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Cureus Apr 2024Intramural intestinal hematoma is a rare disease, one of the triggering factors of which is the use of anticoagulants. In previous reports, most patients were on...
Intramural intestinal hematoma is a rare disease, one of the triggering factors of which is the use of anticoagulants. In previous reports, most patients were on treatment with warfarin. Herein, we report a case of direct-acting oral anticoagulant (DOAC)-induced intramural hematoma of the ascending colon in a patient refractory to conservative treatment and required laparoscopic right hemicolectomy. An 80-year-old male patient with a history of atrial fibrillation and cerebral infarction, on treatment with apixaban, was brought to our hospital with the chief complaints of abdominal pain, vomiting, and melena. Imaging revealed the cause of symptoms to be intestinal obstruction caused by a mass lesion on the wall of the ascending colon. We initially opted for conservative treatment with discontinuation of apixaban and insertion of an ileus tube. Intestinal dilatation findings showed improvement; however, subsequent imaging examinations did not reveal the shrinkage of a lesion in the ascending colon. If the mass was not removed, recurrence of bowel obstruction symptoms was expected, so we decided to perform surgical intervention. A laparoscopic right hemicolectomy was performed, and an intramural hematoma of the ascending colon was diagnosed based on the excised specimen. He needed a blood transfusion for anemia but was discharged on postoperative day 14 with no other complications. DOACs are now widely used in patients with atrial fibrillation, and the risk of bleeding as a side effect is extremely low compared to conventional anticoagulants, including warfarin. However, when abdominal pain occurs, as in the present case, an intramural hematoma should be considered in the differential diagnosis. There is no established treatment plan for intestinal intramural hematoma. Although conservative treatment is effective in some cases, it is difficult to evaluate the risk of bleeding associated with DOACs using coagulation tests. Even if conservative treatment is selected, it is essential to determine surgical resection, if necessary, based on the clinical course and imaging and blood test findings.
PubMed: 38644949
DOI: 10.7759/cureus.58513 -
Medicine Apr 2024Inflammatory fibroid polyp (IFP), also known as Vanek tumor, is a rare, benign gastrointestinal lesion characterized by its inflammatory and fibroid histological...
RATIONALE
Inflammatory fibroid polyp (IFP), also known as Vanek tumor, is a rare, benign gastrointestinal lesion characterized by its inflammatory and fibroid histological features. IFP is often discovered incidentally during endoscopic examinations. It is exceedingly rare for an IFP to prolapse into the duodenum and results in incomplete obstruction of the pylorus.
PATIENT CONCERNS
A 64-year-old male patient was admitted to the hospital with recurrent episodes of melena over a 6-month period, along with complaints of dizziness and fatigue in the past 10 days.
DIAGNOSES
Gastroscopy showed a giant polypoid mass on the posterior wall of the gastric antrum, prolapsing into the duodenum. Abdominal computer tomography (CT) confirmed the tumor protruding into the duodenum. Pathologic examination of the resected specimen confirmed the IFP diagnosis.
INTERVENTIONS
The giant tumor was completely and successfully excised using endoscopic submucosal dissection (ESD). After the surgery, the patient underwent acid suppression and fluid replenishment therapy.
OUTCOMES
The patient responded well to ESD and was discharged in stable condition. As of the submission of the case report, there has been no recurrence of the tumor after a 5-month follow-up, and the patient is still under follow-up.
LESSONS
While IFPs have traditionally been managed surgically, ESD demonstrates promising treatment outcomes, avoiding the need for surgical distal gastrectomy, and emerges as a safe and effective treatment option.
Topics: Male; Humans; Middle Aged; Pyloric Antrum; Stomach Neoplasms; Endoscopic Mucosal Resection; Polyps; Gastroscopy; Gastrointestinal Neoplasms; Duodenum; Leiomyoma
PubMed: 38640263
DOI: 10.1097/MD.0000000000037877 -
Clinical Case Reports Apr 2024Duodenal GISTs are rare and challenging tumors. Acute life-threatening upper GI bleeding is a possible presentation of duodenal GISTs. Surgery is the standard treatment...
KEY CLINICAL MESSAGE
Duodenal GISTs are rare and challenging tumors. Acute life-threatening upper GI bleeding is a possible presentation of duodenal GISTs. Surgery is the standard treatment for localized duodenal GISTs. Imatinib is an effective adjuvant therapy for duodenal GISTs.
