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Acute Medicine & Surgery 2020Epistaxis is a common condition that can sometimes be overlooked. It usually presents with obvious symptoms but could also present as hematemesis and melena.
BACKGROUND
Epistaxis is a common condition that can sometimes be overlooked. It usually presents with obvious symptoms but could also present as hematemesis and melena.
CASE PRESENTATION
A 78-year-old man presented to our emergency department with melena and shock. Initial endoscopy revealed a bleeding gastric ulcer. However, he had recurrent episodes of hematemesis and melena following coagulation therapy, and a repeat esophagogastroduodenoscopy could not identify the source of bleeding for more than 1 week. Epistaxis from nasal polyps was identified as the cause of hemorrhagic shock. Posterior nasal packing was carried out with Foley catheters, and an endoscopic sinus surgery was finally performed.
CONCLUSION
We report a case of epistaxis that caused hematemesis and melena following gastrointestinal bleeding. The diagnosis of epistaxis might have been delayed due to anchoring bias. Clinicians should be aware that epistaxis can mimic upper gastrointestinal bleeding and remember this important differential diagnosis.
PubMed: 31988763
DOI: 10.1002/ams2.451 -
Cureus Dec 2022Renal cell carcinoma (RCC) most commonly metastasizes to the lungs, and it is uncommon for RCC to metastasize to the small bowel. Small bowel metastasis commonly...
Renal cell carcinoma (RCC) most commonly metastasizes to the lungs, and it is uncommon for RCC to metastasize to the small bowel. Small bowel metastasis commonly presents with gastrointestinal (GI) bleeding. In rare cases, a metastatic small bowel mass can serve as a lead point for intussusception. In this report, we present the case of a male patient whose chief complaint was melena. The patient denied any abdominal pain or nausea. Investigation with push enteroscopy revealed a jejunal mass, and further evaluation with CT showed small bowel intussusception. The patient subsequently underwent small bowel resection and anastomosis. Histopathology confirmed that the jejunal mass was metastatic RCC. We present this case in order to showcase the utility of push enteroscopy in the diagnosis of small bowel metastasis in RCC.
PubMed: 36654622
DOI: 10.7759/cureus.32554 -
Gut Jul 1970
Review
Topics: Alcohol Drinking; Animals; Ascorbic Acid Deficiency; Aspirin; Gastrointestinal Hemorrhage; Hematemesis; Humans; Melena; Peptic Ulcer; Solubility; Stomach Ulcer; Stress, Psychological; Tablets, Enteric-Coated
PubMed: 4916213
DOI: 10.1136/gut.11.7.627 -
BMJ Case Reports Jul 2021Neonatal Dieulafoy's lesion is a rare but serious condition that can be life-threatening if not diagnosed and intervened in a timely manner. It presents with episodes of...
Neonatal Dieulafoy's lesion is a rare but serious condition that can be life-threatening if not diagnosed and intervened in a timely manner. It presents with episodes of sudden acute gastrointestinal haemorrhage in the form of blood in vomit and/or blood in stool. In general, most of the lesions are successfully treated with endoscopic or angiographic intervention. Surgery is usually reserved for cases that fail endoscopic or angiographic intervention. We present a neonatal case of duodenal Dieulafoy's lesion that occurred in a 29-week-old male baby with birth weight of 1.2 kg. He developed melena and haematemesis at 4 weeks of life. He required normal saline boluses and transfusion of blood products for acute blood loss. The lesion was successfully treated with endoscopic intervention.
Topics: Angiography; Duodenum; Gastrointestinal Hemorrhage; Hematemesis; Humans; Infant, Newborn; Male; Melena
PubMed: 34257118
DOI: 10.1136/bcr-2021-242911 -
The American Journal of Case Reports Aug 2022BACKGROUND Dieulafoy's lesion is a rare cause of severe gastrointestinal (GI) bleeding, accounting for approximately 1-2% of all cases of GI hemorrhage. Nevertheless, it...
BACKGROUND Dieulafoy's lesion is a rare cause of severe gastrointestinal (GI) bleeding, accounting for approximately 1-2% of all cases of GI hemorrhage. Nevertheless, it can be life-threatening without prompt intervention. Dieulafoy's lesion of jejunal origin can be particularly challenging to identify due to the inability of conventional endoscopic techniques to visualize the jejunum. This case report emphasizes the difficulties in diagnosing and managing jejunal Dieulafoy's lesions and highlights the methods by which to approach refractory bleeding. CASE REPORT This is a case of a 41-year-old man with a history of uncontrolled hypertension who presented with an episode of syncope and melena associated with low hemoglobin levels requiring multiple packed red blood cell transfusions. This warranted searching for a source of bleeding within the gastrointestinal tract via 2 upper-GI endoscopies, a colonoscopy, and an abdominal computed tomography angiogram, all of which failed to localize the site of bleeding. A push enteroscopy was required to identify the lesion in the jejunum, but the bleeding was not controlled despite the application of hemoclips and epinephrine. Consequently, laparotomy and resection of the jejunal segment containing the Dieulafoy's lesion was performed and the diagnosis was established histopathologically. The patient recovered well and was discharged 4 days after the procedure. CONCLUSIONS Suspicion of a jejunal Dieulafoy's lesion should be raised if both upper- and lower-GI endoscopies yield unremarkable findings. Ideally, a push enteroscopy should be utilized diagnostically and to conservatively manage the bleeding. However, laparotomy should be considered in refractory lesions or in the presence of hemodynamic instability.
