal tumor (GIST) is a rare neoplasm of the gastrointestinal (GI) tract. Massive bleeding due to a jejunal GIST is a diagnostic and therapeutic challenge. It may be a life-threatening GIST complication that requires urgent intervention. Acute GI bleeding, which requires urgent surgical intervention, is a very rare clinical manifestation of GIST. A jejunal GIST with massive hemorrhage with coronavirus disease 2019 in a male patient in older age with many comorbidities has been not reported in the worldwide literature. METHODS: In this case report, we present an 80-year-old man who was admitted to surgery due to abdominal pain, melena, and hematochezia for several hours. An upper endoscopy and colonoscopy were inconclusive. A multidetector contrast-enhanced computed tomography (CT) of the abdominal and pelvic cavity showed concentric irregular thickening in the distal jejunum.The histopathological finding showed a GIST measuring 6 cm with a mitotic index 2/50 high power fields. The patient's hemodynamic condition deteriorated despite initial conservative treatment including a blood transfusion. Therefore, patient underwent the emergency surgery 24 hours after admission: partial jejunal resection with the tumor followed by primary end-to-end anastomosis. RESULTS: The mass was removed completely. There were no surgical complications in the postoperative course. On the first postoperative day, a severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test was performed due to a persistent dry cough, which yielded a positive result. After 14 days, the patient died due to pneumonia and circulatory failure. CONCLUSIONS: This case indicates that jejunal GIST can present as massive lower gastrointestinal bleeding and urgent surgery can successfully stop bleeding and save the patient's life. The CT scan was the most effective investigation to find the source of GI bleeding in this case. Therefore, we suggest performing CT in patients with acute massive lower gastrointestinal bleeding when the source of bleeding is not visible on endoscopy, and urgent surgical jejunal resection to stop life-threatening bleeding caused by a jejunal GIST.


Assuntos
COVID-19 , Tumores do Estroma Gastrointestinal , Idoso de 80 Anos ou mais , Endoscopia Gastrointestinal/efeitos adversos , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/cirurgia , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Jejuno/patologia , Jejuno/cirurgia , Masculino
2.
Medicine (Baltimore) ; 101(35): e30335, 2022 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-36107558

RESUMO

RATIONALE: Spontaneous intramural small-bowel hematoma (SISBH) is a rare complication of anticoagulation therapy. Presentation of SISBH can vary from mild abdominal pain to an acute abdomen. PATIENT CONCERNS: A 70-year-old woman was brought to the emergency department because of severe abdominal pain for 1 day. She had a medical history of coronary artery disease and paroxysmal atrial fibrillation and was receiving anticoagulation therapy with warfarin for 3 years. DIAGNOSIS: Computed tomography disclosed disproportional dilatation of the segmental small bowel and near-total obstruction of the intestinal lumen at the level of the jejunum, indicating an acute abdomen. INTERVENTIONS: We performed laparoscopic exploration and found a segmental distal jejunum was tense, heavy, firm, and discolored with a blue hue. Histopathological examination of the resected jejunum revealed diffuse hemorrhage and necrosis at the mucosa and submucosal layers, indicating SISBH. OUTCOMES: The patient had an uneventful recovery and was discharged in a relatively stable condition. LESSONS: Warfarin-induced SISBH presenting as an acute abdomen is an emergency condition that needs early diagnosis and timely management. Surgical intervention may be indicated for intestinal obstruction, ischemia, perforation, peritonitis, and intra-abdominal hemorrhage.


Assuntos
Abdome Agudo , Varfarina , Abdome Agudo/induzido quimicamente , Dor Abdominal/etiologia , Idoso , Anticoagulantes/efeitos adversos , Feminino , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/complicações , Hematoma/diagnóstico , Hematoma/diagnóstico por imagem , Humanos , Varfarina/efeitos adversos
3.
BMJ Case Rep ; 15(9)2022 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-36109092

RESUMO

We present a case of a patient with recurrent squamous cell cancer of the base of the tongue and right tonsil who developed severe haematemesis. An elongated blood cast of the upper gastrointestinal tract was noted in the emesis. The patient required emergent intubation and blood transfusions. A CT scan with contrast revealed the presence of a pseudoaneurysm of the right lingual artery. Successful control of bleeding was achieved with coil embolisation of the pseudoaneurysm and its feeding artery. This case highlights that oropharyngeal bleeding can mimic gastrointestinal bleeding.


