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1.
Yonsei Med J ; 62(2): 182-186, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33527799

RESUMO

Fever is a common complication of endoscopic variceal obturation (EVO) therapy for gastric variceal bleeding. However, fungemia related to EVO therapy has not yet been reported. Herein, we report two cases of post-EVO fungemia in cirrhotic patients who underwent therapeutic EVO for gastric variceal bleeding. Both patients developed sustained high fever after repeated EVO procedures while on prophylactic antibiotic use. In both patients, blood cultures revealed yeast, and they were finally diagnosed with Candida infection. Candida is a common member of the intestinal flora; however, it can cause invasive infection with consequent poor prognosis in cirrhotic patients. The route of Candida invasion is unclear; however, repeated EVO may predispose patients to Candida infection, particularly those who are in the end stage of liver disease and receiving prophylactic antibiotics. Our cases highlight that repeated invasive procedures can increase the risk of fungal infections, and fungemia should be considered in the differential diagnosis of post-EVO fever.


Assuntos
Endoscopia/efeitos adversos , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/cirurgia , Fungemia/etiologia , Hemorragia Gastrointestinal/cirurgia , Feminino , Fungemia/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade
2.
BMJ Case Rep ; 14(2)2021 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-33568413

RESUMO

Cocaine, an alkaloid, is an addictive drug and its abuse as a recreational drug is on the increasing side with its associated complications. Gastrointestinal complications, after cocaine abuse, are less known and need to be addressed since the abuse is on the rise and the existing evidence is scarce. We report a case of a 22-year-old male patient who presented with abdominal pain following a cocaine injection. On examination, signs of peritonitis were noted and laparotomy revealed a 2×1 cm perforation in the distal ileum. The unhealthy intestinal segment was resected and taken out as a double-barrel ileostomy. The patient had an episode of severe lower gastrointestinal bleeding on postoperative day 6. CT and colonoscopy revealed signs of ischaemic bowel and tissue biopsy showed oedematous, inflamed and haemorrhagic bowel mucosa. The patient was managed conservatively and is doing well under follow-up in a de-addiction centre.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/cirurgia , Perfuração Intestinal/induzido quimicamente , Perfuração Intestinal/cirurgia , Doenças Raras/diagnóstico , Doenças Raras/cirurgia , Adulto , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
3.
BMJ Case Rep ; 14(1)2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33408109

RESUMO

An 85-year-old man with Child-Pugh A cirrhosis secondary to non-alcoholic steatohepatitis presented to casualty with four days of painless haematochezia with dark blood without haemodynamic compromise. This was in the setting of receiving stereotactic body radiation therapy (SBRT) as treatment for his hepatocellular carcinoma (HCC).He was found to have haemorrhagic radiation colitis which was treated with argon plasma coagulation (APC). Our case demonstrates the importance of considering radiation induced colitis as a cause for painless lower gastrointestinal bleeding in patients with a background of radiation therapy for HCC. Earlier review of the imaging and consideration of this differential could have prevented the need for repeat hospitalisations and would have led to prompt colonoscopy and diagnosis.


Assuntos
Carcinoma Hepatocelular/radioterapia , Colite/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Neoplasias Hepáticas/radioterapia , Lesões por Radiação/diagnóstico , Radiocirurgia/efeitos adversos , Idoso de 80 Anos ou mais , Coagulação com Plasma de Argônio , Biópsia , Carcinoma Hepatocelular/patologia , Colite/etiologia , Colite/patologia , Colite/cirurgia , Colo/diagnóstico por imagem , Colo/patologia , Colo/efeitos da radiação , Colo/cirurgia , Colonoscopia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Neoplasias Hepáticas/patologia , Masculino , Lesões por Radiação/etiologia , Lesões por Radiação/cirurgia , Tomografia Computadorizada por Raios X
4.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370938

RESUMO

A 31-year-old woman with hepatocellular carcinoma suffered from recurrent oesophageal variceal bleeding due to portal hypertension, which was caused by severe compression of the portal vein by metastatic lymph nodes. Endoscopic band ligation and pharmacological treatment did not suffice to prevent recurrence of variceal bleeding. Eventually, after the fifth variceal bleeding within 6 months, the patient was admitted to the intensive care unit in a haemodynamic shock. A Sengstaken-Blakemore tube was inserted and all treatment options were discussed, but only percutaneous transhepatic recanalisation of the portal vein with stent placement to reduce portal vein pressure was thought to be feasible with any chance to relieve portal vein pressure. After successful portal vein stenting, our patient did not have any recurrent bleeding in the remaining year of her life. We suggest that percutaneous transhepatic portal vein stenting may be a feasible and adequate last line treatment for complications of portal hypertension.


