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Italian Journal of Pediatrics Apr 2020Massive gastrointestinal bleeding in children is uncommon. Dieulafoy lesion is an uncommon disease which may lead to massive and repeated upper gastrointestinal...
BACKGROUND
Massive gastrointestinal bleeding in children is uncommon. Dieulafoy lesion is an uncommon disease which may lead to massive and repeated upper gastrointestinal hemorrhage. We report two cases of gastric Dieulafoy lesion successfully treated with either band ligation or endoscopic hemoclipping.
CASE PRESENTATION
First case report: A previously healthy 18-month-old female infant with E. coli sepsis, pneumonia and respiratory failure with bilateral pneumothorax requiring chest drainage. Over a few days, the patient presented hematemesis and melena with progressively worsening anemia. The esophagogastroduodenoscopy revealed an arterial vessel with eroded apex located between the body and the fundus of the stomach. Two elastic bands were applied which resulted in resolution of hematemesis and melena and improvement of the anemia. Second case report: A 8-year-old male was admitted to our department with sudden massive hematemesis and melena. Clinical examination revealed anemia (hemoglobin, 6.8 g/dl). Esophagogastroduodenoscopy revealed a mucosal erosion with visible vessel located along the small curvature, close to the antrum. Three hemostatic clips were placed on the Dieulafoy lesion and hemostasis was obtained.
CONCLUSIONS
we showed that, similar to gastric DL in adult patients,, gastric DL in pediatric patients can be successfully treated with endoscopic therapy, and both hemoclipping and band ligation are suitable techniques.
Topics: Arteriovenous Malformations; Child; Endoscopy, Gastrointestinal; Female; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Infant; Ligation; Male
PubMed: 32306992
DOI: 10.1186/s13052-020-0814-8 -
Case Reports in Gastroenterology 2023Glomus tumor (glomus cell tumor) is a rare, often benign neoplasm, which is, in most cases, seen as a solitary bluish nodule involving the nail beds. Solid glomus tumor,...
Glomus tumor (glomus cell tumor) is a rare, often benign neoplasm, which is, in most cases, seen as a solitary bluish nodule involving the nail beds. Solid glomus tumor, glomangioma, and glomangiomyoma are the three main histopathological variants. In this case report, we present the rarest subtype of a glomus tumor, glomangiomyoma, in an atypical location: the stomach. A 45-year-old female from Syria presented to the clinic with severe dizziness and left epigastric abdominal pain accompanied by melena. We performed a thorough clinical study, laboratory workup, upper gastrointestinal endoscopy, endoscopic ultrasound, CT scan, as well as macroscopic and microscopic histologic examination of the surgical specimen, in addition to the immunohistochemical staining. Although rare, gastric glomangiomyoma was diagnosed and a 4.5 × 3 × 3 cm soft tissue mass was resected from the gastric antrum, and no clinical or endoscopic evidence of recurrence was observed for the follow-up duration of 4 years. Undiagnosed gastric lesions with unexplained symptoms should be further investigated and not be disregarded immediately. To the best of our knowledge, this is only the second report of an instance of gastric glomangiomyoma.
PubMed: 37065176
DOI: 10.1159/000529044 -
Gastro Hep Advances 2022Over 404 million people worldwide have been infected with coronavirus disease-2019 (COVID-19), 145 million in the United States (77 million) and Europe (151 million)...
BACKGROUND AND AIMS
Over 404 million people worldwide have been infected with coronavirus disease-2019 (COVID-19), 145 million in the United States (77 million) and Europe (151 million) alone (as of February 10, 2022). This paper aims to analyze data from studies reporting gastrointestinal bleeding (GIB) and/or endoscopic findings in COVID-19 patients in Western countries.
METHODS
We conducted a systematic review of articles on confirmed COVID-19 cases with GIB in Western countries published in PubMed and Google Scholar databases from June 20, 2020, to July 10, 2021.