Assuntos
Falso Aneurisma , Trato Gastrointestinal Superior , Falso Aneurisma/complicações , Falso Aneurisma/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Recidiva Local de Neoplasia , Tomografia Computadorizada por Raios X
4.
BMC Pediatr ; 22(1): 522, 2022 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-36056317

RESUMO

BACKGROUND: Large-scale data on esophagogastroduodenoscopy (EGD) in China are scarce. This study aimed to assess the indications and diagnostic yield of EGD in children and the relationship between factors (such as age, sex, and indications) and diagnostic yield. METHODS: We performed a prospective cross-sectional observational study involving patients aged < 18 years who underwent diagnostic EGD. The study was conducted in five children's hospitals, each in a different city. Demographic features, indications for endoscopy, and endoscopic and histopathological findings were collected. Univariable and multivariable ordinal logistic regression analyses of the relationship between the factors and diagnostic yield were performed. RESULTS: The study included 2268 patients (male/female ratio, 1.3:1) with a median age of 8.68 years. Among the 2268 children, the most frequent indications were abdominal pain in 1954 (86.2%), recurrent vomiting in 706 (31.1%), weight loss in 343 (15.1%), and others. The endoscopic yield was 62.5% and was the highest in patients with dysphagia (90.9%). The histologic yield was 30.4% and was the highest in patients with unexplained anemia (45.5%). On multivariable regression analysis, the endoscopic yield was associated with dysphagia, gastrointestinal (GI) bleeding, and recurrent vomiting, and the histologic yield was associated with age. Different groups of patients with abdominal pain had variable probabilities of abnormal endoscopic findings. CONCLUSIONS: The most frequent indication of pediatric EGD is abdominal pain, with variable probabilities of abnormal endoscopic findings in different groups. Endoscopic yield and histologic yield are associated with certain alarming features. TRIAL REGISTRATION: The trial registration number (ClinicalTrials. gov): NCT03603093 (The study was registered on 27/07/2018).


Assuntos
Transtornos de Deglutição , Dor Abdominal/diagnóstico , Criança , China , Estudos Transversais , Endoscopia Gastrointestinal , Feminino , Hemorragia Gastrointestinal/diagnóstico , Humanos , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Vômito
5.
Dtsch Med Wochenschr ; 147(18): 1212-1220, 2022 09.
Artigo em Alemão | MEDLINE | ID: mdl-36070739

RESUMO

Acute gastrointestinal bleeding often leads to admission to the emergency room. Especially in elderly patients and in those with significant comorbidities it is associated with increased morbidity and mortality. Approximately 2 % of the patients with gastrointestinal bleeding present with hemorrhagic shock. This review focusses on the structured preclinical and clinical management of gastrointestinal bleeding in the emergency department.


Assuntos
Serviço Hospitalar de Emergência , Hemorragia Gastrointestinal , Doença Aguda , Fatores Etários , Idoso , Comorbidade , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Humanos
6.
J Int Med Res ; 50(9): 3000605221119662, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36076361

RESUMO

Due to the hypercoagulable status of patients with severe COVID-19 infection, anticoagulants are often used to prevent thrombosis. However, these agents may cause bleeding events such as retroperitoneal hematoma (RPH). We report here on six patients with COVID-19 who developed RPH during treatment. Early evidence of bleeding led to confirmatory diagnosis with imaging. Four patients recovered with supportive treatment (IV fluids and blood transfusions) and two patients recovered by angioembolization. RPH should be considered in COVID patients on anticoagulants as soon as haemoglobin or blood pressure falls. Further studies are required to provide guidance and recommendations on use of anticoagulants in critically ill patients with COVID-19.