Assuntos
Carcinoma Hepatocelular/complicações , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/cirurgia , Neoplasias Hepáticas/complicações , Prevenção Secundária/métodos , Choque Hemorrágico/cirurgia , Adulto , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/etiologia , Esofagoscopia , Esôfago/irrigação sanguínea , Esôfago/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Humanos , Veia Porta/cirurgia , Recidiva , Prevenção Secundária/instrumentação , Choque Hemorrágico/etiologia , Stents , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
Acta Gastroenterol Belg ; 83(3): 373-380, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33094582

RESUMO

Endoscopic variceal ligation (EVL) has been the standard treatment for acute variceal bleeding (AVB). However, reports of long-term prognosis after EVL are scarce. Therefore, the current work aimed to investigate the long-term outcome and prognostic modifiers of cirrhotic cases presented with acute esophageal variceal bleeding and managed with EVL. The current prospective work comprised primarily 276 consecutive grown-up cirrhotic cases presenting with AVB and managed with EVL. Two-hundred patients who completed the study till death or 3-year follow-up were enrolled in final analysis. The primary outcome measure was occurrence of rebleeding and all-cause mortality. By the end of follow up 56 patients (28%) developed rebleeding and 78 (39%) died. The independent factors associated with rebleeding were lacking follow up EVL (OR: 4.8, 95%CI: 1.9-12.2), BMI > 30 kg/m2 (OR: 0.-, 95%CI: 0.2-0.9), Child class C (OR: 3.8, 95%CI: 1.8-7.8), and grade IV varices (OR: 2.6, 95%CI: 1.3-5.3). The independent factors associated with mortality were: Age > 65 years (OR: 32.4, 95%CI: 8.7-120.3), rebleeding (OR: 98.4, 95%CI: 27.9-347.0), coexistence of HCC (OR: 7.4, 95%CI: 2.0-27.4), and lacking follow up EVL (OR: 6.1, 95%CI: 1.2-31.1). Recurrent bleeding after emergency endoscopic ligation of acute esophageal variceal bleeding in cirrhotic cases is a rather common complication that significantly increases the mortality rate. The liver condition, lack of follow up endoscopy, old age, and severity of esophageal varices are independent prognostic indicator of rebleeding and morality.


Assuntos
Carcinoma Hepatocelular , Varizes Esofágicas e Gástricas , Neoplasias Hepáticas , Criança , Endoscopia , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Cirrose Hepática/complicações
6.
Angiol Sosud Khir ; 26(3): 108-114, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063757

RESUMO

An aorto-oesophageal fistula is a rare but life-threatening pathological condition developing on the background of diseases of the aorta and oesophagus, as well as after surgical interventions on the aorta. The article deals with a clinical case report regarding management of a patient presenting with an aorto-oesophageal fistula resulting from a thoracic artery aneurysm. The main clinical manifestations of the diseases included dysphagia (due to oesophageal obstruction caused by thrombotic masses of the aneurysm) and the occurring gastrointestinal haemorrhage. Comprehensive instrumental diagnosis was performed using roentgen examination of the oesophagus, oesophagoscopy, and contrast-enhanced computed tomography of the chest. The obtained findings made it possible to objectively assess the patient's state, to carry out timely treatment in conditions of a surgical hospital, and to avoid severe complications.