RESULTS
A total of 12 studies reporting GIB and/or endoscopic findings in 808 COVID-19 patients in Western countries were collected and analyzed. Outcomes and comorbidities were compared with 18,179 non-GIB COVID-19 patients from Italy and the United States. As per our study findings, the overall incidence of GIB in COVID-19 patients was found to be 0.06%. When compared to the non-GIB cohort, the death rate was significantly high in COVID-19 patients with GIB (16.4% vs 25.4%, < .001, respectively). Endoscopic treatment was rarely necessary, and blood transfusion was the most common GIB treatment. The most common presentation in GIB patients is melena (n = 117, 47.5%). Peptic, esophageal, and rectal ulcers were the most common endoscopic findings in upper (48.4%) and lower (36.4%) endoscopies. The GIB cohort had worse outcomes and higher incidence of hypertension (61.1%), liver disease (11.2%), and cancer (13.6%) than the non-GIB cohort. Death was strongly associated with hypertension ( < .001, r = 0.814), hematochezia ( < .001, r = 0.646), and esophagogastroduodenoscopy ( < .001, r = 0.591) in COVID-19 patients with GIB.
CONCLUSIONS
Overall, the incidence of GIB in COVID-19 patients is similar to that estimated in the overall population, with melena being the most common presentation. The common endoscopic findings in GIB COVID-19 patients were ulcers, esophagitis, gastritis, and colitis. Patients with GIB were more prone to death than non-GIB COVID-19 patients.
PubMed: 35287301
DOI: 10.1016/j.gastha.2022.02.021 -
BMC Gastroenterology Mar 2022Enteric fever is a systemic disease caused by Salmonella enterica serovar Typhi or Salmonella enterica serovar Paratyphi, characterized by high fever and abdominal pain....
BACKGROUND
Enteric fever is a systemic disease caused by Salmonella enterica serovar Typhi or Salmonella enterica serovar Paratyphi, characterized by high fever and abdominal pain. Most patients with enteric fever improve within a few days after antibiotic treatment. However, some patients do not recover as easily and develop fatal life-threatening complications, including intestinal hemorrhage. Lower gastrointestinal bleeding has been reported in 10% of cases. However, upper gastrointestinal bleeding has rarely been reported in patients with enteric fever. We present a case of gastric ulcer hemorrhage caused by enteric fever.
CASE PRESENTATION
A 32-year-old woman, complaining of fever lasting four days and right upper quadrant pain and melena that started one day before admission, consulted our hospital. Abdominal computed tomography revealed mild hepatomegaly and gastroscopy revealed multiple active gastric ulcers with flat black hemorrhagic spots. The melena of the patient stopped on the third day. On the fifth admission day, she developed hematochezia. At that time, Salmonella enterica serovar Typhi was isolated from the blood culture. The antibiotic regimen was switched to ceftriaxone. Her hematochezia spontaneously resolved the following day. Finally, the patient was discharged on the 12th admission day without clinical symptoms. However, her fever recurred one month after discharge, and she was readmitted and Salmonella enterica serovar Typhi was confirmed again via blood culture. She was treated with ceftriaxone for one month, and was discharged without complications.
CONCLUSION
Our case showed that although rare, active gastric ulcers can develop in patients with enteric fever. Therefore, upper and lower gastrointestinal bleeding should be suspected in patients with enteric fever, especially showing relapsing bacteremia.
Topics: Adult; Female; Gastrointestinal Hemorrhage; Humans; Salmonella paratyphi A; Salmonella typhi; Stomach Ulcer; Typhoid Fever
PubMed: 35272630
DOI: 10.1186/s12876-022-02192-2 -
Cureus Feb 2022Colonoscopy is a well-tolerated therapeutic and diagnostic procedure. Although colonoscopy is relatively safe, a few complications have been reported. Abdominal pain...