ABSTRACT
GIST is the most common mesenchymal neoplasm of the gastrointestinal tract, accounting for 1%-2% of gastrointestinal tumors. They originate from the interstitial cells of Cajal and are rare in patients younger than 30 years. The stomach is the most common site, followed by the small intestine and colon. GISTs are caused by a gain-of-function mutation in the proto-oncogene receptor tyrosine kinase, with activating mutations in KIT being the most common. Most GISTs are asymptomatic. Even if gastrointestinal bleeding is the most common complication life-threatening hemorrhage is extremely uncommon. We present a case of a 31-year-old male patient presented with massive active hematemesis and melena with hemorrhagic shock. The patient presented with massive hematemesis and melena of 1 h duration. Endoscopy showed pulsating active bleeding from the third part of the duodenum which was difficult to manage via endoscopy. Histopathologic evaluation showed spindle cell type GIST. Intraoperatively, there was a nodular mass with active bleeding on the third part of the duodenum. Duodenectomy with end-to-end anastomosis was done. Discharged with no postoperative complication and was put on imatinib. There are considerable challenges that arise in the diagnosis and treatment of duodenal gastrointestinal stromal tumors (GISTs) when they present with life-threatening upper gastrointestinal hemorrhage. In order to achieve the best possible outcomes for patients, it is crucial to have a comprehensive understanding of the clinical presentation, diagnostic methods, and treatment approaches.
PubMed: 38634092
DOI: 10.1002/ccr3.8796 -
Journal of Indian Association of... 2024More than 20% of patients with extrahepatic portal vein obstruction (EHPVO) may be deemed as nonshuntable due to lack of a suitable vein. The role of "makeshift shunts"...
BACKGROUND AND OBJECTIVES
More than 20% of patients with extrahepatic portal vein obstruction (EHPVO) may be deemed as nonshuntable due to lack of a suitable vein. The role of "makeshift shunts" or "lesser shunts" assumes importance in such cases. In this report, the authors have shared their experience with the makeshift shunts in the management of portal hypertension in children with emphasis upon anatomic considerations, resolution of symptoms, outcomes after surgery, and shunt patency.
MATERIALS AND METHODS
During the period 1983-2018, 138 children with portal hypertension were managed under the care of a single surgeon (VB). Of them, 134 were EHPVO. Children with EHPVO were treated with splenectomy and proximal lienorenal shunt ( = 107), splenectomy and devascularization ( = 21), and makeshift shunts ( = 6). Makeshift shunts comprised (i) side-to-side right gastroepiploic vein (Rt-GEV) to left renal vein (LRV) shunt ( = 1), (ii) superior mesenteric vein (SMV) to inferior vena cava (IVC) shunt using a spiral saphenous venous graft ( = 1), (iii) side-to-side inferior mesenteric vein (IMV) to LRV shunt ( = 2), (iv) side-to-side IMV to IVC shunt ( = 1), (v) end-to-side IMV to IVC shunt ( = 1), and (vi) side-to-side IMV to LRV shunt ( = 1) in a case of crossed fused renal ectopia.
RESULTS
Following the creation of portosystemic shunt, a decline in portal pressure was demonstrated in all six patients. There was resolution of symptoms including hematemesis, melena, and anorectal variceal bleed. None of the patients demonstrated the features of hepatic encephalopathy. The associated portal cavernoma cholangiopathy ( = 1) also resolved following Rt-GEV to LRV shunt. Shunt patency was documented for the entire duration of follow-up (1.5-4 years) in five of six patients; the sixth patient demonstrated shunt block at 6-month follow-up but without recurrence of symptoms.
CONCLUSIONS
Makeshift shunts offer a viable alternative to standard portosystemic shunting in pediatric patients with a nonshuntable vein. The selection of such shunts is, however, subject to surgeon's preferences and has to be individualized to local anatomy.
PubMed: 38616824
DOI: 10.4103/jiaps.JIAPS_21_21 -
The Journal of International Medical... Apr 2024The mortality rate of gastric varices bleeding can reach 20% within 6 weeks. Isolated gastric varices (IGVs) refer to gastric varices without esophageal varices and... (Review)
Review
The mortality rate of gastric varices bleeding can reach 20% within 6 weeks. Isolated gastric varices (IGVs) refer to gastric varices without esophageal varices and typically arise as a common complication of left portal hypertension. Although IGVs commonly form in the setting of splenic vein occlusion, the combination of antiphospholipid syndrome and protein S deficiency leading to splenic vein occlusion is rare. We herein present a case of a 28-year-old woman with intermittent epigastric pain and melena. She was diagnosed with antiphospholipid syndrome based on the triad of pregnancy morbidity, unexplained venous occlusion, and positive lupus anticoagulant. Laparoscopic splenectomy and pericardial devascularization were performed for the treatment of IGVs. During the 6-month postoperative follow-up, repeated endoscopy and contrast-enhanced computed tomography revealed disappearance of the IGVs. This is the first description of splenic vein occlusion associated with both antiphospholipid syndrome and protein S deficiency. We also provide a review of the etiology, clinical manifestations, diagnosis, and treatment methods of IGVs.