Assuntos
Aneurisma da Aorta Torácica , Doenças da Aorta , Fístula Esofágica , Fístula Vascular , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Doenças da Aorta/diagnóstico , Doenças da Aorta/cirurgia , Fístula Esofágica/diagnóstico , Fístula Esofágica/etiologia , Fístula Esofágica/cirurgia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Fístula Vascular/diagnóstico , Fístula Vascular/etiologia , Fístula Vascular/cirurgia
7.
Am Surg ; 86(9): 1049-1055, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33049164

RESUMO

Dr Dean Warren was born in 1924 and died prematurely from cancer in 1989. He was a man of uncommon intelligence, wit, collegiality, integrity, honesty, and a true leader in American surgery. In 1966, he and his colleagues (Drs Zeppa and Fomon) presented a new concept for surgical shunts to control variceal hemorrhage while maintaining portal perfusion or hepatopetal blood flow. He termed this new shunt the distal splenorenal shunt (DSRS), which was the first selective shunt invented. The DSRS selective shunt was a brilliant improvement over the total shunt concept proposed by Nicolai Eck and was practiced worldwide during the 1980s. In a space of 2 decades, Dr Warren's pioneering work would show that the selective DSRS was superior to total shunts for treatment of portal hypertension, but that endoscopic sclerotherapy was a better first-line treatment for variceal hemorrhage than his own creation. His absolute adherence to the principles he espoused in his presidential address to the Society for Surgery of the Alimentary Tract in 1973 were employed in his research and treatment of patients. This paper details Dr Warren's extraordinary research accomplishments and sets a lesson for us that well-designed clinical trials including randomization are essential in the advancement of the care of surgical patients.


Assuntos
Varizes Esofágicas e Gástricas/história , Hemorragia Gastrointestinal/história , Derivação Esplenorrenal Cirúrgica/história , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , História do Século XX , Humanos , Estados Unidos
9.
Z Gastroenterol ; 58(9): 877-889, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32947633

RESUMO

For 30 years the transjugular intrahepatic portosystemic shunt (TIPS) is successfully used for the treatment of portal hypertension. Indication for TIPS in relation to variceal bleeding and refractory ascites is scientifically documented and defined by national and international guidelines. For rare indications such as hepatorenal syndrome, portal vein thrombosis or the neodjuvant TIPS larger evidence-based studies are missing. An important contraindication and the leading clinical complication after TIPS is the development of hepatic encephalopathy (HE). Reduction of post-TIPS HE is therefore aimed through development of further technical enhancements of the TIPS-stents.


Assuntos
Varizes Esofágicas e Gástricas , Hipertensão Portal/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/cirurgia , Encefalopatia Hepática/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
12.
Tokai J Exp Clin Med ; 45(2): 75-80, 2020 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-32602105

RESUMO

CASE PRESENTATION: The patient was a 72-year-old man who consulted with his previous physician for chief complaints of palpitations, fatigue, and blackish feces persisting for 1 month. After confirming the presence of anemia, the patient was referred to our hospital. Blood test findings upon hospital arrival revealed a hemoglobin (Hb) level of 6.0 g/dL. Computed tomography revealed a tumor of 32 mm × 30 mm with a low-density area extending from the bulb to the second part of the duodenum. Magnetic resonance imaging revealed high signal intensity on T1- and T2-weighted imaging and low signal intensity on fat-suppressed T2-weighted imaging, findings consistent with lipoma. Upper gastrointestinal endoscopy revealed a yellowish submucosal tumor that had perforated into the intestinal tract from the external wall extending from the upper corner to the second part of the duodenum. After determining that the tumor was sessile, laparoscopic partial duodenectomy with Roux-en-Y reconstruction was planned and performed. Pathology revealed a yellowish tumor 4 cm × 4 cm in size extending from the pyloric area to the duodenal bulb arising from the tunica muscularis. The present case report details our experience involving a patient who underwent surgical resection for hemorrhagic duodenal lipoma.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Duodenopatias/cirurgia , Neoplasias Duodenais/cirurgia , Duodeno/cirurgia , Hemorragia Gastrointestinal/cirurgia , Laparoscopia/métodos , Lipoma/cirurgia , Idoso , Anastomose em-Y de Roux , Imagem de Difusão por Ressonância Magnética , Duodenopatias/patologia , Neoplasias Duodenais/diagnóstico por imagem , Neoplasias Duodenais/patologia , Duodeno/patologia , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/patologia , Humanos , Lipoma/diagnóstico por imagem , Lipoma/patologia , Masculino
13.
PLoS One ; 15(6): e0234417, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574171

