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1.
BMC Gastroenterol ; 21(1): 343, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488642

RESUMO

BACKGROUND: Hereditary hemorrhagic telangiectasia is an autosomal dominant hereditary hemorrhagic disease. Its main feature is an abnormal structure of the blood vessel wall. Cirrhosis of the liver is a common chronic progressive disease with one or more causes in which diffuse liver damage occurs after long-term or repeated injury. Liver cirrhosis can cause dilation of gastrointestinal capillaries. Many patients with hereditary hemorrhagic telangiectasia accompanied by gastrointestinal vascular malformations and liver cirrhosis may be diagnosed only with liver cirrhosis if the clinician does not pay attention to physical examination findings and family history. Moreover, general treatment measures, such as blood transfusion, iron supplementation, and application of hemostatic drugs, are less effective for bleeding in patients with hereditary hemorrhagic telangiectasia than in those with liver cirrhosis alone. CASE PRESENTATION: Here, we report the rare case of a 75-year-old Chinese man who was admitted to the hospital with repeated melena and epistaxis. He was diagnosed with unexplained liver cirrhosis, which was later confirmed as hereditary hemorrhagic telangiectasia. Subsequently, we implemented the treatment intervention of oral thalidomide combined with gastrointestinal argon plasma coagulation. A follow-up of more than 8 months showed that the treatment effect was excellent. CONCLUSIONS: If patients with liver cirrhosis and gastrointestinal vascular malformations also have a family history of epistaxis, special attention should be paid to targeted physical examination results, and the possibility of hereditary hemorrhagic telangiectasia should be considered. Moreover, for patients with hereditary hemorrhagic telangiectasia and both gastrointestinal bleeding caused by gastrointestinal capillaries and repeated epistaxis, when other general treatment measures are ineffective, thalidomide combined with gastrointestinal argon plasma coagulation may be an effective intervention.


Assuntos
Telangiectasia Hemorrágica Hereditária , Idoso , Epistaxe/etiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Cirrose Hepática , Masculino , Telangiectasia Hemorrágica Hereditária/complicações , Telangiectasia Hemorrágica Hereditária/terapia
2.
BMJ Case Rep ; 14(9)2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34497057

RESUMO

A Dieulafoy's lesion is a rare cause of massive gastrointestinal (GI) bleeding. It represents an abnormally dilated submucosal artery that erodes the overlying epithelium in the absence of a primary ulcer. These lesions are usually located in the stomach, nevertheless, they have been found in all areas of the GI tract, including the oesophagus, duodenum and colon. Bleeding episodes are often self-limited, although bleeding can be recurrent and profuse. The case describes a 50-year-old woman who developed haemorrhagic shock secondary to a rectal Dieulafoy's lesion and discusses the diagnostic and therapeutic approaches.


Assuntos
Hemorragia Gastrointestinal , Reto , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Pessoa de Meia-Idade , Estômago , Úlcera
4.
Can J Gastroenterol Hepatol ; 2021: 2534975, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34513750

RESUMO

The novel coronavirus disease 2019 (COVID-19) has been reported to affect the gastrointestinal system with a variety of symptoms, including bleeding. The prevalence of bleeding in these patients remains unclear. The aim of this meta-analysis is to estimate the rate of gastrointestinal bleeding in COVID-19 patients and its association with mortality. MEDLINE and Embase were searched through December 20, 2020. Studies reporting COVID-19 patients with and without gastrointestinal bleeding were included. Estimated prevalence with 95% confidence intervals (CI) was pooled; heterogeneity was expressed as I 2. Metaregression analysis was performed to assess the impact of confounding covariates. Ten studies met the inclusion criteria and were included in the analysis. A total of 91887 COVID-19 patients were considered, of whom 534 reported gastrointestinal bleeding (0.6%) [409 (76.6%) upper and 121 (22.7%) lower gastrointestinal bleeding (UGIB and LGIB, resp.)]. The overall pooled gastrointestinal bleeding rate was 5% [95% CI 2-8], with high heterogeneity (I 2 99.2%); "small study effect" was observed using the Egger test (p=0.049). After removing two outlier studies, the pooled bleeding rate was 2% [95% CI 0-4], with high heterogeneity (I 2 99.2%), and no "small study effect" (p=0.257). The pooled UGIB rate was 1% (95% CI 0-3, I 2 98.6%, p=0.214), whereas the pooled LGIB rate was 1% (95% CI 0-2, I 2 64.7%, p=0.919). Metaregression analysis showed that overall estimates on gastrointestinal bleeding were affected by studies reporting different sources of bleeding. No significant association between gastrointestinal bleeding and mortality was found. In this meta-analysis of published studies, individuals with COVID-19 were found to be at risk for gastrointestinal bleeding, especially upper gastrointestinal bleeding.


