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Cureus Oct 2022Hepatic Portal Venous Gas (HPVG) is the abnormal presence of gas in the portal venous system. It is associated with life-threatening conditions and is a sinister...
Hepatic Portal Venous Gas (HPVG) is the abnormal presence of gas in the portal venous system. It is associated with life-threatening conditions and is a sinister radiological sign. This case report aims to evaluate the significance of HPVG as a radiological sign. Our case involves a 49-year-old man who was admitted to the hospital following a one-day history of severe epigastric pain and haematemesis. Investigations showed extensive HPVG, gastric pneumatosis, a large retroperitoneal haematoma, and an obstructive lesion between the first and second part of the duodenum. Our patient was managed conservatively in the High Dependency Unit (HDU). A repeat Computerised Tomography (CT) scan showed successful resolution of the HPVG and gastric pneumatosis without any invasive intervention.
PubMed: 36320790
DOI: 10.7759/cureus.30689 -
Medicine Mar 2017A novel case is reported of upper gastrointestinal (UGI) bleeding from sinistral portal hypertension, caused by a left gastric artery (LGA) pseudoaneurysm (PA)... (Review)
Review
Case report and systematic literature review of a novel etiology of sinistral portal hypertension presenting with UGI bleeding: Left gastric artery pseudoaneurysm compressing the splenic vein treated by embolization of the pseudoaneurysm.
INTRODUCTION
A novel case is reported of upper gastrointestinal (UGI) bleeding from sinistral portal hypertension, caused by a left gastric artery (LGA) pseudoaneurysm (PA) compressing the splenic vein (SV) that was successfully treated with PA embolization.
CASE REPORT
A 41-year-old man with previous medical history of recurrent, alcoholic pancreatitis presented with several episodes of hematemesis and abdominal pain for 48 hours. Physical examination revealed a soft abdomen, with no abdominal bruit, no pulsatile abdominal mass, and no stigmata of chronic liver disease. The hemoglobin declined acutely from 12.3 to 9.3 g/dL. Biochemical parameters of liver function and routine coagulation profile were entirely within normal limits. Abdominal CT revealed a 5-cm-wide peripancreatic mass compressing the stomach and constricting the SV. Esophagogastroduodenoscopy showed blood oozing from portal hypertensive gastropathy, small nonbleeding gastric cardial and fundal varices, gastric compression from the extrinsic mass, and no esophageal varices. MRCP and angiography showed that the mass was vascular, arose from the LGA, compressed the mid SV without SV thrombosis, and caused sinistral portal hypertension. At angiography, the PA was angioembolized and occluded. The patient has been asymptomatic with no further bleeding and a stable hemoglobin level during 8 weeks of follow-up.
DISCUSSION
Literature review of the 14 reported cases of LGA PA revealed that this report of acute UGI bleeding from sinistral portal hypertension from a LGA PA constricting the SV is novel; one previously reported patient had severe anemia without acute UGI bleeding associated with sinistral portal hypertension from a LGA PA.
CONCLUSION
A patient presented with UGI bleeding from sinistral portal hypertension from a LGA PA compressing the SV that was treated by angiographic obliteration of the PA which relieved the SV compression and arrested the UGI bleeding. Primary therapy for this syndrome should be addressed to obliterate the PA and not the secondarily constricted SV.
Topics: Adult; Aneurysm, False; Embolization, Therapeutic; Hematemesis; Humans; Hypertension, Portal; Male; Splenic Vein; Tomography, X-Ray Computed
PubMed: 28353569
DOI: 10.1097/MD.0000000000006413 -
BMC Gastroenterology Jul 2022Gastrointestinal bleeding is one of the major gastrointestinal diseases. In this study, our objective was to compare Glasgow-Blatchford score (GBS), AIMS65 score, MAP...
BACKGROUND
Gastrointestinal bleeding is one of the major gastrointestinal diseases. In this study, our objective was to compare Glasgow-Blatchford score (GBS), AIMS65 score, MAP score, Modified GBS, and Iino score as outcome measures for upper gastrointestinal bleeding. In addition, we extracted factors associated with hemostatic procedures including endoscopy, and proposed a new robust score model.
METHODS
From January 2015 to December 2019, 675 patients with symptoms such as hematemesis who visited the National Hospital Organization Disaster Medical Center and underwent urgent upper endoscopy with diagnosis of suspected non-variceal upper gastrointestinal bleeding were retrospectively reviewed. We evaluated the GBS, AIMS65 score, MAP score, Modified GBS, and Iino score, and assessed the outcomes of patients requiring hemostatic treatments at the subsequent emergency endoscopy. We performed logistic regression analysis of factors related to endoscopic hemostasis and upper gastrointestinal bleeding, created a new score model, and evaluated the prediction of hemostatic treatment and mortality in the new score and the existing scores.