Assuntos
COVID-19 , Anticoagulantes/efeitos adversos , COVID-19/complicações , Hemorragia Gastrointestinal/complicações , Hematoma/induzido quimicamente , Hematoma/diagnóstico por imagem , Humanos , Espaço Retroperitoneal/diagnóstico por imagem
9.
Arq Gastroenterol ; 59(3): 365-369, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36102433

RESUMO

BACKGROUND: Suspicion of food protein-induced proctocolitis based on empirical understanding of rectal bleeding can lead to misdiagnosis. OBJECTIVE: to verify clinical and evaluative characteristics of patients who presented neonatal rectal bleeding and were on a restricted cow's milk diet. METHODS: A cross-sectional retrospective study included patients followed up in a tertiary care center, who presented rectal bleeding in the neonatal period. The analyzed data included gender, gestational age, type of delivery, use of antibiotics during the last trimester of pregnancy, use of parenteral nutrition before the first manifestation, use of mechanical ventilation, initial clinical manifestations associated with rectal bleeding, diet before the first manifestation, period of elimination diet, oral food challenge (OFC) results and symptoms presented in cases of positive OFC. Fisher's exact test and Mann-Whitney test were used to analyze the data. The level of significance was set to 5%. RESULTS: Forty-two patients were selected: 30 preterm infants, 34 cesarean deliveries, 10 exclusively breastfed patients before rectal bleeding. Median age at OFC was 6.3 months old. Median of length of the elimination period before OFC was 5.9 months. OFC was negative in 33/42 (79%) patients and positive in 9/42 (21%). There was no association between OFC results and the evaluated data. The main symptom observed in patients with positive OFC was blood in stools. CONCLUSION: OFC was negative in most cases of suspected cow's milk allergy due to rectal bleeding in neonates, most of them with a history of prematurity.


Assuntos
Hipersensibilidade a Leite , Proctocolite , Estudos Transversais , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Hipersensibilidade a Leite/complicações , Hipersensibilidade a Leite/diagnóstico , Proctocolite/complicações , Proctocolite/etiologia , Estudos Retrospectivos
10.
Arq Gastroenterol ; 59(3): 434-438, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36102444

RESUMO

BACKGROUND: In natural history of cirrhosis, variceal bleeding is one of the earliest decompensations to happen, and, if adequately managed, survival is improved. Gastric varices have challenges in management due to their location, size and propensity to bleed. The N-butyl 2-cyanoacrylate (NBC) glue application has emerged as definitive therapy in bleeding gastric varices. Here we present our experience with use of NBC in management of gastric and difficult cases of esophageal varices. METHODS: A total of 75 patients underwent NBC glue application for varices which included 69 patients with gastric varices and six patients with esophageal varices. All the procedures were done with flexible endoscope and sclerotherapy needle after due precautionary measures. RESULTS: Hemostasis was varices in all patients after endotherapy. The average quantity of glue used was 2.75±0.95 mL. Complete obliteration with single session of NBC application was achieved in 55 patients. Re-bleeding occurred in five patients within 5 days of index event. 20 patients had in-hospital mortality but none was related to gastrointestinal bleeding. 6-week all-cause mortality was 26 (35%). CONCLUSION: Glue therapy with NBC is a life saving therapy in patients with bleeding gastric varices and esophageal varices not amenable to endoscopic variceal ligation or sclerotherapy.


Assuntos
Embucrilato , Varizes Esofágicas e Gástricas , Varizes , Cianoacrilatos/uso terapêutico , Embucrilato/uso terapêutico , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Índia , Resultado do Tratamento , Varizes/complicações
11.
Medicine (Baltimore) ; 101(36): e30410, 2022 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-36086775