RESUMO

INTRODUCTION: Jejunoileal diverticular haemorrhage is a rare disease that is difficult to diagnose and treat. Despite advances in endoscopic technology, recommendations on diagnosis and management for jejunoileal diverticular haemorrhage have remained unchanged and these new options have not been compared against traditional surgical management. MATERIALS AND METHODS: We retrospectively reviewed the diagnosis, management, and outcome for jejunoileal diverticular haemorrhage cases at our institution over the past 20 years. Data were organized and analysed by chi-square test, student t-test and Kaplan-Meier survival analysis. RESULTS: The most utilised diagnostic procedure was computed tomography, followed by enteroscopy, angiography, small bowel flow-through and surgery. Primary treatments included, in a decreasing order, medical therapy, surgery, endoscopy and radiology. Surgical treatment was not associated with rebleeding, but it did result in longer hospital stays and larger blood transfusions than non-surgical treatments. The bleeding-related mortality rate was very low. Notably, there was also little change in the diagnosis and treatment between decades. CONCLUSION: We presented our experience with the diagnosis and management of jejunoileal diverticular haemorrhage, as well as long-term follow-up after treatments that have not been reported previously. Surgical treatment continues to dominate management for jejunoileal diverticular haemorrhage, but we support increasing the role of endoscopy for select patient groups.


Assuntos
Divertículo/diagnóstico , Divertículo/terapia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Doenças do Íleo/diagnóstico , Doenças do Íleo/terapia , Doenças do Jejuno/diagnóstico , Doenças do Jejuno/terapia , Idoso , Idoso de 80 Anos ou mais , Angiografia , Técnicas de Diagnóstico do Sistema Digestório/tendências , Divertículo/cirurgia , Endoscopia Gastrointestinal , Feminino , Hemorragia Gastrointestinal/cirurgia , Humanos , Doenças do Íleo/cirurgia , Doenças do Jejuno/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taiwan , Tomografia Computadorizada por Raios X
14.
Medicine (Baltimore) ; 99(18): e19836, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358354

RESUMO

INTRODUCTION: Acute hemorrhagic rectal ulcer (AHRU) is a rare entity which has most frequently been described in Japan and Taiwan literature. This study characterizes 11 AHRUs identified and managed at an urban acute care hospital in the United States of America (USA). METHODS: A total of 2253 inpatients underwent colonoscopy. In 1172 patients (52%), colonoscopy was performed for evaluation of lower gastrointestinal (LGI) bleeding. Eleven (0.9%) of the 1172 patients with LGI bleeding had AHRU. RESULTS: AHRU is characterized by a sudden onset of painless and massive lower rectal bleeding in elderly, bedridden patients (pts) with major underlying diseases. The endoscopic findings were classified into 4 types. All 11 ulcers were located in the distal rectum within 10 cm of the dentate line. All 11 patients required blood transfusion (mean = 3.7 units; range 2-9 units). Seven patients responded to blood, plasma, and platelet transfusions. The other 4 patients required endoscopic hemostasis.Three patients died within a month of colonoscopy from comorbidities. None had bleeding as a cause of death. Eight surviving patients did not have recurrent bleeding. CONCLUSION: AHRU does exist in the USA and should be considered as an important cause of acute lower GI bleeding in elderly, critically ill, and bedridden patients. AHRU should be recognized and managed correctly.


Assuntos
Colonoscopia/estatística & dados numéricos , Hemorragia Gastrointestinal/cirurgia , Hemostase Endoscópica/métodos , Doenças Retais/cirurgia , Úlcera/cirurgia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hospitais Urbanos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Retais/diagnóstico , Reto/irrigação sanguínea , Reto/cirurgia , Úlcera/diagnóstico , Estados Unidos
15.
Am J Emerg Med ; 38(7): 1541.e1-1541.e2, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32224041

RESUMO

Meckel's diverticulum classically follows the rule of two's; presenting before the age of two years, found 2 ft. from the ileocecal valve, approximately 2 in. in length, and present in roughly 2% of the population. To our knowledge, there are few cases detailing emergent medicine management of hemorrhagic shock in patients with acute blood loss from a Meckel's diverticulum. We report the case of a 13-year-old male presenting in hemorrhagic shock secondary to an undifferentiated gastrointestinal bleed who was effectively resuscitated in a children's emergency department. Meckel's scan revealed abnormal tracer uptake consistent with Meckel's diverticulum and the patient underwent surgical resection of the diverticulum. This case report details the importance of prompt recognition and appropriate volume resuscitation in a pediatric patient suffering from hemorrhagic shock. Emergency medicine physicians should maintain an index of suspicion for Meckel's diverticulum in any pediatric patient presenting with undifferentiated gastrointestinal hemorrhage.


