Massive gastrointestinal hemorrhage in the presence of portacaval anastomosis.
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Some coagulation deficiencies are known to cause bleeding by unmasking existing gastrointestinal pathology, as opposed to directly causing mucosal blood loss. Characteristics and etiology of gastrointestinal hemorrhage associated with thrombocytopenia have not been analyzed. Our objectives were to correlate the distribution and cause of gastrointestinal bleeding, as diagnosed by fiberoptic endoscopy, with the severity of thrombocytopenia. One hundred thirty-three patients were divided into three groups, determined by platelet count at the time of bleeding (group A: less than 20,000/mm3; group B: 20,000 to 40,000/mm3; group C greater than 40,000/mm3). Results of 187 endoscopies revealed unifocal sources of blood loss in over 50% of each group, and diffuse mucosal oozing independent of gastrointestinal pathology was seen in only 1% of group C. The only significant difference (p = 0.04) comparing unifocal, multifocal, and diffuse sources of bleeding was observed between groups A and C, where in the distribution of multifocal or diffuse sources of bleeding was more common in group A. Esophagitis was more common and gastric ulceration less common in group A. No endoscopic complications occurred. Gastrointestinal bleeding associated with thrombocytopenia is most commonly due to co-existent gastrointestinal pathology as opposed to diffuse mucosal bleeding. Even when an inflammatory process, such as esophagitis or gastritis, affects a particular organ, bleeding is usually unifocal or multifocal as opposed to diffuse even in the presence of moderately severe thrombocytopenia.
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BACKGROUND: There is no consensus as to the best treatment for non-variceal, non-ulcer gastrointestinal hemorrhage. Endoscopic band ligation is an inexpensive, readily available, and easily learned technique in contrast to conventional thermal methods of endoscopic hemostasis. We present the preliminary results of an open trial using endoscopic band ligation for non-variceal, non-ulcer bleeding in the gastrointestinal tract. METHODS: Eighteen patients were treated by band ligation between June 1996 and November 1997. The lesions treated were: arteriovenous malformations in 10, Dieulafoy's lesions in 4, Mallory-Weiss tear in 2, and post-colonic polypectomy bleeding in 2. RESULTS: Endoscopic band ligation was successful in 17 of 18 cases, with a follow-up period ranging from 2 to 18 months. The remaining case, a duodenal Dieulafoy's lesion, bled again at 24 hours but was successfully treated by adrenalin injection. CONCLUSIONS: Endoscopic band ligation is effective for non-variceal, non-ulcer bleeding. It has the advantage of ease of use and is relatively inexpensive.
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Despite widespread dissemination of primary lung carcinoma by lymphangitic and hematogenous routes, acute gastrointestinal signs and symptoms are rarely presenting symptoms for bronchogenic carcinoma. We present a patient with small cell carcinoma of the lung who came to medical attention because of a lower gastrointestinal hemorrhage. In the absence of radiographically apparent pulmonary disease, the correct diagnosis was suggested by the biopsy specimens of the colon.
The high mortality rate of up to 64% as a result of emergency for gastrointestinal hemorrhage indicates the need for a reliable method for endoscopic bleeding control. By developing a special flexible endoscopic laser transmission system it was possible to transmit high-power Nd-Yag laser radiation, which is especially effective in massive hemorrhages. In 1 1/2 years 186 (94%) of 198 bleeding incidents in 150 unselected patients could be controlled by endoscopic laser irradiation (varices: 60; Mallory-Weiss tears: 14; ulcers: 101; multiple erosions: 11).
Aneurysmal degeneration of gastroduodenal and pancreaticoduodenal arteries due to acute and chronic forms of pancreatitis is uncommon. Gastrointestinal hemorrhage secondary to these vascular lesions has been recognized in only 23 patients. Eight of these patients, including five with gastroduodenal and three with pancreaticoduodenal artery aneurysms, have been encountered at the University of Michigan Medical Center. Selective mesenteric arteriography provided the greatest diagnostic specificity. Computerized axial tomography was of discriminate diagnostic value in two patients. Seven of eight patients underwent surgical therapy: transcystic arterial ligation and external pancreatic pseudocyst drainage (four), arterial ligation with abscess drainage (two), and pancreaticoduodenectomy (one). Three patients died after operation from intraabdominal sepsis as well as delayed arterial hemorrhage. Earlier operative intervention, dictated by the patient's clinical status and relevant anatomic findings, may improve survival rates in this complex disease state.
The treatment efficacy of sorbentic blood (SB) for the blood loss compensation in patients with an acute gastrointestinal hemorrhage (AGIH) was studied up. High efficacy of the SB transfusion in restoration of hematological and volumetric indexes and the acid-base state, providing clinical effect and lowering of the postoperative complications occurrence, was determined.