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PubMedDate not supplied

[A fatal case of lower gastrointestinal hemorrhage: report of case and review of the literature].

Gastrointestinal hemorrhage continues to be a major medical problem. Even with improvements in both diagnostic and therapeutic, a significant number of patients still require surgical intervention for control of hemorrhage. When the source of persistent lower gastrointestinal hemorrhage is unknown, subtotal colectomy is a conceptually rational management choice. The authors present a case of massive lower gastrointestinal hemorrhage with unusual fatal outcome. A review of literature of this condition and a discussion about the diagnosis, treatment and etiopathogenesis are presented.

Angiography↗
PubMed1983

Gastrointestinal hemorrhage.

Two types of upper gastrointestinal bleeding can be differentiated in the critical care setting: bleeding caused by a gastroenterologic disorder or bleeding that develops as a complication of a nongastroenterologic critical illness. A clinical approach to upper gastrointestinal bleeding is presented. Lower gastrointestinal hemorrhage and the diagnosis of gastrointestinal bleeding in infants and children are also briefly discussed.

Adolescent↗
PubMed1989

Pancreatic lithiasis: a rare cause of gastrointestinal hemorrhage.

The rare instance of a gastrointestinal hemorrhage caused by a lithiasis of the duct of Wirsung is described. The world literature records only 13 other cases. Pancreatic calculi cause hemorrhage by either migrating through the pancreatic parenchyma to perforate the duodenum, ulcerating the vessels of the periductal parenchyma, or rupturing the pancreas. The usual sign of this complication of chronic calcifying pancreatitis, difficult to diagnose, is repeated gastrointestinal hemorrhages and sometimes pain, as in epigastric colitis. The immediate therapy is control of the hemorrhage. With transcatheter occlusive techniques, radical surgery can be postponed until it is more tolerable.

Adult↗
PubMedDate not supplied

Embolization for treatment of gastrointestinal hemorrhage secondary to recurrent renal cell carcinoma.

Massive gastrointestinal hemorrhage secondary to metastatic renal cell carcinoma involving the jejunum is rare but has been previously described in the medical literature. Treatment options for metastatic renal cell carcinoma are limited, but transcatheter arterial embolization can be performed to control gastrointestinal hemorrhage either alone or prior to surgical resection. We describe a case of successful transcatheter arterial embolization for control of massive gastrointestinal hemorrhage secondary to locally recurrent renal cell carcinoma invading the jejunum and review the literature. Arteriography provided both the diagnosis of recurrent disease and the means of therapy.

Aged↗
PubMed1983

Gastrointestinal hemorrhage from pseudoaneurysms in pancreatic pseudocysts.

Gastrointestinal hemorrhage secondary to hemosuccus pancreaticus is a rare condition that poses a significant diagnostic and therapeutic challenge. It is reported to occur most commonly in the setting of acute or chronic pancreatitis with rupture of pseudoaneurysms of the spleen or hepatic artery into the pancreatic duct. In this report three such cases have been reported. Abdominal ultrasound and CT scanning can noninvasively define pancreatic pseudocysts with a high degree of accuracy. Real-time ultrasonography may document a pulsatile pseudoaneurysm. Radionuclide arterial scanning, by demonstrating pooling of blood in the area of a pseudocyst, can point to the source of bleeding in patients with pancreatitis and gastrointestinal hemorrhage. Selective celiac angiography, however, is the only diagnostic test that can definitively outline a pseudoaneurysm and demonstrate its rupture into a pseudocyst or into the pancreatic duct. Pancreatic resection including excision of the pseudoaneurysm and pseudocyst (when present) is the treatment of choice. In cases where resection is not possible, ligation of the artery proximal and distal to the pseudoaneurysm and drainage of the pseudocyst into the gastrointestinal tract is an acceptable alternative procedure. Although intraarterial catheter embolization of the bleeding vessel can be a lifesaving procedure in these very sick patients, subsequent resection of the lesion is warranted as the definitive treatment.

Adult↗
PubMed1999

Diagnosis and percutaneous treatment of gastrointestinal hemorrhage. Long-term experience.