RESUMO

Few studies have focused on assessing the usefulness of scoring systems such as the Rockall score (RS), Glasgow-Blatchford score (GBS), and AIMS65 score for risk stratification and prognosis prediction in peptic ulcer bleeding patients. This study aimed to assess scoring systems in predicting clinical outcomes of patients with peptic ulcer bleeding. A total of 682 peptic ulcer bleeding patients who underwent esophagogastroduodenoscopy between January 2013 and December 2017 were found eligible for this study. The area under the receiver-operating characteristic curve (AUROC) of each score was calculated for predicting rebleeding, hospitalization, blood transfusion, and mortality. The median age of patients was 64 (interquartile range, 56-75) years. Of the patients, 74.9% were men, and 373 underwent endoscopic intervention. The median RS, GBS, and AIMS65 scores were significantly higher in patients who underwent endoscopic intervention than in those who did not. The AUROC of RS for predicting rebleeding was significantly higher than that of GBS (P = .022) or AIMS65 (P < .001). GBS best predicted the need for blood transfusion than either pre-RS (P = .013) or AIMS65 (P = .001). AIMS65 score showed the highest AUROC for mortality (0.652 vs. 0.622 vs. 0.691). RS was significantly associated with rebleeding (odds ratio, 1.430; P < .001) and overall survival (hazard ratio, 1.217; P < .001). The RS, GBS, and AIMS65 scoring systems are acceptable tools for predicting clinical outcomes in peptic ulcer bleeding. RS is an independent prognostic factor of rebleeding and overall survival.


Assuntos
Hemorragia Gastrointestinal , Úlcera Péptica , Idoso , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Péptica/complicações , Úlcera Péptica/diagnóstico , Úlcera Péptica Hemorrágica/diagnóstico , Úlcera Péptica Hemorrágica/terapia , Medição de Risco , Índice de Gravidade de Doença
12.
Ann Ital Chir ; 112022 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-36065803

RESUMO

Duodenal lipomas are uncommon and rare causes of gastrointestinal bleeding. Here, we present the case of a 45-yearold male patient who was admitted to University Clinical Centre because of melaena. After initial diagnostics, including echosonography, esophagogastroduodenoscopy revealed bleeding from protruding blood vessel at the polypoid submucosal change in the posterior duodenal bulb. Upon two urgent unsuccessful endoscopic hemostasis, a duodenotomy was performed. Definitive diagnosis was based on histological findings, describing duodenal lipoma with Bruner's gland hyperplasia. Upper GI bleeding is a serious challenge that requires adequate diagnostics necessary for the right choice of therapeutic approach. Unsuccessful endoscopic hemostasis could be followed by serious complications in bleeding duodenal lipoma when surgery should be always considered as the treatment of choice in patients with this kind of bleeding tumor. KEY WORDS: Bruner Glands Hyperplasia, Duodenal Lipoma, Upper Gastrointestinal Bleeding.


Assuntos
Hemorragia Gastrointestinal , Lipoma , Duodeno , Hemorragia Gastrointestinal/etiologia , Humanos , Hiperplasia , Lipoma/complicações , Lipoma/diagnóstico por imagem , Lipoma/cirurgia , Masculino , Melena , Pessoa de Meia-Idade
13.
Khirurgiia (Mosk) ; (9): 35-39, 2022.
Artigo em Russo | MEDLINE | ID: mdl-36073581

RESUMO

OBJECTIVE/: To objectify patient condition and improve treatment outcomes in patients with benign severe gastroduodenal bleeding. MATERIAL AND METHODS: We analyzed the immediate results of staged surgical treatment of patients with benign severe gastroduodenal bleeding according to the accepted concept of «Damage Control Surgery¼. The Rockall risk scoring system and the Glasgow-Blatchford score (GBS) were used. We preferred two-stage intervention in patients with Rockall score ≥5 and Glasgow-Blatchford score ≥11. RESULTS: Staged approach according to the concept of «Damage Control Surgery¼ in patients with benign severe gastroduodenal bleeding ensures positive results by minimizing surgical trauma and perioperative bleeding, early stabilization of hemostasis and subsequent successful restoration of digestive function. CONCLUSION: The concept of «Damage Control Surgery¼ in patients with benign severe gastroduodenal bleeding can reduce mortality and incidence of postoperative complications.