Colonoscopy is a well-tolerated therapeutic and diagnostic procedure. Although colonoscopy is relatively safe, a few complications have been reported. Abdominal pain after colonoscopy is one of the most reported symptoms, and acute pancreatitis is uncommon after colonoscopy. We present a case of acute pancreatitis in a 51-year-old female who presented with a complaint of melena. She underwent colonoscopy to rule out lower gastrointestinal pathology and developed sudden onset diffuse abdominal pain and vomiting two hours after the procedure. She was diagnosed with colonoscopy-induced acute pancreatitis based on physical examination and detailed investigations after ruling out all other potential causes. She was treated conservatively with bowel rest, intravenous fluids, analgesic, and prophylactic antibiotics. Abdominal symptoms improved quickly in a few days with complete resolution of abdominal pain, fever, and normalization of serum amylase and lipase. Early recognition and diagnosis can lead to successful treatment, and the patients should be informed about the possibility of this complication before undergoing colonoscopy.
PubMed: 35308753
DOI: 10.7759/cureus.22128 -
International Journal of Surgery Case... Jul 2021Hemangioma of the small intestine is a rare disease that causes acute and chronic intestinal bleeding and is difficult to diagnose before surgery. This report presents a...
INTRODUCTION AND IMPORTANCE
Hemangioma of the small intestine is a rare disease that causes acute and chronic intestinal bleeding and is difficult to diagnose before surgery. This report presents a case of a cavernous hemangioma confined to the jejunum of a man with intermittent melena.
CASE PRESENTATION
A 38-year-old man presented with an episode of melena one and a half month ago. He had similar symptoms a year ago and had undergone esophagogastroduodenoscopy, colonoscopy, and abdominopelvic computed tomography, but the results were normal. Abdominopelvic computed tomography performed after hospitalization showed a small intraluminal protruding mass in the jejunum. A jejunal hemangioma was found during laparoscopy and was successfully treated with intestinal resection.
CLINICAL DISCUSSION
It is difficult to identify the cause of gastrointestinal bleeding preoperatively in patients with normal esophagogastroduodenoscopy, colonoscopy, and abdominopelvic computed tomography results. Small bowel tumors, especially small hemangiomas, should be considered as a cause. Laparoscopy may be one option for finding and treating lesions of the small intestine in hospitals where capsule endoscopy or double-balloon intestinal enteroscopy is not available.
CONCLUSION
This report presents a case of a cavernous hemangioma localized in the jejunum of a 38-year-old man with intermittent melena that was successfully treated with laparoscopy and intestinal resection, thereby emphasizing the usefulness of laparoscopy in hospitals where capsule endoscopy or double-balloon intestinal enteroscopy is not available.
PubMed: 34175681
DOI: 10.1016/j.ijscr.2021.106121 -
Cureus Jul 2021Hemorrhagic cholecystitis -- a rare cause of hemobilia and melena -- is an atypical presentation of calculous cholecystitis, associated with significant morbidity and...
Hemorrhagic cholecystitis -- a rare cause of hemobilia and melena -- is an atypical presentation of calculous cholecystitis, associated with significant morbidity and mortality. A 75-year-old woman with multiple comorbidities, who was undergoing dual antiplatelet therapy, presented with symptoms of acute cholecystitis. Two days later, she developed melena and symptoms of obstructive jaundice. Following radiological evaluation, a diagnosis of hemorrhagic cholecystitis was made. The patient was managed conservatively with IV antibiotics and blood transfusion in the initial period (clopidogrel was withheld); an interval cholecystectomy was performed six weeks later. Hemorrhagic cholecystitis is a rare complication of acute cholecystitis, and its diagnosis is challenging as it mimics various other hepatopancreaticobiliary diseases. Management options include early surgery or conservative management at the initial stage, followed by interval cholecystectomy.
PubMed: 34306900
DOI: 10.7759/cureus.16385 -
Journal of Veterinary Internal Medicine Mar 2020Antiplatelet antibodies are detected in multiple diseases including primary immune thrombocytopenia (ITP). Dynamics of how these antibodies change over time in ITP is...
BACKGROUND
Antiplatelet antibodies are detected in multiple diseases including primary immune thrombocytopenia (ITP). Dynamics of how these antibodies change over time in ITP is unknown in dogs.
