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Results for “HEMORRHAGE, GASTROINTESTINAL”

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At least 505 records · Page 28Linked to original sources
PubMed1997

Acute upper gastrointestinal hemorrhage in older people: a prospective study in two neighboring districts.

OBJECTIVE: To study the distribution of mucosal lesions and outcomes in older people with acute upper gastrointestinal hemorrhage (UGIH). DESIGN: Prospective case study. SETTING: Two neighboring district hospitals with similar admission policies. SUBJECTS: Consecutive patients aged 75 years or older admitted with hematemesis and/or melena during the study period. OUTCOME MEASURES: Length of hospital stay, mortality, surgical intervention, and transfusion requirements. RESULTS: A total of 109 patients were entered into the study. Of these, 106 (97%) underwent gastroscopy, and bleeding sites were identified in 98%. Upper gut malignancies were identified in eight patients, ulcerative esophagitis in 32, benign gastric ulcers in 24, and duodenal ulcers in 23 patients. Forty-seven percent had severe anemia on admission (Hb < 10 g/dL). Thirty-eight patients were referred for surgery, and eight were operated on, with one postoperative death. Six other patients died, five of whom had malignancies. The overall mortality of 6% reduced to 2% if those with malignancy were excluded. The 92 patients discharged had a median hospital stay of 15 days (range 2-30). CONCLUSIONS: Older people with acute UGIH have advanced upper gut pathology with preponderance of esophageal lesions. Classical symptoms seem lacking, but mortality can be decreased despite adverse comorbid factors. Lower thresholds for endoscopy are advocated in older adults, and comparative studies of UGIH symptoms with younger patients are required.

Acute Disease↗
PubMed1994

[High-dose omeprazole versus famotidine, pirenzepine and antacid in therapy of acute upper gastrointestinal hemorrhage in a retrospective comparison].

We retrospectively investigated the efficacy of high dose omeprazole compared to a combined therapy of famotidine, pirenzepine and antacid for acute upper gastrointestinal hemorrhage (AUGIH) also adjuvant to endoscopic injection therapy if indicated. The clinical course of AUGIH was evaluated, if emergency endoscopy revealed lesions substantially dependent on intragastric acidity with respect to pathogenesis and/or healing (peptic ulcer, erosive gastroduodenitis, reflux-esophagitis, Mallory-Weiss tears) and patients either received a combined therapy of famotidine (20 mg i.v. every 12 hrs), pirenzepine (10 mg i.v. every 12 hrs) and antacid (control group: n = 96) or omeprazole (40 mg i.v. every 6 hrs; omeprazole group: n = 100). Rate of rebleeding was lower in the omeprazole group without reaching significance (12 vs. 21; p = 0.06). No difference was found for rates of operation (6 vs. 6; p = 0.94), death from bleeding (5 vs. 9; p = 0.22), transfusions ([mean +/- SD] 3.3 +/- 5.0 vs. 3.2 +/- 5.7; p = 0.51) and hospitalisation ([mean +/- SD] 26.8 +/- 12.1 vs. 27.8 +/- 16.0 days; p = 0.88). Considering prognostic risk factors (age > or = 65, actively bleeding lesion, initial state of shock) logistic regression showed that high dose omeprazole inhibited rebleeding (p = 0.01) but had no effect as regards surgery or mortality. Within two selected subgroups defined by additional criteria (no endoscopic treatment and anamnestic peptic lesion) omeprazole-treated cases showed lower rates of rebleeding (3/49 vs. 12/54, p " 0.02 and 3/44 vs. 13/48, p = 0.01 resp.) and death from bleeding (0/46 vs. 6/50, p = 0.03 and 0/43 vs. 5/45, p = 0.03 resp.).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Severe gastrointestinal hemorrhage in Crohn's disease.