Assuntos
Hemorragia Gastrointestinal , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Prognóstico , Medição de Risco/métodos , Índice de Gravidade de Doença , Resultado do Tratamento
14.
Eur J Gastroenterol Hepatol ; 34(10): 1090-1097, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-36062499

RESUMO

BACKGROUND AND AIM: The aim of this study was to evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of portal hypertension caused by schistosomiasis. METHODS: This study included 43 patients with schistosomiasis-induced portal hypertension treated with TIPS in our institution from December 2015 to May 2021. The demographic, imaging, clinical and follow-up data of patients were recorded retrospectively to evaluate the efficacy and safety of the procedure. RESULTS: All patients were successfully implanted with stents to establish shunt, and 90.7% of the patients were in good postoperative condition with no complications. After TIPS, the Yerdel grade of portal vein thrombosis decreased, and the portal pressure gradient decreased from 27.0 ± 4.9 mmHg to 11.3 ± 3.8 mmHg (P < 0.001). Bleeding was effectively controlled, with a postoperative rebleeding rate of 9.3%, which was an 87.9% reduction from the preoperative rate. The cumulative incidence of postoperative refractory ascites, shunt dysfunction, overt hepatic encephalopathy (OHE) and death were all similar to those of TIPS for nonschistosomiasis portal hypertension. There were no differences in liver and kidney function and blood coagulation indexes before and 3 months after TIPS. Albumin was identified as an independent risk factor for mortality after TIPS for schistosomal liver fibrosis. CONCLUSION: TIPS can be used as a well-tolerated and effective treatment for schistosomiasis-induced portal hypertension, effectively reduce portal pressure gradient and improve portal vein thrombosis.


Assuntos
Varizes Esofágicas e Gástricas , Hipertensão Portal , Derivação Portossistêmica Transjugular Intra-Hepática , Esquistossomose , Trombose Venosa , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Estudos Retrospectivos , Esquistossomose/complicações , Esquistossomose/diagnóstico , Esquistossomose/cirurgia , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
15.
BMC Nephrol ; 23(1): 310, 2022 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-36085017

RESUMO

BACKGROUND: Performing percutaneous renal biopsy procedures in lupus nephritis (LN) and nephrotic syndrome presents a unique challenge to the nephrologist because of the risk of bleeding from the procedure and the hypercoagulable state in hypoalbuminemia. The management of a patient with venous thrombosis with perinephric hematoma post renal biopsy can be difficult if occurred. CASE PRESENTATION: We are presenting a case of perinephric hematoma following percutaneous renal biopsy in a 23-year-old man with lupus nephritis, nephrotic syndrome, and lower limbs deep vein thrombosis (DVT). The patient developed persistent frank haematuria, flank pain and acute urinary retention post-procedure. We have withheld his oral warfarin three days before the procedure, and no anticoagulation was given subsequently. Initial CT Angiography (CTA) renal showing stable hematoma and no visible evidence of vascular injury. Three weeks later, the patient still has persistent frank haematuria and a repeated CTA renal revealed new bilateral renal vein thrombosis. Considering the high risk of worsening symptomatic venous thrombosis, we gave subcutaneous enoxaparin sodium and restart oral warfarin despite ongoing haematuria. The frank haematuria resolved within two days of anticoagulation with no radiological evidence of worsening of the perinephric hematoma. The follow-up ultrasonography a month later showed resolution of the hematoma and renal vein thrombosis with no adverse effect. CONCLUSION: Our experience, in this case, highlighted the importance of case selection for percutaneous renal biopsy among high-risk patients. Additionally, a prolonged frank haematuria in post-renal biopsy with nephrotic syndrome warranted a reassessment, as a clinical presentation of post-procedure perinephric hematoma and renal vein thrombosis can overlap. We also demonstrated that restarting anticoagulation earlier than four weeks in a patient with renal vein thrombosis and post-renal biopsy perinephric hematoma can be safe in the selective case.


