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BMJ Case Reports Sep 2014A 74-year-old man on warfarin for aortic valve replacement presented with recurrent episodes of melaena. An initial oesophagogastroduodenoscopy (OGD) was normal, as were...
A 74-year-old man on warfarin for aortic valve replacement presented with recurrent episodes of melaena. An initial oesophagogastroduodenoscopy (OGD) was normal, as were red cell scanning and colonoscopy. It was a third OGD that revealed the cause of the melaena-a vascular lesion in the duodenum, at the junction between D1 and D2. An extragastric Dieulafoy's lesion was diagnosed, and the lesion was injected with epinephrine and tattooed. Over the following months, episodes of bleeding recurred despite further attempts at injection. Percutaneous radiologically assisted embolisation of the gastroduodenal artery, and eventually duodenotomy and oversuturing of the lesion were performed to no avail. The patient has undergone over 10 endoscopies, and has received over 70 units of packed red cells to date, since his initial presentation 6 years ago. Attempts to stop the bleeding permanently have been difficult, highlighting the complexity of managing such a lesion.
Topics: Aged; Diagnosis, Differential; Duodenum; Endoscopy, Gastrointestinal; Gastrointestinal Hemorrhage; Humans; Male; Vascular Malformations
PubMed: 25216921
DOI: 10.1136/bcr-2014-204627 -
Academic Emergency Medicine : Official... Feb 2010The utility of nasogastric aspiration and lavage in the emergency management of patients with melena or hematochezia without hematemesis is controversial. This... (Review)
Review
OBJECTIVES
The utility of nasogastric aspiration and lavage in the emergency management of patients with melena or hematochezia without hematemesis is controversial. This evidence-based emergency medicine review evaluates the following question: does nasogastric aspiration and lavage in patients with melena or hematochezia and no hematemesis differentiate an upper from lower source of gastrointestinal (GI) bleeding?
METHODS
MEDLINE, EMBASE, the Cochrane Library, and other databases were searched. Studies were selected for inclusion in the review if the authors had performed nasogastric aspiration (with or without lavage) in all patients with hematochezia or melena and performed esophagogastroduodenal endoscopy (EGD) in all patients. Studies were excluded if they enrolled patients with history of esophageal varices or included patients with hematemesis or coffee ground emesis (unless the data for patients without hematemesis or coffee ground emesis could be separated out). The outcome was identifying upper GI hemorrhage (active bleeding or high-risk lesions potentially responsible for hemorrhage) and the rate of complications associated with the nasogastric tube insertion. Quality of the included studies was assessed using standard criteria for diagnostic accuracy studies.
RESULTS
Three retrospective studies met our inclusion and exclusion criteria. The prevalence of an upper GI source for patients with melena or hematochezia without hematemesis was 32% to 74%. According to the included studies, the diagnostic performance of the nasogastric aspiration and lavage for predicting upper GI bleeding is poor. The sensitivity of this test ranged from 42% to 84%, the specificity from 54% to 91%, and negative likelihood ratios from 0.62 to 0.20. Only one study reported the rate complications associated with nasogastric aspiration and lavage (1.6%).
CONCLUSIONS
Nasogastric aspiration, with or without lavage, has a low sensitivity and poor negative likelihood ratio, which limits its utility in ruling out an upper GI source of bleeding in patients with melena or hematochezia without hematemesis.
Topics: Aged; Emergency Service, Hospital; Endoscopy, Digestive System; Gastrointestinal Hemorrhage; Humans; Intubation, Gastrointestinal; Male; Melena; Predictive Value of Tests; Rectum; Therapeutic Irrigation
PubMed: 20370741
DOI: 10.1111/j.1553-2712.2009.00609.x -
Canadian Family Physician Medecin de... Nov 1995Acute gastrointestinal hemorrhage is a common problem that requires prompt recognition and management to prevent serious morbidity and mortality. Management goals are... (Review)
Review
Acute gastrointestinal hemorrhage is a common problem that requires prompt recognition and management to prevent serious morbidity and mortality. Management goals are stabilization of the patient with vigorous fluid resuscitation followed by investigation and definitive treatment of the bleeding source. Endoscopy is often the initial diagnostic test and allows therapeutic measures to be performed at the same time.