Twenty-one of fifteen hundred twenty-six patients with Crohn's disease (CD) treated at The Mount Sinai Hospital between 1960 and 1986 developed severe gastrointestinal hemorrhage. There were 26 separate episodes of severe hemorrhage: 17 patients bled only once, three bled twice and one bled three times. The frequency of bleeding was significantly higher among patients with colonic involvement (17 of 929; 1.9%) than among those with small bowel disease alone (4 of 597; 0.7%) (p less than 0.001). Twelve patients required surgery on 13 occasions, which involved colon resection in all but one case. Eleven of these patients underwent surgery during their first hemorrhagic episodes, and 1 of 11 had a second operation for recurrent bleeding; the 12th patient, whose first hemorrhage had been treated medically, had surgery during a repeated episode of hemorrhage. The precise bleeding points could be located in only 2 of the 26 bleeding episodes, both at the ileocecal area. Three patients died, of whom two had not undergone surgery when they had bled a few weeks earlier. Primary bleeding episodes subsided without surgery in 10 of 21 cases, but 3 of these 10 patients (30%) rebled massively. By contrast primary excisional surgery was followed by recurrent hemorrhage in only 1 of 11 cases (9%). These differences in mortality and in recurrent bleeding rates, although not statistically significant, seem to favor removal of diseased bowel at the time of the first episode of massive hemorrhage.

Acute Disease↗
PubMed2000

[Jejunal diverticulosis: a cause of infrequent gastrointestinal hemorrhage. Case report].

Jejunal diverticulosis is a very uncommon acquired disease. Clinical manifestations include acute life threatening complication such as perforation, obstruction and bleeding. Jejunal diverticulosis is an extremely rare site of origin of gastrointestinal bleeding, with fewer than seventy cases reported in the literature. We report a 77-year-old patient with a recurrent severe gastrointestinal bleeding manifested by melena and hematochaezia. During the hospitalization the tagged red blood cell scanning was positive for bleeding in the jejunum. At laparotomy, several large-mouthed diverticula at the proximal jejunum were identified. Approximately 30 centimeters of the involved segment was resected with primary end-to-end anastomosis. Postoperative 7 month evolution has been favorable, without any evidence of rebleeding. This report reviews the literature concerning this disease, discusses some diagnostic methods of studying small bowel bleeding and highlights the need to consider this diagnosis in old patients with a gastrointestinal hemorrhage of unknown origin (Rev Méd Chile 2000; 128: 1133-38).

Aged↗
PubMed1993

Arteriovenous fistula of the jejunum associated with gastrointestinal hemorrhage in a dog.

Hemorrhage from the gastrointestinal tract of a young dog resulted in melena with concurrent anemia. Exploratory laparotomy revealed the hemorrhage originated from an arteriovenous fistula in the jejunum. Resection of the abnormal part of the jejunum was curative. The arteriovenous fistula in the dog was probably congenital in origin, but may have been the result of gastrointestinal tract trauma.

Anastomosis, Surgical↗
PubMed1990

Massive gastrointestinal hemorrhage in an immunosuppressed man due to gastric Kaposi's sarcoma.

Kaposi's sarcoma, a neoplasm that occurs in immunocompromised patients and people of Mediterranean origin, usually presents with skin lesions. However, extracutaneous lesions are common, and the gastrointestinal tract is often involved. We report the case of an iatrogenically immunosuppressed patient who presented with a massive upper gastrointestinal hemorrhage that was caused by Kaposi's sarcoma of the stomach. Kaposi's sarcoma in the setting of immunosuppression and the gastrointestinal manifestations of this disease are reviewed.

Adrenal Cortex Hormones↗
PubMed2000

Upper gastrointestinal hemorrhage secondary to erosion of a biliary Wallstent in a woman with pancreatic cancer.

A 77-year-old patient with unresectable pancreatic adenocarcinoma sustained a life-threatening, upper gastrointestinal hemorrhage 1 month after placement of a biliary Wallstent. Radiographic and endoscopic studies revealed a choledocho-arterio-enteric fistula caused by erosion of the stent through the posterior duodenal wall. The patient was treated successfully with arterial embolization. This represents an unusual case of arterial bleeding with choledocho-arterio-enteric fistulization into the duodenum subsequent to biliary stent erosion.

Adenocarcinoma↗
PubMed2004

Aortoesophageal fistula: a life-threatening cause of upper gastrointestinal hemorrhage in double aortic arch, a case report.

The authors present the case of a 2-month-old infant with double aortic arch that developed massive bright red upper gastrointestinal hemorrhage from aortoesophageal fistula (AEF) after prolonged endotracheal and nasogastric intubation. Emergency thoracotomy with AEF and double aortic arch repaired were done successfully under cardiopulmonary bypass. Due to tracheomalacia and left phrenic nerve injury, tracheal extubation could not be done until 1 month after correction of the vascular ring. The endotracheal and nasogastric tube led to fistula formation by compression of the esophageal wall against an abnormal double aortic arch. When a double aortic arch is suspected, prolonged nasogastric intubation should be avoided.

Aorta, Thoracic↗