Assuntos
COVID-19 , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Prevalência , SARS-CoV-2
5.
JNMA J Nepal Med Assoc ; 59(239): 706-708, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34508492

RESUMO

Arteriovenous malformations in the ileum are a rare cause of gastrointestinal bleeding in young adults with few reported cases and pose difficulty in diagnosing. They usually present with chronic gastrointestinal bleed. A 30-year-old woman presented with an acute episode of hematochezia with a history of intermittent melena for 1.5 years. Complete blood count revealed a low hemoglobin level of 3.5g/dl and hypochromic microcytic anemia. Oesophago-gastro-duodenoscopy was normal; however, a colonoscopy revealed the terminal ileum and colon filled with blood. Computed tomography-Angiogram showed local intraluminal contrast extravasation in the ileum. Explorative laparotomy and on-table enteroscopy were performed identifying a small elevated, pigmented, and eroded mucosa (5 to 6 mm) in proximal ileum; resection and primary anastomosis were performed. The patient was followed after surgical resection and her symptoms improved dramatically with no additional episodes of melena and with the normalization of hemoglobin.


Assuntos
Malformações Arteriovenosas , Hemorragia Gastrointestinal , Adulto , Malformações Arteriovenosas/diagnóstico , Malformações Arteriovenosas/diagnóstico por imagem , Endoscopia Gastrointestinal , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Íleo/diagnóstico por imagem , Íleo/cirurgia , Melena/etiologia
6.
BMJ Open ; 11(9): e044117, 2021 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493500

RESUMO

OBJECTIVE: To investigate the incidence of gastrointestinal bleeding (GIB) in patients with acute myocardial infarction (AMI), clarify the association between adverse clinical outcomes and GIB and identify risk factors for in-hospital GIB after AMI. DESIGN: Retrospective cohort study. SETTING: 108 hospitals across three levels in China. PARTICIPANTS: From 1 January 2013 to 31 August 2014, after excluding 2659 patients because of incorrect age and missing GIB data, 23 794 patients with AMI from 108 hospitals enrolled in the China Acute Myocardial Infarction Registry were divided into GIB-positive (n=282) and GIB-negative (n=23 512) groups and were compared. PRIMARY AND SECONDARY OUTCOME MEASURES: Major adverse cardiovascular and cerebrovascular events (MACCEs) are a composite of all-cause death, reinfarction and stroke. The association between GIB and endpoints was examined using multivariate logistic regression and Cox proportional hazards models. Independent risk factors associated with GIB were identified using multivariate logistic regression analysis. RESULTS: The incidence of in-hospital GIB in patients with AMI was 1.19%. GIB was significantly associated with an increased risk of MACCEs both in-hospital (OR 2.314; p<0.001) and at 2-year follow-up (HR 1.407; p=0.0008). Glycoprotein IIb/IIIa (GPIIb/IIIa) receptor inhibitor, percutaneous coronary intervention (PCI) and thrombolysis were novel independent risk factors for GIB identified in the Chinese AMI population (p<0.05). CONCLUSIONS: GIB is associated with both in-hospital and follow-up MACCEs. Gastrointestinal prophylactic treatment should be administered to patients with AMI who receive primary PCI, thrombolytic therapy or GPIIb/IIIa receptor inhibitor. TRIAL REGISTRATION NUMBER: NCT01874691.