Assuntos
Hemorragia Gastrointestinal/etiologia , Divertículo Ileal/diagnóstico , Choque Hemorrágico/etiologia , Adolescente , Hemorragia Gastrointestinal/cirurgia , Humanos , Masculino , Divertículo Ileal/cirurgia , Choque Hemorrágico/cirurgia
17.
Rev. esp. enferm. dig ; 112(4): 249-257, abr. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-187502

RESUMO

INTRODUCTION: the aim of this study was to determine the risk factors for rebleeding following device-assisted enteroscopy therapy of small bowel vascular lesions. METHODS: this is a systematic review and meta-analysis. A literature search was performed from January 2003 to October 2019. All studies reporting on at least one risk factor for bleeding recurrence after endoscopic therapy of small bowel vascular lesions were included. A meta-analysis of those risk factors reported in at least three studies was performed to assess their association with rebleeding. The OR and 95 % CI were used for binary outcome data. Heterogeneity analysis was performed using the Tau and I2 index. If I2 > 20 %, potential sources of heterogeneity were identified by sensitivity analyses and a random-effect model was used. RESULTS: the search identified a total of 572 articles and 35 full-text records were assessed for eligibility after screening. Finally, eight studies that included 548 patients were selected. The overall median rebleeding rate was 38.5 % (range: 10.9-53.3 %) with a median follow-up of 24.5 months. Female sex (OR: 1.96, 95 % CI: 1.14-3.37, p = 0.01, I2 = 0 %), Osler-Weber syndrome (OR: 4.35, 95 % CI: 1.22-15.45, p = 0.02, I2 = 0 %) and cardiac disease (OR: 1.89, 95 % CI: 1.12-2.97, p = 0.005, I2: 0 %) were associated with rebleeding. According to the sensitivity analysis, overt bleeding (OR: 2.13, 95 % CI: 1.22-3.70, p = 0.007, I2 = 0 %), multiple lesions (OR: 4.57, 95 % CI: 2.04-10.22, p < 0.001, I2 = 0 %) and liver cirrhosis (OR: 2.61, 95 % CI: 1.11-6.13, p = 0.03, I2 = 0 %) were also predictors for rebleeding. CONCLUSIONS: patient characteristics and comorbidities should be considered for follow-up patient management after effective device-assisted endoscopic therapy, as they can predict rebleeding


No disponible


Assuntos
Humanos , Enteroscopia de Balão/métodos , Hemorragia Gastrointestinal/cirurgia , Enteropatias/cirurgia , Intestino Delgado/cirurgia , Intestino Delgado/irrigação sanguínea , Enteroscopia de Balão/efeitos adversos , Fatores de Risco , Recidiva
18.
Rev. esp. enferm. dig ; 112(4): 258-261, abr. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-187503