RESULTS
The factors associated with endoscopic treatment were hematemesis, heart rate, HB (hemoglobin), blood pressure, blood urea nitrogen (BUN). Based on these predictors and the partial regression coefficients, a new score named H3B2 (using the initial letters of hematemesis, heart rate, HB, blood pressure, and BUN) was generated. H3B2 score was slightly more discriminatory compared to GBS and Modified GBS (area under the receiver operating characteristic curves (AUROC): 0.73 versus 0.721 and 0.7128, respectively) in predicting hemostatic treatment in emergency endoscopy. The H3B2 score also showed satisfactory prediction accuracy for subsequent deaths (AUROC: 0.6857. P < 0.001).
CONCLUSIONS
We proposed a new score, the H3B2 score, consisting of simple and objective indices in cases of suspected upper gastrointestinal bleeding. The H3B2 score is useful in identifying high-risk patients with suspected upper gastrointestinal bleeding who require urgent hemostatic treatment including emergency endoscopy.
Topics: Endoscopy, Gastrointestinal; Gastrointestinal Hemorrhage; Hematemesis; Hemostatics; Humans; Prognosis; Retrospective Studies; Risk Assessment; Severity of Illness Index
PubMed: 35820868
DOI: 10.1186/s12876-022-02413-8 -
British Medical Journal Apr 1977
Topics: Adult; Hematemesis; Humans; Melena; Middle Aged; Peptic Ulcer Hemorrhage
PubMed: 851843
DOI: 10.1136/bmj.1.6067.989 -
Revista de Gastroenterologia de Mexico... 2022
Topics: Abdominal Pain; Adolescent; Female; Hematemesis; Humans; Intestine, Small; Intussusception; Peutz-Jeghers Syndrome; Tomography, X-Ray Computed
PubMed: 35484077
DOI: 10.1016/j.rgmxen.2022.03.002 -
European Journal of Case Reports in... 2018Haemoptysis is a common symptom which can sometimes mimic gastrointestinal bleeding.
INTRODUCTION
Haemoptysis is a common symptom which can sometimes mimic gastrointestinal bleeding.
CASE DESCRIPTION
We describe the case of a 31-year-old man who presented to the emergency department after an episode of sudden nausea and presumed massive haematemesis. The situation was interpreted as gastrointestinal bleeding but clinical evolution and greater attention to the anamnesis resulted in a diagnosis of pulmonary tuberculosis and the provision of appropriate care.
DISCUSSION
This report emphasizes the difficulty of differentiating between haemoptysis and haematemesis and the importance of a careful anamnesis and attention to all clinical circumstances for an accurate diagnosis.
LEARNING POINTS
Haematemesis and haemoptysis are not always distinguished from each other when a patient's history is being collected.Despite being a rare manifestation of tuberculosis, in the correct epidemiological context, haemoptysis should raise the suspicion of pulmonary tuberculosis.The clinical setting and the need for immediate care should not limit clinical investigation or the differential diagnosis.
PubMed: 30756040
DOI: 10.12890/2018_000862 -
Medicine Dec 2021Henoch-Schoenlein purpura (HSP) is a systemic small-vessel vasculitis that commonly occurs in children. Gastrointestinal HSP can rarely progress to gastrointestinal...
RATIONALE
Henoch-Schoenlein purpura (HSP) is a systemic small-vessel vasculitis that commonly occurs in children. Gastrointestinal HSP can rarely progress to gastrointestinal perforation, followed by massive gastrointestinal bleeding.
PATIENT CONCERNS
An 8-year-old Chinese boy was transferred to the pediatric intensive care unit of our hospital with an emergency occurrence of purpura, severe hematemesis, large bloody stools, and sharp abdominal pain, and complained of abdominal pain and rash 2 weeks prior.
DIAGNOSIS
The patient had purpura with lower limb predominance, abdominal pain, and gastrointestinal bleeding. Immunofluorescence microscopy of histological sections showed granular and lumpy IgA focal deposition in the blood vessel walls. He was diagnosed with HSP.
INTERVENTIONS
Initially, he was treated with methylprednisolone, posterior pituitary injection, somatostatin, and hemocoagulase, together with the infusion of large blood products. Postoperatively, he was administered nasal continuous positive airway pressure -assisted ventilation, anti-infection treatment, albumin transfusion, platelet transfusion, abdominal drainage, methylprednisolone, fluconazole anti-fungal treatment, and wound dressing.
OUTCOMES
There was no evidence of rebleeding, abdominal pain, or purpura at the 2-month follow-up assessment.
LESSONS
Abdominal HSP should be alert to gastrointestinal perforation when using hormone therapy.