Assuntos
Nefropatias , Nefrite Lúpica , Síndrome Nefrótica , Doenças Ureterais , Trombose Venosa , Adulto , Biópsia/efeitos adversos , Enoxaparina/análogos & derivados , Hemorragia Gastrointestinal , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematúria/etiologia , Humanos , Nefropatias/complicações , Nefrite Lúpica/complicações , Masculino , Síndrome Nefrótica/complicações , Veias Renais/diagnóstico por imagem , Doenças Ureterais/complicações , Trombose Venosa/complicações , Trombose Venosa/etiologia , Varfarina/efeitos adversos , Adulto Jovem
16.
Crit Care Nurs Clin North Am ; 34(3): 303-309, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36049849

RESUMO

Gastroesophageal variceal (GEV) bleeding is one of the most fatal complications of cirrhosis and can result in increased morbidity and mortality rates. This discussion focuses on management of acute gastrointestinal bleeding caused by esophageal and gastric varices and measures aimed at prevention of an initial or secondary GEV bleed.


Assuntos
Varizes Esofágicas e Gástricas , Hipertensão Portal , Varizes Esofágicas e Gástricas/etiologia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Hipertensão Portal/complicações , Cirrose Hepática/complicações
17.
Med Sci Monit ; 28: e937763, 2022 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-36039028

RESUMO

BACKGROUND Portal hypertension associated with liver cirrhosis can be treated by splenectomy. During splenectomy, the gastrosplenic and the splenorenal ligaments that form the hilar splenic pedicle can be surgically divided by several approaches, with the aim to reduce portal vein thrombosis (PVT) and postoperative pancreatic fistula (PPF). This 12-year retrospective study from a single center aimed to evaluate postoperative outcomes following use of a modified method of surgical division of the splenic pedicle (MSDSP) in 719 patients who underwent splenectomy for portal hypertension (PH). MATERIAL AND METHODS From January 2010 to December 2021, 719 consecutive cirrhotic patients with PH and splenomegaly underwent splenectomy in our department. According to different methods of surgical division of the splenic pedicle, patients were divided into a Control Group (n=349) and a Study Group (n=370). The characteristics of the patients, perioperative indicators, postoperative complications (PVT, PPF and abdominal hemorrhage) and follow-up data were compared between the 2 groups. Propensity score matching was conducted to adjust for differences in preoperative characteristics at a 1: 1 ratio, resulting in 260 patients in each group. RESULTS After PSM was conducted, intraoperative blood loss, PVT, PPF, and hospital stay were decreased significantly in the matched Study Group (all P<0.01). Both groups showed similar results concerning recurrent esophagogastric variceal bleeding and overall survival during the follow-up period. CONCLUSIONS Our MSDSP help to reduce postoperative complications and shorten hospital stay.


Assuntos
Varizes Esofágicas e Gástricas , Hipertensão Portal , Trombose Venosa , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertensão Portal/complicações , Cirrose Hepática/complicações , Cirrose Hepática/cirurgia , Veia Porta , Complicações Pós-Operatórias , Estudos Retrospectivos , Esplenectomia/efeitos adversos , Trombose Venosa/etiologia
18.
Medicina (Kaunas) ; 58(8)2022 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-36013603

RESUMO

Solitary rectal ulcer syndrome (SRUS) is a benign and chronic disorder well known in young adults that is characterized by a series of symptoms such as rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, a feeling of incomplete defecation, constipation and, rarely, rectal prolapse. The etiology of this syndrome remains obscure, and the diagnosis is easily confused with that of other diseases, contributing to difficulties in treatment. We present a case of a 37-year-old male with a nonulcerated rectal lesion grossly resembling a superficial depressed rectal cancer misdiagnosed in another hospital and describe its appearance on endoscopy and in the analysis of its pathological manifestations. The aim of this case report is to report an easily misdiagnosed case of SRUS, which needs to be distinguished from superficial rectal cancer, which should be educational for endoscopists.


