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PubMedDate not supplied

Embolization of the vasa recta in acute lower gastrointestinal hemorrhage: A report of five cases.

PURPOSE: To present our preliminary experience in embolization of the vasa recta in acute gastrointestinal hemorrhage. METHODS: In four of five patients with acute gastrointestinal hemorrhage superselective embolization of the vasa recta was performed. In one patient in whom superselective catheterization of the bleeding vas rectum was technically impossible, the origin of this vessel was embolized at the level of the terminal arcade. The following embolization materials were used: microcoils and polyvinyl alcohol particles (355-500 microm), n = 2; microcoils only, n = 2; Gelfoam particles, n = 1. RESULTS: Bleeding was found in two patients in the small bowel (jejunum and ileum) and in three patients in the colon. Immediate hemostasis was achieved in all patients. No signs of ischemia or infarction were observed after intervention. CONCLUSIONS: Superselective embolization of the vasa recta proved efficient and safe in our small patient group. Advantages of this technique are reduction of the embolized area to a minimum and direct control of hemostasis.

Acute Disease↗
PubMedDate not supplied

Pancreaticoduodenal artery aneurysm--a life-threatening cause of gastrointestinal hemorrhage: case report and review of the literature.

Gastrointestinal bleeding caused by erosion of a pancreaticoduodenal artery aneurysm in patients with pancreatitis is a rare but potentially life threatening disease. In this case report, the successful treatment of a patient bleeding from a ruptured pancreaticoduodenal artery aneurysm is described. A review of the literature of reported cases discusses the value of early angiographic intervention in patients with unexplained gastrointestinal hemorrhage and suspected rupture of an aneurysm.

Adult↗
PubMed1998

[Dieulafoy colonic ulcer. A rare cause of lower gastrointestinal hemorrhage].

Dieulafoy's disease is an unusual cause of gastrointestinal hemorrhage, reported to account for less than 2% of acute gastrointestinal bleeding episodes. Bleeding occurs from a defect in an unusually large submucosal artery, through a minute mucosal erosion. Endoscopic diagnosis is sometimes difficult, but primary endoscopic therapy may be successful and should be attempted. In most cases the lesion is found in the proximal stomach. Sixteen cases of Dieulafoy's lesion located in the colon have been reported in the literature but only nine have been confirmed by histology. We present the case of a 63 year-old male with Dieulafoy's lesion of the transverse colon which was diagnosed by endoscopy and confirmed by histology.

Arteries↗
PubMed1998

An autopsy case of unusual massive gastrointestinal hemorrhaging.

An autopsy case is presented involving massive gastrointestinal hemorrhaging. A 58-year-old woman was found dead with bloody patches on her body. An autopsy revealed a lacerated wound to the mucosa of the stomach and a sharp fish bone was found among bloody contents within the stomach. The duodenum and small intestines contained abundant tarry contents, but the mucosa of the intestinal tract was intact. The cause of death was certified as hemorrhagic shock due to massive bleeding from a wound to the gastric mucosa inflicted by a sharp fish bone. Therefore the possibility that some foreign body has been swallowed must be considered when forensic pathologists investigate cases with bleeding of unknown origin from the alimentary tract.

Animals↗
PubMed1995

A prospective study of upper gastrointestinal hemorrhage in patients with hepatocellular carcinoma.

Our purpose was to determine, in a prospective study, the causes of gastrointestinal hemorrhage in patients with hepatocellular carcinoma, and the relationship of portal vein invasion with variceal hemorrhage in these patients. During an 11-month period, 55 patients presented with hepatocellular carcinoma presented with signs and/or symptoms of upper gastrointestinal hemorrhage. Forty-seven percent had bleeding from varices, whereas the majority, 53%, had a nonvariceal bleeding source. Among those with nonvariceal bleeding, duodenal ulceration was the commonest cause. Direct tumor invasion into the gastrointestinal tract was found in three patients. Tumor invasion of the portal venous system was detected by ultrasound examination in 76% of the variceal bleeders, compared to only 45% of the nonvariceal bleeders. Despite the very high frequency of cirrhosis among patients with hepatocellular carcinoma, the source of bleeding was variceal in less than half of the patients. Portal vein invasion is a risk factor for subsequent variceal bleed.

Carcinoma, Hepatocellular↗
PubMed1999

Prediction of resource utilization and case cost for acute nonvariceal upper gastrointestinal hemorrhage at a Canadian community hospital.

OBJECTIVE: Upper gastrointestinal hemorrhage (UGIH) is common, and thus imposes a substantial burden on health care resources. We describe resource utilization and cost for management of acute nonvariceal UGIH, and studied their variation among population subgroups. METHODS: Resource utilization and direct medical case costs were extracted for consecutive admissions for nonvariceal UGIH at a large community hospital in southern Ontario through chart review and adaptation of an administrative case cost database. Univariate and multiple regression models were then developed to identify independent demographic predictors of case cost and length of stay. RESULTS: Among 116 eligible admissions the average length of stay and case cost were 4.26 days and Can$2690, respectively (Can$1 = US$0.70). Both cost and length of stay demonstrated significant univariate relationships with age, comorbid illness, prior peptic ulcer disease (PUD), and prior UGIH. Age and prior PUD persisted as independent predictors in multiple regression models. An inverse transformation of total case cost allowed these variables to explain 26% of the total variance. CONCLUSIONS: Resource utilization for management of acute nonvariceal UGIH at a Canadian community hospital varies substantially among population subgroups, but correlates independently with age and prior ulcer history. Careful attention must be paid to practice environments and demographic profiles before economic models of strategies to prevent or treat UGIH are applied to specific subpopulations.

Acute Disease↗
PubMed2006

Acute lower gastrointestinal hemorrhage originating in the small intestine.