Assuntos
Infarto do Miocárdio , Intervenção Coronária Percutânea , China/epidemiologia , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Hospitais , Humanos , Incidência , Infarto do Miocárdio/complicações , Infarto do Miocárdio/epidemiologia , Complexo Glicoproteico GPIIb-IIIa de Plaquetas , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
7.
Zhonghua Gan Zang Bing Za Zhi ; 29(8): 759-765, 2021 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-34517457

RESUMO

Objective: To study the predictive value for esophageal variceal bleeding (EVB) after esophageal variceal ligation (EVL) based on clinical data and endoscopic ultrasound examination among patients with liver cirrhosis. Methods: Routine endoscopy and endoscopic ultrasound were performed on 400 preventive EVL cases who met the enrollment criteria, and their clinical indicators, microscopic manifestations, diameter and number of peripheral collateral veins, para-esophageal veins, perforating veins, and so on were monitored. Multivariate Cox proportional hazard regression analysis was performed to determine the relevant factors. Nomogram predictive model was established based on the independent prognostic factors. Nomogram internal validation was carried out with C-index to check the prediction accuracy, calibration curve evaluation consistency, and clinical benefit evaluation for decision-making. Results: Age, gender, etiology, peri-ECV number, para-ECV diameter, portal vein diameter, and azygous vein diameter were the risk factors for disease progression (P < 0.05), and they were all included in the establishment of nomogram. The C-index obtained by internal validation was 0.864, and the area under the receiver operating characteristic curve (AUC) of the predicting bleeding progression model was 0.994 (P < 0.001), suggesting that the disease had high predictive value and the calibration curve validity had consistency. Conclusion: Nomogram predictive model established based on the clinical data and endoscopic ultrasound examination is a preventive and therapeutic intervention for liver cirrhotic patients with esophageal varices, which can effectively improve the therapeutic effects of this population, reduce the EVs occurrence, and improve their quality of life. In addition, it also has an outstanding favorable performance. Therefore, it has certain guiding significance for the judgment of clinical treatment.


Assuntos
Varizes Esofágicas e Gástricas , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/etiologia , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Humanos , Ligadura , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico por imagem , Nomogramas , Qualidade de Vida
8.
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
9.
BMC Gastroenterol ; 21(1): 311, 2021 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-34404350

RESUMO

BACKGROUND: Gastrointestinal mucormycosis (GIM) is a rare, opportunistic fungal infection with poor prognosis. Clinically, it is difficult to diagnose GIM owing to its nonspecific clinical symptoms and poor suspicion. The estimated incidence of GIM is inaccurate, and most cases are diagnosed accidentally during surgery or upon postmortem examination. GIM usually occurs in patients with immune deficiencies or diabetes. Here, we report two cases of immunocompetent young patients with GIM who had good prognosis after treatment. Compared to other case reports on GIM, our cases had unusual infection sites and no obvious predisposing factors, which make it important to highlight these cases. CASE PRESENTATION: The first case was that of a 16-year-old immunocompetent boy who was admitted with gastrointestinal bleeding and perforation due to a gastric ulcer. Strategies used to arrest bleeding during emergency gastroscopy were unsuccessful. An adhesive mass was then discovered through laparoscopy. The patient underwent type II gastric resection. Pathological examination of the mass revealed bacterial infection and GIM. The second case was of a 33-year-old immunocompetent woman with a recent history of a lower leg sprain. The patient subsequently became critically ill and required ventilatory support. After hemodynamic stabilization and extubation, she presented with hematemesis due to exfoliation and necrosis of the stomach wall. The patient underwent total gastrectomy plus jejunostomy. The pathology results revealed severe bacterial infection and fungal infection that was confirmed as GIM. The patient fully recovered after receiving anti-infective and antifungal treatments. CONCLUSIONS: Neither patient was immunosuppressed, and both patients presented with gastrointestinal bleeding. GIM was confirmed via pathological examination. GIM is not limited to immunocompromised patients, and its diagnosis mainly relies on pathological examination. Early diagnosis, timely surgical treatment, and early administration of systemic drug treatment are fundamental to improving its prognosis.