HYPOTHESIS/OBJECTIVES
Antiplatelet antibodies (APA) will be detected in thrombocytopenic dogs with multiple etiologies and dynamics of APA in dogs with ITP can be used to evaluate response to treatment and relapse. Determine APA at the time of diagnosis in thrombocytopenic dogs and serially in primary ITP dogs.
ANIMALS
Seventy-nine thrombocytopenic dogs and 28 primary ITP dogs.
METHODS
Direct flow cytometry was performed in thrombocytopenic dogs at initial evaluation and serially in suspected primary ITP dogs. In primary ITP dogs, a 2-tailed Fisher's exact test was performed comparing survival to discharge between dogs with and without melena and to relate response to treatment and relapse to changes in APA and platelet count (repeated measures analysis, Spearman correlation).
RESULTS
Twenty percent (16/79) of thrombocytopenic non-ITP dogs with infectious, neoplastic, or other diseases and all primary ITP dogs were positive for APA. Melena at initial evaluation was associated with decreased survival to discharge (odds ratio 0.06; P = .01). Persistence of APA was not associated with response to treatment, but recurrence of antibodies was associated with relapse (odds ratio 205.0; P < .01). There was no difference in percentage of APA or platelet count at initial diagnosis between dogs that did or did not respond to treatment.
CONCLUSIONS AND CLINICAL IMPORTANCE
Serial monitoring of APA in dogs with primary ITP appeared beneficial for determining relapse of disease.
Topics: Animals; Autoantibodies; Blood Platelets; Case-Control Studies; Dog Diseases; Dogs; Female; Flow Cytometry; Male; Purpura, Thrombocytopenic, Idiopathic
PubMed: 32072705
DOI: 10.1111/jvim.15737 -
Clinical Endoscopy Jan 2020Peptic ulcer disease is the most common cause of acute gastrointestinal bleeding, followed by variceal bleeding, Mallory-Weiss syndrome, and malignancy. On the contrary,...
Peptic ulcer disease is the most common cause of acute gastrointestinal bleeding, followed by variceal bleeding, Mallory-Weiss syndrome, and malignancy. On the contrary, acquired hemophilia A is a very rare hemorrhagic disease, which usually manifests with musculocutaneous bleeding, caused by autoantibodies against coagulation factor VIII. A 78-year-old man presented to the Emergency Department with melena. Dieulafoy's lesions were observed on esophagogastroduodenoscopy, and endoscopic cauterization was performed. However, the patient complained of back pain and symptoms indicative of upper gastrointestinal bleeding. Abdominopelvic computed tomography was performed, and hematoma in the psoas muscle was detected. Antibodies against coagulation factor VIII were confirmed with a blood test, and the diagnosis of acquired hemophilia A was made. Here, we report a case of acquired hemophilia A presenting with upper gastrointestinal bleeding symptoms and present a brief review of literature.
PubMed: 31280527
DOI: 10.5946/ce.2019.036 -
Cureus Feb 2022Ectopic variceal bleeding is an uncommon cause of gastrointestinal bleeding and carries a high mortality. Management depends on provider comfort and...
Ectopic variceal bleeding is an uncommon cause of gastrointestinal bleeding and carries a high mortality. Management depends on provider comfort and resource availability as treatment guidelines are lacking due to the infrequent occurrence of bleeding ectopic varices. We present a case of a middle-aged woman who presented with melena and anemia requiring transfusion. She was diagnosed with cirrhosis, and computed tomography of the abdomen revealed active bleeding at the proximal duodenum. She underwent emergent esophagogastroduodenoscopy, which showed actively bleeding duodenal varices secondary to portosystemic shunt from portal hypertension. Endoscopic hemostasis was achieved with variceal band ligation, a useful modality when alternative methods of emergent variceal management are unavailable. Given the risk of recurrent bleeding, the patient underwent embolization of varices by interventional radiology.
PubMed: 35340508
DOI: 10.7759/cureus.22009