INTRODUCTION: Lower gastrointestinal hemorrhage (LGIH) is generally self-limiting, and the most frequent etiologies are located at colonic level. The objective here is to analyze the diagnostic and therapeutic handling of acute LGIH when its etiology was located in the small intestine. PATIENTS AND METHODS: Between 1975 and March 2002, 12 acute cases of LGIH originating in the small intestine were admitted to our service. All consulted the hospital with acute rectorrhage, requiring a transfusion of at least 3 units of concentrated red blood cells. The mean age was 54 +/- 21 years, 58% were women, and 83% had experienced previous episodes of LGIH. RESULTS: in eleven cases (92%) an urgent lower and upper endoscopy was performed without locating the source of bleeding. An arteriography was indicated in 7 patients (58%), which located the bleeding origin in 5 of them. In two cases a scintigraphy was performed, showing a Meckel's diverticulum in one patient and a normal image in another. All were operated on; in 8 cases (67%), surgery was urgent; in 9 cases, a tumor was found, and in three additional patients, a case of Meckel's diverticulum was found, with a resection being carried out for all lesions. Histology showed a leiomyoma in 7 cases, a Meckel's diverticulum in 3 cases, a leiomyoblastoma in 1, and an angioma in the remaining case. After a mean follow-up of 132 +/- 75 months, the leiomyoblastoma resulted in death, and there was a relapse in the case of angioma, which was successfully embolized with interventional radiology. CONCLUSIONS: Acute LGIH originating in the small intestine should be considered a possible etiology when digestive endoscopy does not locate the source of bleeding, with arteriography being a useful diagnostic technique for bleeding localization. Surgery is the definitive treatment--it confirms the etiology and rules out the presence of malignancy.

Acute Disease↗
PubMed2002

Non-traumatic abdominal emergencies: imaging and intervention in gastrointestinal hemorrhage and ischemia.

Radiologist and radiological techniques play a crucial role in imaging and interventional procedures in gastrointestinal hemorrhage and ischemia. They are involved in emergency situations that may lead to the death of the patient. Therefore correct diagnosis and treatment are absolutely decisive. We have a great potential in tools of diagnosis, with angiography serving not only as the gold standard for diagnosis even offering a potentially effective treatment for various pathologies. Nevertheless, other techniques have developed greatly during the past decade, including in standard protocols for the management of vascular pathologies such as those discussed here. Ultrasound, computed tomography, and magnetic resonance imaging and their applications in the vascular field such as in as Doppler ultrasound, computed tomography angiography, and magnetic resonance angiography provide sensitivity as high as that of angiography for detecting vascular-dependent lesions and for evaluating and excluding other causes of acute or chronic abdomen disorders. This contribution evaluates clinical aspects, various imaging techniques, and interventional effectiveness related to gastrointestinal hemorrhage and ischemia.

Diagnostic Imaging↗
PubMed1989

[Diagnosis and therapy of gastrointestinal hemorrhage].

In the upper gastrointestinal tract endoscopic hemostasis has not replaced surgery, but reduced it to a necessary minimum. Active bleeding can be stanched by the injection method during emergency endoscopy. For bleeding esophageal varices we use polidocanol, in other lesions in the upper gastrointestinal tract we apply thrombin and in the lower intestinal tract adrenalin. If endoscopic hemostasis is successful in small bleeding vessels, the efficiency of hemostatic injections can be trusted. Large visible vessels need to be operated early electively. After the introduction of this therapeutic concept, for example the operation frequency in bleeding gastroduodenal ulcers could be reduced from 51% in 1982 to 28% in 1988. Mortality was improved from 22.1% to 4.7%. In gastrointestinal bleeding diagnostic problems occur especially with angio dysplasia in the small intestine and colon. This is due to impaired accessibility in the small intestine and problematic cleaning of the colon. In the intestine surgical therapy of bleeding lesions has very few alternatives, for example palliative embolization of infusion of vasoconstrictiva.

Emergencies↗
PubMed1985

[Prevention and therapy of acute gastrointestinal hemorrhage].

85% of all gastrointestinal bleeding occurs in the upper gastrointestinal tract. For this reason prophylactic and therapeutic efforts concentrate on the esophagus, stomach and duodenum. Prophylaxis of stress ulcers with H2-blockers and, in some specially endangered patients, with a combination treatment is well accepted. In regard to therapy of bleeding complications, however, medical and surgical treatment procedures compete. Stopping the bleeding during diagnostic endoscopy has gained considerable importance. Success depends - just as does success of pharmacotherapy - upon intensity of bleeding and morphology of the bleeding source (Forrest criteria). For prophylaxis of bleeding relapses from peptic lesions H2-blockers in combination with antacids or pirenzepine are treatment of choice.

Duodenal Ulcer↗
PubMed1996

[Diagnosis and treatment of gastrointestinal hemorrhage].

The handling of gastrointestinal bleeding was discussed at a national expert symposium in February 1995. Internists are in charge of therapeutic endoscopy of upper gastrointestinal bleeding at the majority of Norwegian hospitals, but close collaboration with the surgeon on call is vital. The need for intensive care and monitoring may have been underestimated, since decompensation of co-existing diseases is a more frequent cause of death than the haemorrhage itself. Endoscopic treatment is the primary choice in all parts of the gut where endoscopy is possible, but surgery must be considered for patients who rebleed. Injection of sclerosering agents is the most prevalent mode of treatment for oesophageal varices and ulcers, but thermal probes and rubber band ligation are probably equally effective in experienced hands. Major lower bowel haemorrhage can render colonoscopy impossible, and emergency resections may be warranted, but preferably after angiography or peroperative endoscopic localisation of the area of bleeding.

Acute Disease↗