Topics: Adult; Endoscopy, Gastrointestinal; Gastrointestinal Hemorrhage; Humans; Jejunum; Male; Melena; Vascular Diseases
PubMed: 35941804
DOI: 10.12659/AJCR.936313 -
World Journal of Gastroenterology Apr 2020Gastrointestinal hemangiomas are rare benign tumors. According to the size of the affected vessels, hemangiomas are histologically classified into cavernous, capillary,... (Review)
Review
BACKGROUND
Gastrointestinal hemangiomas are rare benign tumors. According to the size of the affected vessels, hemangiomas are histologically classified into cavernous, capillary, or mixed-type tumors, with the cavernous type being the most common and racemose hemangiomas being very rare in the clinic. Melena of uncertain origin and anemia are the main clinical manifestations, and other presentations are rare. Due to the rarity of gastrointestinal hemangiomas and lack of specific manifestations and diagnostic methods, preoperative diagnoses are often delayed or incorrect.
CASE SUMMARY
We report a 5-year-old girl who presented with abdominal pain, nausea, and vomiting for a duration of 10 h. The laboratory studies showed prominent anemia. Computed tomography and contrast-enhanced computed tomography of the abdomen revealed a small bowel obstruction caused by a giant abdominal mass. Segmental resection of the ileal lesions was performed through surgery, and the final pathology results revealed a diagnosis of racemose hemangioma complicated by a small bowel obstruction and simultaneous chronic anemia.
CONCLUSION
The current report will increase the understanding of the diagnosis and treatment of gastrointestinal hemangiomas and provide a review of the related literature.
Topics: Anemia; Child, Preschool; Chronic Disease; Diagnosis, Differential; Female; Hemangioma; Humans; Ileal Neoplasms; Ileum; Intestinal Obstruction; Laparoscopy; Melena; Teratoma; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 32327915
DOI: 10.3748/wjg.v26.i14.1674 -
The Journal of Veterinary Medical... Aug 2010An 11-year-old, castrated male beagle dog was presented with a sudden onset of clinical signs of depression, abdominal discomfort, anorexia and melena. Radiography and...
An 11-year-old, castrated male beagle dog was presented with a sudden onset of clinical signs of depression, abdominal discomfort, anorexia and melena. Radiography and ultrasonography revealed a well-circumscribed mass lesion with a size of 5 cm in diameter at the hypogastrium. A complete blood count and blood chemistry revealed severe anemia, hypoproteinemia and hypoalbuminemia. Through celiotomy, a large tumor mass involving the ileum was resected. The inside of the mass was irregular and sponge-like structure with multiple cavitated structures. On histology, the lesion was diagnosed to be hemangioma of the ileal wall. To the best of our knowledge, this unusual case is the first clinical report on the ileal hemangioma in non-human animal species.
Topics: Animals; Anorexia; Depression; Dog Diseases; Dogs; Hemangioma; Humans; Ileal Neoplasms; Male; Melena; Orchiectomy; Radiography; Species Specificity; Ultrasonography
PubMed: 20234109
DOI: 10.1292/jvms.10-0017 -
Scandinavian Journal of Gastroenterology Apr 2013The authors aimed to investigate the incidence and outcomes of acute upper gastrointestinal bleeding (AUGIB) and to examine the role of drugs potentially associated with... (Comparative Study)
Comparative Study
OBJECTIVE
The authors aimed to investigate the incidence and outcomes of acute upper gastrointestinal bleeding (AUGIB) and to examine the role of drugs potentially associated with AUGIB.
METHODS
The study was prospective, population-based and consisted of all patients who underwent upper gastrointestinal endoscopy (UGE), during the year of 2010 at the National University Hospital of Iceland. Drug intake of NSAIDs, low-dose aspirin (LDA), warfarin, SSRIs and bisphosphonates prior to GIB was prospectively registered and also checked in a Pharmaceutical Database covering all prescriptions in Iceland. An age- and gender-matched control group consisted of patients who underwent UGE during the study period and were without GIB.
RESULTS
A total of 1731 patients underwent 2058 UGEs. Overall, 156 patients had AUGIB. The crude incidence for AUGIB was 87/100,000 inhabitants per year. The most common etiologies were duodenal (21%) and gastric ulcers (15%). Use of LDA (40% vs. 30%), NSAIDs (20% vs. 8%), warfarin (15% vs. 7%), combination of NSAIDs + LDA (8% vs. 1%) and SSRIs + LDA (8% vs. 3%) were significantly more common among bleeders than non-bleeders. Three patients (1.9%) had emergency surgery and two patients died of AUGIB. Independent predictors of clinically significant bleeding were gastric ulcer (OR 6.6, p = 0.012) and NSAIDs (OR 6.6, p = 0.004).