Topics: Acute Disease; Combined Modality Therapy; Diagnosis, Differential; Endoscopy, Gastrointestinal; Gastrointestinal Hemorrhage; Humans; Melena; Resuscitation
PubMed: 8563510
DOI: No ID Found -
Cleveland Clinic Journal of Medicine Oct 2022
Topics: Aged; Diagnosis, Differential; Humans; Male; Melena
PubMed: 36192027
DOI: 10.3949/ccjm.89a.20175 -
Provincial Medical & Surgical Journal Nov 1845
PubMed: 20793832
DOI: 10.1136/bmj.s1-9.45.658 -
Journal of Postgraduate Medicine 2021
Topics: Acute Disease; Comorbidity; Diabetes Mellitus, Type 2; Esophageal Diseases; Esophagus; Hematemesis; Humans; Hypertension; Male; Melena; Middle Aged; Necrosis
PubMed: 33942775
DOI: 10.4103/jpgm.JPGM_635_20 -
The American Journal of Case Reports Apr 2020BACKGROUND Aortoenteric fistula is a dreadful and uncommon complication after abdominal aortic aneurysm repair. Continuous friction against the intestine and the aortic...
BACKGROUND Aortoenteric fistula is a dreadful and uncommon complication after abdominal aortic aneurysm repair. Continuous friction against the intestine and the aortic graft along with local inflammation is thought to be the major cause of aortoenteric fistula formation, although it is unexpected to have fistula formation with a thrombosed aortic graft. CASE REPORT Here, we report a case of an aortoenteric fistula between a thrombosed aortoiliac bypass graft and the duodenum in a 75-year-old male patient who presented with a 2-month history of melena. In this case, the aortoduodenal fistula was repaired with excision of the aortic graft, proximal and distal oversewing of the aorta, omental flap coverage, pyloric exclusion and loop gastrojejunostomy creation. CONCLUSIONS An aortoenteric fistula can form through a thrombosed graft. Since this is not an expected route of fistula formation, there may be a delay in identification.
Topics: Aged; Aortic Aneurysm, Abdominal; Humans; Intestinal Fistula; Male; Melena; Thrombosis; Tomography, X-Ray Computed; Vascular Fistula; Vascular Grafting
PubMed: 32253368
DOI: 10.12659/AJCR.922153 -
Annals of Surgery Jul 1952
Topics: Humans; Melena
PubMed: 14934029
DOI: 10.1097/00000658-195207000-00016 -
Archives of Disease in Childhood Dec 1967
Topics: Blood Cell Count; Eczema; Humans; Infant, Newborn; Isoantibodies; Male; Melena; Pedigree; Sex Factors; Wiskott-Aldrich Syndrome
PubMed: 6073827
DOI: 10.1136/adc.42.226.604 -
Journal of Clinical and Diagnostic... May 2016Lipomas of the gastrointestinal tract are rare. Duodenal lipomas are incidental and mostly asymptomatic. Tumours may produce symptoms of abdominal pain and discomfort or... (Review)
Review
Lipomas of the gastrointestinal tract are rare. Duodenal lipomas are incidental and mostly asymptomatic. Tumours may produce symptoms of abdominal pain and discomfort or cause bleeding due to ulceration or intestinal obstruction due to intussusception. We describe a 45-year-old man presenting in emergency with 3 days history of melena with normal gastroduodenoscopy and contrast enhanced computed tomography revealing multiple polypoid lesion in duodenum and proximal jejunum suggestive of lipoma. Due to ongoing bleed, he underwent laparotomy with duodenectomy and uneventful postoperative recovery. Our review of cases published in last 67 years indicate that duodenal lipomas are rare to occur but commonly found in second part, they may be seen in third and fourth part of duodenum which may be missed on endoscopy. They can be multiple and may present as severe UGI bleeding which could be managed surgically. Though CT is diagnostic, histopathology confirms the diagnosis which shows lipomatous lesion composed of mature adipose arranged in lobules.
PubMed: 27437304
DOI: 10.7860/JCDR/2016/19851.7881