Assuntos
Gastroenteropatias , Mucormicose , Úlcera Gástrica , Adolescente , Adulto , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Mucormicose/complicações , Mucormicose/diagnóstico , Úlcera
10.
Orv Hetil ; 162(31): 1252-1259, 2021 08 01.
Artigo em Húngaro | MEDLINE | ID: mdl-34333456

RESUMO

Összefoglaló. Bevezetés: Az akut varixeredetu gastrointestinalis vérzés napjainkban is jelentos morbiditással és mortalitással jár. Célkituzés: Célunk az akut varixeredetu felso gastrointestinalis vérzések incidenciájának, ellátási folyamatainak és kimeneteli tényezoinek átfogó felmérése volt. Módszer: Prospektív, multicentrikus vizsgálatunk keretében hat nyugat-magyarországi gasztroenterológiai centrum bevonásával elemeztük az ott diagnosztizált és kezelt, varixvérzo betegek adatait. Rögzítettük a demográfiai, az anamnesztikus, a diagnosztikus, valamint a terápiát és a betegség kimenetelét érinto adatokat. Minden beteg esetében kockázat- és predikcióbecslést végeztünk a Glasgow-Blatchford Score (GBS), a pre- és posztendoszkópos Rockall Score (RS) és az American Society of Anesthesiologists (ASA) Score alapján. Eredmények: A vizsgált egyéves periódusban (2016. 01. 01. és 2016. 12. 31. között) 108, akut varixeredetu gastrointestinalis vérzést találtunk (átlagéletkor: 59,6 év). Endoszkópos terápiára 57,4%-ban került sor, 39,8% sclerotherapiában, 18,5% ligatióban részesült. Transzfúziót a betegek 76,9%-a igényelt. A teljes halálozás 24,1% volt. A transzfúziós igény vonatkozásában a legmagasabb prediktív értéku a GBS volt (AUC: 0,793; cut-off: GBS >8 pont). Az ASA-pontszám szignifikáns összefüggést mutatott a transzfúzió-szükséglettel (OR 7,6 [CI 95% 2,7-21,6]; p<0,001), az endoszkópos intervencióval (OR 12,6 [CI 95% 3,4-46,5]; p = 0,033) és trendszeru kapcsolatot a mortalitással (OR 3,6 [0,8-16,7]; p = 0,095). Emellett a nemzetközi normalizált ráta (INR) értéke (p = 0,001) és a szérumkreatinin-szint (p = 0,002) állt kapcsolatban a mortalitással. Az endoszkópos intervenció aránya szignifikáns összefüggésben volt a varix Paquet-stádiumával (p<0,001) és az ASA-pontszámmal (OR = 12,6 [3,4-46,5]; p = 0,033). Következtetés: Nyugat-Magyarországon magas az akut varixeredetu vérzés elofordulási gyakorisága. Az ASA-pontszám és a GBS jó prediktív faktor a betegségkimenetel és a transzfúziós igény vonatkozásában. A megfigyelt magas mortalitás és az endoszkópos ligatio alacsony aránya indokolja a kezelési stratégiák optimalizálását akut varixeredetu gastrointestinalis vérzés esetén. Orv Hetil. 2021; 162(31): 1252-1259. INTRODUCTION: Acute variceal gastrointestinal bleeding is associated with significant morbidity and mortality. OBJECTIVE: Our aim was to evaluate the characteristics and prognostic factors in the management of acute upper gastrointestinal bleeding in a large multi-center study from Hungary. METHOD: This prospective one-year study (between January 1, 2016 and December 31, 2016) involved six community hospitals in Western Hungary. Data collection included demographic characteristics, vital signs at admission, comorbidities, medications, time to hospital admission and endoscopy, laboratory results, endoscopic management, risk assessment using Glasgow-Blatchford Score (GBS), Rockall Score (RS) and the American Society of Anesthesiologists (ASA) Physical Status Score, transfusion requirements, length of hospital stay and mortality. RESULTS: 108 cases (male: 69.4%) of acute variceal gastrointestinal bleeding were registered during the 1-year period. Endoscopic therapeutic intervention was performed in 57.4%. On initial endoscopy, 39.8% of the patients were treated with sclerotherapy and 18.5% had ligation. 76.9% of the patients required blood transfusion. The overall mortality (including in-hospital bleedings) was 24.1%. The GBS predicted transfusions (AUC: 0.793; cut-off: GBS >8 points). The ASA Score was associated with transfusion (OR 7.6 [CI 95% 2.7-21.6]; p<0.001), endoscopic intervention (OR 12.6 [CI 95% 3.4-46.5]; p = 0.033), and showed similar trend with mortality (OR 3.6 [0.8-16.7]; p = 0.095). The increased international normalized ratio (INR) and creatinine levels were associated with mortality (p = 0.001 and p = 0.002). CONCLUSION: Incidence rates of acute variceal gastrointestinal bleeding in Western Hungary are high. The ASA Score, GBS predicted outcomes and transfusion requirements. The observed high mortality rates, coupled with relatively low rates of endoscopic ligation, warrant optimization of management strategies in acute variceal gastrointestinal bleeding. Orv Hetil. 2021; 162(31): 1252-1259.