Topics: Female; Humans; Adult; Esophageal and Gastric Varices; Antiphospholipid Syndrome; Protein S Deficiency; Gastrointestinal Hemorrhage; Vascular Diseases
PubMed: 38603605
DOI: 10.1177/03000605241240579 -
Annals of Medicine and Surgery (2012) Apr 2024Angiodysplasia, a rare cause of gastrointestinal (GI) bleeding, presents a spectrum of clinical manifestations from anemia to life-threatening hemorrhage. This case...
INTRODUCTION
Angiodysplasia, a rare cause of gastrointestinal (GI) bleeding, presents a spectrum of clinical manifestations from anemia to life-threatening hemorrhage. This case study emphasizes the significance of considering intestinal vascular malformations as a differential diagnosis, especially in the context of chronic anemia and GI bleeding. Jejunal angiodysplasia, though infrequent, poses diagnostic challenges due to the hidden nature of the small bowel in the GI system.
CASE PRESENTATION
A 23-year-old male presented with acute hematochezia and melena, necessitating prompt intervention. Despite a normal esophagogastroduodenoscopy, colonoscopy was hindered, CT angiography could not be performed due to the patient's unstable condition, leading to a planned exploratory laparotomy. Surgical exploration revealed a mucosal vascular lesion in the jejunum, prompting resection, and anastomosis. The patient's postoperative course was uneventful, reinforcing the importance of swift diagnosis and intervention.
CLINICAL DISCUSSION
Angiodysplasia's pathogenesis remains unclear, with hypotheses implicating vascular endothelial growth factor and submucosal changes. Challenges in management revolve around lesion localization and stabilizing hemodynamics, necessitating a multidisciplinary approach. While endoscopy is often diagnostic and therapeutic, advanced modalities such as CT angiography may be required. Literature review highlights diverse presentations and successful interventions, including embolization and surgical resection.
CONCLUSION
Jejunal angiodysplasia demands a comprehensive diagnostic and therapeutic strategy. The presented case underscores the pivotal role of endoscopy, embolization, and surgery in managing this condition. Timely diagnosis and intervention are crucial for mitigating the impact of angiodysplasia, necessitating further research and collaborative efforts for improved management of this rare condition.
PubMed: 38576924
DOI: 10.1097/MS9.0000000000001799 -
World Journal of Clinical Cases Mar 2024Congenital enteric duplication cysts are tubular or cystic structures that normally lie alongside the gastrointestinal (GI) tract. Enteric duplication cysts are...
BACKGROUND
Congenital enteric duplication cysts are tubular or cystic structures that normally lie alongside the gastrointestinal (GI) tract. Enteric duplication cysts are typically solitary lesions that occur anywhere near the GI tract from the neck to the rectum, but having multiple duplication cysts is rare, and presentation within the pancreas is extremely rare.
CASE SUMMARY
We herein demonstrate a case of esophageal, gastric, and gastric-type duplication cyst of the pancreas in a seventeen-month-old girl who presented with failure to thrive, abdominal pain, vomiting, hematemesis, and melena since the age of three months. The cysts were excised by thoracoscopy and laparoscopy in the same setting. To our knowledge, no such case has been published.
CONCLUSION
Enteric duplications can occur throughout the entire alimentary tract. When they occur in the pancreas, they present a formidable challenge in both diagnosis and treatment. Due to the risk of complications and malignant transformation, surgical removal is the recommended treatment of all duplication cysts.
PubMed: 38576813
DOI: 10.12998/wjcc.v12.i8.1504 -
HCA Healthcare Journal of Medicine 2024Upper gastrointestinal (GI) bleeding is a medical condition commonly seen in clinical practice due to variable etiologies and a multitude of presentations. The patients...
INTRODUCTION
Upper gastrointestinal (GI) bleeding is a medical condition commonly seen in clinical practice due to variable etiologies and a multitude of presentations. The patients can present with hematemesis, melena, or hematochezia in case of severe bleeding. The initial evaluation should involve assessing the hemodynamic status with adequate resuscitation followed by diagnostic tests to identify the source and potentially treat it. Dieulafoy's lesion, sometimes referred to as Dieulafoy's disease, is a rare cause of upper GI bleeding with no clear risk factors, which makes it a diagnostic conundrum. Here we describe an unusual case of Dieulafoy's lesion developing following percutaneous endoscopic gastrostomy (PEG) placement.