RESUMO

INTRODUCCIÓN: la insuflación de dióxido de carbono (CO2) durante la enteroscopia reduce el tiempo del procedimiento y los síntomas posteriores al mismo e incrementa la profundidad de inserción comparado con aire ambiente. En colonoscopia, la técnica de intercambio de agua (IA) se asocia a menor dolor en comparación con la insuflación de CO2. La técnica IA no está bien estudiada en enteroscopia. El objetivo de este estudio es comparar la seguridad y eficacia de la enteroscopia con IA y la enteroscopia con CO2. MÉTODOS: estudio prospectivo, comparativo y observacional, que incluyó enteroscopias de doble balón (EDB) que fueron aleatorizadas en dos grupos: el primero con IA y el segundo con insuflación de CO2. Los datos recopilados se evaluaron mediante análisis univariado y una regresión logística múltiple (variables con p ≤ 0.10 en análisis univariado). RESULTADOS: se incluyeron 46 EDB (23 por brazo; mediana de edad 63,5 años, 37% mujeres). No hubo diferencias estadísticas en la vía de acceso, los hallazgos, la terapéutica y las complicaciones entre grupos. Cuatro pacientes (20%) en el grupo de CO2 tuvieron eventos adversos (distensión abdominal y dolor) y uno en el grupo IA (náuseas) sin diferencia estadística. La mediana de profundidad de inserción fue mayor en el grupo de CO2 (260 cm vs. 160 cm; p = 0,048). La regresión logística múltiple mostró una diferencia estadística en la profundidad de inserción utilizando insuflación de CO2 (OR 1,009, 1,001-1,017; p = 0,034). CONCLUSIONES: las EDB con técnica de insuflación de CO2 y con IA son seguras con una mayor profundidad de inserción con CO2


No disponible


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Ciências da Saúde , Enteroscopia de Balão/métodos , Dióxido de Carbono/administração & dosagem , Hemorragia Gastrointestinal/cirurgia , Água/administração & dosagem , Enteroscopia de Balão/efeitos adversos , Resultado do Tratamento , Estudos Prospectivos , Insuflação/métodos
19.
Rev. esp. enferm. dig ; 112(4): 262-268, abr. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-187504

RESUMO

BACKGROUND: data on the long-term outcome of patients with obscure gastrointestinal bleeding (OGIB) with positive small bowel findings in capsule endoscopy but negative small bowel findings in device-assisted enteroscopy are scarce. OBJECTIVE: this study aimed to evaluate the rebleeding rate and time to rebleed in patients with no small bowel findings in enteroscopy, after a positive capsule endoscopy in the setting of OGIB. Baseline predictors for rebleeding were assessed. METHODS: a retrospective double-center study was performed, including patients with OGIB with positive findings by capsule endoscopy and negative small bowel findings by enteroscopy. RESULTS: thirty-five patients were included. Rebleeding occurred in 40 % of patients during a median follow-up of 27 months. Further evaluation in patients with a rebleed was performed in 85.7 %, leading to a final diagnosis in 78.6 %. The rebleeding rate increased progressively over time, from 17.2 % at one month to 54.4 % at four years. Overt bleeding at the time of the first episode was a predictor of rebleeding (p = 0.03) according to the multivariate analysis. This was 50 % at one year compared with 21.8 % in patients with occult bleeding on admission. CONCLUSIONS: in obscure gastrointestinal bleeding, long-term follow-up and further evaluation may be considered after a positive capsule endoscopy. Even if there are no small bowel findings by device-assisted enteroscopy. The rebleeding rate in our study was 40 %, mainly in the presence of an overt bleeding on admission


No disponible


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/cirurgia , Enteroscopia de Balão , Recidiva , Endoscopia por Cápsula , Estudos Retrospectivos , Fatores de Risco
20.
Rev. esp. enferm. dig ; 112(4): 269-272, abr. 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-187505

RESUMO

INTRODUCCIÓN: la lesión de Dieulafoy en intestino delgado es una causa infrecuente de hemorragia digestiva que recidiva frecuentemente tras su tratamiento endoscópico. MATERIAL Y MÉTODOS: se presenta un estudio observacional, descriptivo, retrospectivo y unicéntrico de 15 pacientes con hemorragia de intestino delgado, diagnosticados de lesión de Dieulafoy con cápsula endoscópica o enteroscopia doble balón, en los que se realizó tratamiento endoscópico combinado. Resultados y conclusiones: durante una mediana de seguimiento de 33,5 meses (rango 2-145), recidivaron tres de los 12 casos que se pudieron seguir (25 %) y todos ocurrieron precozmente en las primeras 48 horas tras la terapéutica. Se retrataron con éxito dos de ellos con una nueva enteroscopia


No disponible


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Intestino Delgado/irrigação sanguínea , Intestino Delgado/cirurgia , Hemorragia Gastrointestinal/cirurgia , Recidiva , Estudos Retrospectivos , Enteroscopia de Duplo Balão , Endoscopia por Cápsula , Seguimentos
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