Assuntos
Hemorragia Gastrointestinal , Feminino , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Hungria , Incidência , Tempo de Internação , Masculino , Estudos Prospectivos
11.
Pan Afr Med J ; 38: 342, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34367421

RESUMO

Duodenal lipoma is a rare location of visceral lipomas, most are found incidentally via endoscopy or surgery and usually are asymptomatic. We report the case of a 58-year-old patient with an active bleeding duodenal lipoma. Although endoscopic treatment was scheduled initially, surgical intervention ultimately was indicated due to large size of tumor.


Assuntos
Neoplasias Duodenais/diagnóstico , Hemorragia Gastrointestinal/etiologia , Lipoma/diagnóstico , Neoplasias Duodenais/complicações , Neoplasias Duodenais/patologia , Humanos , Lipoma/complicações , Lipoma/patologia , Masculino , Pessoa de Meia-Idade
13.
BMJ Case Rep ; 14(8)2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404658

RESUMO

Massive upper gastrointestinal bleed is an emergency in newborns. Common causes are coagulopathy and thrombocytopenia. Stress-induced duodenal ulcer has also been reported as an unusual cause for massive upper gastrointestinal bleed. Managing such cases requires correct diagnosis and prompt treatment to prevent catastrophic complications. We report a case of bleeding duodenal ulcer probably secondary to ovarian torsion.


Assuntos
Úlcera Duodenal , Úlcera Péptica , Úlcera Gástrica , Úlcera Duodenal/complicações , Úlcera Duodenal/diagnóstico , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Recém-Nascido , Torção Ovariana , Úlcera Péptica Hemorrágica
16.
Intern Med ; 60(16): 2529-2535, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34393154

RESUMO

Objective We examined the clinical course and treatment method of a case series of radiation-induced hemorrhagic gastroduodenitis with clinical signs. Methods This was a single-center retrospective observational study. Patients We included seven patients with radiation-induced hemorrhagic gastroduodenitis treated at our hospital between April 2014 and May 2020. Results One male patient each had cancer of the head of the pancreas, bile duct cancer, hepatocellular carcinoma, and ureteral cancer, whereas two women had recurrent endometrial cancer and one woman had recurrent cervical cancer. The onset occurred 3-5 months after the end of radiation treatment. Endoscopic examinations showed a red edematous mucous membrane in a fragile condition stretching from the antrum of the stomach to the duodenum, with telangiectasia and ulcer. For endoscopic hemostasis, five patients underwent argon plasma coagulation (APC), which was successful in three patients. Two of these were being administered an antithrombotic at the time. One case resistant to conservative treatment required repeated transfusion for recurring hemorrhaging over a short period of time and therefore underwent surgical treatment. Thereafter, the postoperative course was favorable. Conclusions Actively attempting hemostasis through APC and surgery is effective for treating radiation-induced hemorrhagic gastroduodenitis. The use of an antithrombotic agent might lead to a risk of repeated hemorrhaging. Therefore, repeated hemostasis through APC is crucial.