CASE PRESENTATION
We describe a case of a 70-year-old female patient with a past medical history of hyperlipidemia, well-controlled hypertension, and an ischemic cerebrovascular accident, which caused neurologic dysphagia and placement of a PEG tube 3 weeks prior. She presented to the emergency department due to melena, with hypotension of 90/50 mmHg, tachycardia of 126 beats/minute, and hemoglobin of 5.6 g/dl. An endoscopy revealed a Dieulafoy's lesion on the lesser curvature of the stomach just across the PEG tube, which was managed with epinephrine and hemoclips.
CONCLUSION
This is a rare case of Dieulafoy's lesion on the lesser curvature of the stomach, potentially developing due to PEG placement.
PubMed: 38560388
DOI: 10.36518/2689-0216.1587 -
International Journal of General... 2024Gastrointestinal bleeding in COVID-19-infection poses unique challenges to patients owing to the high risk of concomitant respiratory failure. However, endoscopic care...
INTRODUCTION
Gastrointestinal bleeding in COVID-19-infection poses unique challenges to patients owing to the high risk of concomitant respiratory failure. However, endoscopic care providers are prone to transmission. This study aimed to understand the risk and management outcomes of gastrointestinal bleeding in COVID-19-infected patients.
METHODS
Data were abstracted from electronic patient medical records, using ICD 10 codes, and demographic and clinical data were collected, for COVID-19-infected patients who developed gastrointestinal (GI) bleeding. Complications related to COVID-19 infection and management outcomes of GI bleeding were studied. Statistically, descriptive analysis was used because of the small sample size.
RESULTS
Eighteen COVID-19-infected patients developed episodes of GI bleeding, yielding a prevalence of 0.45%. Their mean age was 74.8 years, 55.5% were female, and 66.6% of patients (n=12) had upper GI bleeding symptoms, predominantly melena (55.5%), followed by coffee ground nasogastric aspirates (n=2). Only two patients (11.11%) had episodes of lower GI bleeding, and the remaining four patients (22.2%) had recurrent acute anemia requiring blood transfusion. The Glasgow-Blatchford score (GBS) at presentation ranged between 6 to 16 (mean 8.8) and seven patients (38.8%) underwent endoscopic evaluation for GI bleeding. The predominant comorbid conditions included hypertension (22.2%), diabetes mellitus (27.7%), chronic kidney disease (50%), ischemic heart disease (33%), atrial fibrillation (11.1%), and peripheral vascular disease (11.1%). The median hospitalization was 24.6 days (range: 3-54 days). The 30-day mortality rate in our cohort was 22.2%, (4/18) mainly noted in older patients aged> 60 years with comorbid conditions and severe COVID-19 infection.
CONCLUSION
The prevalence of GI bleeding observed in our cohort was approximately 0.45%, significantly lower than the global prevalence observed, majority (66%) had upper GI bleeding. The exact reasons for the observed low prevalence of GI bleeding cannot be explained and will be the subject of future research.
PubMed: 38559591
DOI: 10.2147/IJGM.S454841 -
A case report of a gastric ulcer in a 2.5-month-old infant in Syria: and Aspirin as possible causes.SAGE Open Medical Case Reports 2024A gastric ulcer is a tear in the stomach lining that manifests as abdominal pain, nausea, vomiting, and weight loss. Its occurrence is lesser in children as compared to...
A gastric ulcer is a tear in the stomach lining that manifests as abdominal pain, nausea, vomiting, and weight loss. Its occurrence is lesser in children as compared to adults and its incidence in children ranges between 2% and 8%. and nonsteroidal anti-inflammatory drugs are the most common causes of gastric ulcers. In our case, we report a 2.5-month-old male who presented with severe pallor, hematemesis, and melena with normal weight gain. The patient's mother was infected with COVID-19 a month ago and recovered within 5 days but kept using aspirin and nonsteroidal anti-inflammatory drugs for a month during breastfeeding. An upper gastrointestinal endoscopy revealed a gastric ulcer and the antigen was positive in the biopsy. A COVID-19 infection was detected later in the patient. The patient was administered proton pump inhibitor, clarithromycin, and amoxicillin for antigen and symptomatic treatment for COVID-19. This case report shows that a stomach ulcer can appear in infancy, but opportune interventions such as timely diagnosis and treatment can solve the problem. It also marks the pathophysiological connection between and gastric ulcer.
PubMed: 38559406
DOI: 10.1177/2050313X241242932