Assuntos
Doenças Retais , Neoplasias Retais , Adulto , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Doenças Retais/complicações , Doenças Retais/diagnóstico , Doenças Retais/patologia , Neoplasias Retais/complicações , Neoplasias Retais/diagnóstico , Neoplasias Retais/patologia , Reto , Úlcera/diagnóstico , Úlcera/patologia , Úlcera/terapia
19.
Medicine (Baltimore) ; 101(31): e29636, 2022 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-35945721

RESUMO

RATIONALE: Upper gastrointestinal hemorrhage (UGIH) is defined as hemorrhage originating from the gastrointestinal tract proximal to the ligament of Treitz. The causes of UGIH include esophagitis, gastritis, peptic ulcers, Mallory-Weiss syndrome, and cancer. However, a rare cause of UGIH, such as an accessory spleen, may lead to serious complications if left untreated and can sometimes be very difficult to diagnose preoperatively. PATIENT CONCERNS: An 18-year-old man was admitted to the Department of Gastroenterology of our hospital due to "repeated black stool for 2 months with aggravation, accompanied by hematemesis for 9 days." He denied any history of hepatitis, trauma, or surgery. DIAGNOSIS: Laboratory evaluation revealed severe anemia (hemoglobin, 6.4 g/dL). Computed tomography revealed a mass measuring 127 mm in its largest dimension, located in the upper left abdomen, with varicose veins in the gastric fundus. Moreover, distended blue-purple tortuous veins were observed by gastroscopy in the gastric fundus. We believed the mass was likely an abnormally proliferating accessory spleen; however, the causes of severe anemia and gastrointestinal hemorrhage were unknown. INTERVENTIONS: After discussion in a multidisciplinary conference, the mass was completely resected laparoscopically, and the subserosal veins in the gastric fundus were sutured using absorbable threads. OUTCOMES: After the surgery, the patient recovered uneventfully without any complications. Clinicopathological examination showed that the mass was chronic congestive splenomegaly. Gastrointestinal hemorrhage secondary to an abnormally proliferating accessory spleen was confirmed as the diagnosis. Laboratory evaluation revealed hemoglobin at 12.1 g/dL 2 months after surgery. At the 12-month follow-up, the patient showed no recurrence of gastrointestinal hemorrhage. LESSONS: UGIH caused by accessory spleen is extremely rare. This entity should be considered in differential diagnosis of gastrointestinal hemorrhage. Surgical intervention is necessary for timely diagnosis and treatment in case of gastrointestinal hemorrhage in critical clinical situations.


Assuntos
Anormalidades do Sistema Digestório , Síndrome de Mallory-Weiss , Esplenopatias , Adolescente , Anormalidades do Sistema Digestório/complicações , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Hematemese/etiologia , Humanos , Masculino , Síndrome de Mallory-Weiss/complicações , Esplenopatias/complicações
20.
Medicine (Baltimore) ; 101(31): e29342, 2022 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-35945735

RESUMO

We evaluated clinical outcome and prognostic factors predicting mortality of transcatheter arterial embolization (TAE) for acute gastrointestinal (GI) bleeding. Fifty-nine patients (42 men, 17 women; mean age 66.1 ± 17.0) who underwent 59 TAE procedures for GI bleeding during 2013-2018 were retrospectively evaluated. Clinical outcomes included technical success, adverse events, and rebleeding and mortality rate within 30 days. The technical success rate was 100%. Angiography showed contrast extravasation in 41 (69.5%) patients and indirect signs of bleeding in 16 (27.1%) patients. Two (3.4%) patients underwent prophylactic embolization. TAE-related adverse events occurred in 7 (11.9%) patients; adverse events were more common for mid GI or lower GI bleeding than for upper GI bleeding (22.6% vs 0%, P = 0.007). Rebleeding within 30 days was observed in 22 (37.3%) patients after TAE. Coagulopathy was a prognostic factor for rebleeding (odds ratio [OR] = 3.53, 95% confidence interval 1.07-11.67, P = .038). Mortality within 30 days occurred in 11 (18.6%) patients. Coagulopathy (OR = 24, 95% confidence interval 2.56-225.32, P = .005) was an independent prognostic factor for mortality within 30 days. TAE is an effective, safe, and potentially lifesaving procedure for GI bleeding. If possible, coagulopathy should be corrected before TAE as it may reduce rebleeding and mortality.


Assuntos
Embolização Terapêutica , Hemorragia Gastrointestinal , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
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