Assuntos
Neoplasias Hepáticas , Lesões por Radiação , Coagulação com Plasma de Argônio , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Masculino , Recidiva Local de Neoplasia , Lesões por Radiação/etiologia , Resultado do Tratamento
17.
BMC Gastroenterol ; 21(1): 315, 2021 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-34353278

RESUMO

BACKGROUND: Gastrointestinal bleeding caused by gastrointestinal tract involvement in patients with Klippel-Trenaunay syndrome (KTS) is extremely rare and often overlooked. Case presentation A 9-year-old girl who presented with chronic gastrointestinal bleeding was admitted to our hospital. Laboratory examinations revealed microcytic hypochromic anemia and a positive fecal occult blood test. Computed tomography (CT) of the lower limbs combined with physical examination confirmed KTS. The pelvic CT showed concentric thickening of the sigmoid colon and rectum, with progressive enhancement after the administration of a contrast agent. Colonoscopy demonstrated vascular malformations of the sigmoid colon and rectum. The patient was finally diagnosed with KTS with gastrointestinal tract involvement. The patient improved after receiving conservative treatment. CONCLUSIONS: A suspicion of gastrointestinal tract involvement as an etiology for gastrointestinal bleeding should not be overlooked in patients with KTS. Endoscopy and imaging modalities can synergistically help diagnose this condition.


Assuntos
Síndrome de Klippel-Trenaunay-Weber , Criança , Colonoscopia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Síndrome de Klippel-Trenaunay-Weber/complicações , Síndrome de Klippel-Trenaunay-Weber/diagnóstico , Reto
18.
Medicine (Baltimore) ; 100(34): e26985, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34449467

RESUMO

BACKGROUND: The management of aspirin before transrectal prostate puncture-guided biopsy continues to be controversial. The conclusions in newly published studies differ from the published guideline. Therefore, an updated meta-analysis was performed to assess the safety of continuing to take aspirin when undergoing a transrectal ultrasound-guided prostate biopsy (TRUS-PB). METHODS: We searched the following databases for relevant literature from their inception to October 30, 2020: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Medline, Web of Science, Sinomed, Chinese National Knowledge Internet, and WANGFANG. Studies that compared the bleeding rates between aspirin that took aspirin and non-aspirin groups were included. The quality of all included studies was evaluated using the Newcastle-Ottawa Scale. Revman Manger version 5.2 software was employed to complete the meta-analysis to assess the risk of hematuria, hematospermia, and rectal bleeding. RESULTS: Six articles involving 3373 patients were included in this meta-analysis. Our study revealed that compared with the non-aspirin group, those taking aspirin exhibited a higher risk of rectal bleeding after TRUS-PB (risk ratio [RR] = 1.27, 95% confidence interval [CI] [1.09-1.49], P = .002). Also, the meta-analysis results did not reveal any significant difference between the 2 groups for the risk of hematuria (RR = 1.02, 95%CI [0.91-1.16], P = .71) and hematospermia (RR = 0.93, 95%CI [0.82-1.06], P = .29). CONCLUSION: Taking aspirin does not increase the risk of hematuria and hematospermia after TRUS-PB. However, the risk of rectal bleeding, which was slight and self-limiting, did increase. We concluded that it was not necessary to stop taking aspirin before undergoing TRUS-PB.


Assuntos
Aspirina/efeitos adversos , Biópsia por Agulha/efeitos adversos , Inibidores da Agregação Plaquetária/efeitos adversos , Aspirina/administração & dosagem , Ensaios Clínicos como Assunto , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/etiologia , Hematúria/induzido quimicamente , Hematúria/etiologia , Hemospermia/induzido quimicamente , Hemospermia/etiologia , Humanos , Masculino , Inibidores da Agregação Plaquetária/administração & dosagem , Próstata/patologia , Neoplasias da Próstata/patologia , Ultrassonografia de Intervenção
19.
Endoscopy ; 53(9): 970-980, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34320664