Topics: Abdominal Pain; Child; Gastrointestinal Hemorrhage; Hematemesis; Humans; IgA Vasculitis; Male; Methylprednisolone
PubMed: 34918691
DOI: 10.1097/MD.0000000000028240 -
Henry Ford Hospital Medical Journal 1990Gallstones are usually silent. Less commonly, patients with cholelithiasis develop symptoms and/or complications; biliary fistula occurs in 3% to 5% of the cases. When a... (Review)
Review
Gallstones are usually silent. Less commonly, patients with cholelithiasis develop symptoms and/or complications; biliary fistula occurs in 3% to 5% of the cases. When a large stone is passed and occludes the duodenum, gastric outlet obstruction (the Bouveret syndrome) may result. In reported cases, the stones are usually larger than 2.5 cm. The usual presenting symptoms are those of bowel obstruction: abdominal pain, nausea, and vomiting. Less commonly, the patients experience melena and, rarely, hematemesis. We describe a patient who had the largest stone reported to cause hematemesis rather than bowel obstruction and to be diagnosed endoscopically. The 5 X 4 X 3 cm stone was extracted surgically. Endoscopic diagnosis and extraction of stones up to 3 cm in size has been reported, avoiding the need for surgery.
Topics: Aged; Cholelithiasis; Duodenal Diseases; Hematemesis; Humans; Intestinal Obstruction; Male; Pyloric Stenosis; Syndrome
PubMed: 2228712
DOI: No ID Found -
Journal of Feline Medicine and Surgery Feb 2023The purpose of this study was to describe B-mode and colour Doppler ultrasound (US) features of gastric lymphoma in cats.
OBJECTIVES
The purpose of this study was to describe B-mode and colour Doppler ultrasound (US) features of gastric lymphoma in cats.
METHODS
Cats with histopathological or cytological confirmation of gastric lymphoma that underwent abdominal US were included in this retrospective study. Clinical signs were recorded and radiographs reviewed when available. Gastric lesions were ultrasonographically evaluated for location, distribution, wall layering, echogenicity and thickness. Colour Doppler assessment was based on vessels, location and direction.
RESULTS
Forty-five cats were included. All presented with vomiting, 7/45 (15.5%) with haematemesis. Radiographs were available in 27/45 cases, and demonstrated a gastric mass in 19/27 (70.4%) cases. The most common US appearance was transmural wall thickening with absent layering 42/45 (93.3%) and hypoechogenicity 39/45 (86.7%). Median maximum thickness was 2.1 cm. Ulceration or erosion was suspected in 23/45 (51%) cases, two of which perforated. Colour Doppler images were available in 33/45 cases. The most common Doppler finding was transmural vessels coursing perpendicularly to the lumen in 14/33 (42.4%). Abdominal effusion was uncommon (n = 11/45; 24.4%). Regional lymphadenopathy was frequent, observed in 44/54 lymph nodes reviewed on US, and US suspicion of splenic, hepatic and intestinal lymphomatous infiltration was reported in 24/45 (53.3%) cases.
CONCLUSIONS AND RELEVANCE
The most common US appearance of gastric lymphoma was transmural hypoechoic segmental wall thickening with layering loss. Location and distribution were variable. Colour Doppler displayed increased blood supply with a predominant pattern of perpendicular vessels, possibly representing aberrant arteries originating from subserosal and submucosal plexus. Lymphomatous infiltration of lymph nodes and other abdominal organs was frequent, confirming local and distant aggressiveness of gastric lymphoma in cats. Vomiting and haematemesis were frequently associated with the suspicion of ulcer on US. Perforation was a rare occurrence.
Topics: Cats; Animals; Hematemesis; Retrospective Studies; Color; Lymphoma; Ultrasonography; Vomiting; Cat Diseases
PubMed: 36786666
DOI: 10.1177/1098612X221150174 -
Chirurgia (Bucharest, Romania : 1990) 2015We report the case of an elderly woman, 81 years old, who was admitted in our department for hematemesis, hematochezia and lower abdominal pain. The abdominal ultrasound...
We report the case of an elderly woman, 81 years old, who was admitted in our department for hematemesis, hematochezia and lower abdominal pain. The abdominal ultrasound and the CT scan diagnosed a primary aortoenteric fistula between an abdominal aortic aneurysm (AAA) and the second part of the duodenum, which is a very rare localization regarding this condition. Surgical pathology,diagnosis and management are discussed.
Topics: Abdominal Pain; Aged, 80 and over; Aortic Dissection; Aortic Aneurysm, Abdominal; Aortic Rupture; Duodenal Diseases; Fatal Outcome; Female; Gastrointestinal Hemorrhage; Hematemesis; Humans; Intestinal Fistula; Vascular Fistula
PubMed: 25800321
DOI: No ID Found