CONCLUSIONS
LDA, NSAIDs and warfarin play an important role in AUGIB etiology and particularly combinations of drugs. Gastric ulcer and NSAIDs were independent predictors of severe bleeding. Mortality and the need for surgery during hospitalization was low in this population-based setting.
Topics: Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Female; Gastrointestinal Hemorrhage; Hematemesis; Humans; Iceland; Incidence; Male; Melena; Middle Aged; Prospective Studies; Risk Factors; Severity of Illness Index; Upper Gastrointestinal Tract; Warfarin
PubMed: 23356751
DOI: 10.3109/00365521.2012.763174 -
BMC Emergency Medicine Sep 2023Bleeding from the upper gastrointestinal (GI) tract is one of the common medical emergencies. In this study, we assessed patients' socio-demographic and clinical... (Observational Study)
Observational Study
Prospective observational study on clinical and epidemiological profile of adult patients presenting to the emergency department with suspected upper gastrointestinal bleed.
BACKGROUND AND OBJECTIVE
Bleeding from the upper gastrointestinal (GI) tract is one of the common medical emergencies. In this study, we assessed patients' socio-demographic and clinical characteristics and the association of clinical characteristics with treatment outcomes among patients with suspected upper gastrointestinal bleed (UGIB) presenting to the emergency department (ED). At present, there is a scarcity of data on UGIB in Northern part of India.
MATERIAL AND METHOD
The study was a single-center, prospective observational study conducted at an urban tertiary care center. Consecutive patients with suspected UGIB were enrolled in the study from August 2020 to February 2022. A detailed history was obtained, including demographic data such as age and sex, presenting complaints, history of presenting illness, history related to co-morbidities, addiction, and drug history. Pre-endoscopic Rockall and Glasgow-Blatchford Score were calculated for each patient. The patients were subsequently followed up till discharge from the hospital. The final outcomes with regard to mortality, need for blood transfusion, length of emergency department stay, and discharge were noted.
RESULT
141 patients were included in the study. The mean age of the patients with suspected UGIB was 48 ± 14 years. 115 (81.6%) patients were male. The most common co-morbidity was chronic liver disease (40;28.4%). The most frequent presenting complaint in this study was hematemesis (96; 68.1%), followed by melena (76;53.9%). The mean (Standard Deviation, SD) of the Rockall Score was 2.46 ± 1.75. The mean (SD) of the Glasgow Blatchford Score was 12.46 ± 3.15 in patients with UGIB.
CONCLUSION
In our study, hematemesis was the most prevalent symptom of suspected UGIB, followed by melena. Portal hypertension was the most common cause of UGIB. Most frequent comorbidities in patients suspected of UGIB were alcohol intake, Nonsteriodal Antiinflammatory Drugs (NSAIDs) abuse, and co-morbidities such as underlying chronic liver disease, hypertension, and diabetes. Early endoscopy can be of great utility to reduce morbidity and mortality.
Topics: Humans; Adult; Male; Middle Aged; Female; Hematemesis; Melena; Gastrointestinal Hemorrhage; Alcohol Drinking; Emergency Service, Hospital
PubMed: 37726688
DOI: 10.1186/s12873-023-00885-9 -
Medicine Jun 2021A Dieulafoy lesion is a rare cause of gastrointestinal (GI) bleeding, especially in the jejunum, and the presence of calcifications on CT might be suspicious of the...
RATIONALE
A Dieulafoy lesion is a rare cause of gastrointestinal (GI) bleeding, especially in the jejunum, and the presence of calcifications on CT might be suspicious of the diagnosis.
PATIENT CONCERNS
We describe a 72-year-old woman with anemia and melena. Hemoglobin was 6.0 g/dL, and the stools were positive for occult blood (4+). Blood pressure was 116/54 mm Hg. Physical examination showed pale face and pitting edema in both lower limbs. Abdominal computerized tomography showed calcification in the small intestine of the left lower abdomen. Capsule endoscopy showed a blood clot.
DIAGNOSES
Dieulafoy lesion.
INTERVENTIONS
Single balloon endoscopy was performed via the oral approach and showed a blood clot on the suspected submucosal tumor of jejunum. A hemostatic clip was placed at the base of the lesion to allow the surgeon to locate it during the operation. Laparoscopy was performed, and the lesion was resected.
OUTCOMES
The postoperative pathology showed a Dieulafoy lesion. The lower extremity edema subsided. GI bleeding did not recur over 1 year of follow-up, and hemoglobin was 12.2 g/dL. A Dieulafoy lesion is a rare cause of GI bleeding, and it is even rarer in the jejunum.
LESSONS
A Dieulafoy lesion does not have special imaging features, but the presence of calcifications in the small intestine on computerized tomography might be suspicious of the diagnosis. When endoscopic treatment is difficult, surgical treatment could be considered.
Topics: Aged; Anemia; Arterioles; Capsule Endoscopy; Female; Humans; Intestinal Mucosa; Jejunum; Laparoscopy; Melena; Tomography, X-Ray Computed; Treatment Outcome; Vascular Calcification
PubMed: 34160386
DOI: 10.1097/MD.0000000000026229