RESUMO

BACKGROUND: We aimed to document international practices in small-bowel capsule endoscopy (SBCE), measuring adherence to European Society of Gastrointestinal Endoscopy (ESGE) technical and clinical recommendations. METHODS: Participants reached through the ESGE contact list completed a 52-item web-based survey. RESULTS: 217 responded from 47 countries (176 and 41, respectively, from countries with or without a national society affiliated to ESGE). Of respondents, 45 % had undergone formal SBCE training. Among SBCE procedures, 91 % were performed with an ESGE recommended indication, obscure gastrointestinal bleeding (OGIB), iron-deficiency anemia (IDA), and suspected/established Crohn's disease being the commonest and with higher rates of positive findings (49.4 %, 38.2 % and 53.5 %, respectively). A watchful waiting strategy after a negative SBCE for OGIB or IDA was preferred by 46.7 % and 70.3 %, respectively. SBCE was a second-line exam for evaluation of extent of new Crohn's disease for 62.2 % of respondents. Endoscopists adhered to varying extents to ESGE technical recommendations regarding bowel preparation ( > 60 %), use in those with pacemaker holders (62.5 %), patency capsule use (51.2 %), and use of a validated scale for bowel preparation assessment (13.3 %). Of the respondents, 67 % read and interpreted the exams themselves and 84 % classified exams findings as relevant or irrelevant. Two thirds anticipated future increase in SBCE demand. Inability to obtain tissue (78.3 %) and high cost (68.1 %) were regarded as the main limitations, and implementation of artificial intelligence as the top development priority (56.2 %). CONCLUSIONS: To some extent, endoscopists follow ESGE guidelines on using SBCE in clinical practice. However, variations in practice have been identified, whose implications require further evaluation.


Assuntos
Endoscopia por Cápsula , Inteligência Artificial , Hemorragia Gastrointestinal/etiologia , Humanos , Intestino Delgado/diagnóstico por imagem , Inquéritos e Questionários
20.
Am J Case Rep ; 22: e931921, 2021 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-34247182

RESUMO

BACKGROUND Acute lower gastrointestinal bleeding (GIB) is often associated with favorable outcomes. It is readily diagnosed and managed with colonoscopy, or may resolve spontaneously. Rarely, extra-colonic sources of bleeding may masquerade as lower GIB, posing a diagnostic challenge and potentially lead to harm if there are therapeutic delays. An example is cystic artery pseudoaneurysm, a rare complication of acute cholecystitis and laparoscopic cholecystectomy, which may bleed through a cholecystocolic fistula presenting as lower GIB. CASE REPORT A 66-year-old man with multiple comorbidities including coronary artery disease with multiple stents and peripheral arterial disease presented with massive hematochezia. He was on aspirin 81 mg, clopidogrel 75 mg, and rivaroxaban 20 mg daily. The patient was hemodynamically unstable with BP 77/50 mmHg and heart rate 115 beats/min. Pertinent laboratory investigations showed hemoglobin 10.4 g/dL, WBC 17.2×10³/uL, platelet 437×10³/uL, and INR 1.28. Total bilirubin and liver enzymes were normal. Following prompt volume resuscitation with crystalloids and 2 units of O-negative blood, CT angiogram of the abdomen revealed a ruptured cystic artery pseudoaneurysm bleeding through a cholecystocolic fistula. This developed as a complication of undiagnosed gangrenous cholecystitis. The patient was sent for transcatheter embolization and the bleeding was controlled. The gangrenous cholecystitis was managed conservatively due to the patient's high surgical risk. CONCLUSIONS Although extra-intestinal sources of gastrointestinal bleeding are rare, clinicians should maintain a high index of suspicion, especially in elderly patients presenting concomitantly with right upper-quadrant pain. As delayed diagnosis leads to increased fatality rates, a prompt CT angiogram of the abdomen is pertinent in suspected cases.


Assuntos
Falso Aneurisma , Fístula , Doenças da Vesícula Biliar , Idoso , Falso Aneurisma/complicações , Artérias , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino
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