OBJECTIVE: to report our experience in the diagnosis and treatment of gastrointestinal hemorrhage. METHOD: from April 1987 to April 1997, 196 patients with gastrointestinal hemorrhage (134 men and 62 women) were studied. 165 (84%) were diagnosed as presenting upper gastrointestinal hemorrhage, and 31 (16%) presented lower gastrointestinal hemorrhage. The patients were studied with endoscopy and arteriography, and embolization was prescribed in 131 (67%). Patients with bleeding from esophageal varices were excluded from this study. RESULTS: a bleeding point was identified angiographically in 33% (n = 65) patients. 131 (67%) patients were treated with therapeutic embolization, which was successful in 89% (n = 116) patients. The bleeding was resolved in 80% (n = 93) of the patients. Complications included arterial spasm (n = 12), pain (n = 24), coil migration (n = 8), allergic reaction (n = 2) and celiac trunk dissection (n = 2). During follow-up 16 patients presented rebleeding that stopped after reembolization in 9 cases, whereas in 7 cases surgery was needed. CONCLUSIONS: in our experience, diagnostic angiography and percutaneous therapeutic embolization are effective, less aggressive methods that lead to few complications. Both methods have become indispensable tools in managing patients with gastrointestinal hemorrhage that does not respond to conservative therapy. Even in patients with no evidence of angiographic bleeding, embolization in selected patients is successful.

Adult↗
PubMed2005

Safety and efficacy of superselective angioembolization in control of lower gastrointestinal hemorrhage.

BACKGROUND: We evaluated the safety and efficacy of angioembolization to control lower gastrointestinal hemorrhage. METHODS: Retrospective chart review of patients undergoing angiography for lower gastrointestinal hemorrhage from January 2000 to December 2002. RESULTS: Seventy-seven patients with lower gastrointestinal hemorrhage underwent mesenteric angiography. Angioembolization was performed in 11 patients. Sixty-six patients were not embolized; 47 of these were treated medically and 19 surgically. Mortality rate was not significantly different in patients treated surgically (3 of 19, 16%) versus those managed medically (6 of 47, 13%; P = 0.746). Of the 11 patients who were embolized, 10 had immediate cessation of hemorrhage, 7 had gastrointestinal ischemia, and 6 died (55%). Overall mortality in non-embolized patients was 9 of 66 (14%; P = 0.002 versus mortality in embolized patients). CONCLUSIONS: Angioembolization, though effective at controlling hemorrhage, is associated with ischemic complications and a high mortality rate. Our data support surgical or medical management for lower gastrointestinal hemorrhage.

Aged↗
PubMed1982

Diagnostic and interventional angiography in acute gastrointestinal hemorrhage.

The use of vasopressin infusion or arterial embolization in the treatment of 87 patients with gastrointestinal hemorrhage is reviewed. A bleeding point was identified angiographically in 46 patients (53%), with a higher success rate in those with upper gastrointestinal hemorrhage (63%) than in those with lower (39%) gastrointestinal hemorrhage. Vasopressin infusion in 33 patients completely stopped hemorrhage in 14 and slowed hemorrhage pending surgery in another 5. Gelfoam embolization was successful as definitive therapy in 12 of 15 patients. Mortality as a result of hemorrhage or its sequelae was 40% in patients with upper gastrointestinal hemorrhage and 21% in those with lower gastrointestinal hemorrhage.

Acute Disease↗
PubMed1978

[Angiographic diagnosis and therapy of acute and chronic gastrointestinal hemorrhages].

In acute gastrointestinal bleeding visceral angiography has been showing its importance for years. It contributes to diagnosis especially in cases with persistent acute hemorrhage. In chronic gastrointestinal bleeding conventional radiographic procedures such as upper gastrointestinal series and barium enema will be preferred to angiography. The function of the radiologist goes beyond mere diagnosis of gastrointestinal bleeding. Treatment with vasopressin via the angiographic catheter has proven its clinical value. This method will be indicated especially in cases with high risk anesthesia and surgery. It will help to postpone necessary surgery to a more favorable moment following hemostasis. Side effects such as hypertension and antidiuresis are relatively rare and easy to manage. Numerous substances are used for embolization showing that ideal material has not been found yet and further development seems necessary. In contrast to vasopressin treatment, vascular occlusion is often irreversible, complications (unwanted reflux of embolization material, necrosis and plugging of the catheter) are more difficult to manage. Superselective visualization of a bleeding artery is always needed. Embolization is justified in cases when a possibility for anesthesia and surgery cannot be foreseen. The electrical vascular occlusion using direct current is still in the phase of animal experiments; its clinical value has not sufficiently been assessed as yet.

Aneurysm↗
PubMed2003

[Gastrointestinal hemorrhage in cirrhosis at Dakar. Predictive factors study].

Our aim were to describe the epidemiological and clinical as well as therapeutical features and to look for predictive factors of occurrence of gastrointestinal hemorrhage among cirrhotic patients. We included all cirrhotic patients with acute gastrointestinal hemorrhage hospitalized in the Service of Internal Medicine of Aristide Le Dantec University Teaching Hospital from January 1990 to December 1999. The diagnosis of cirrhosis was established according to two situations: prebiopsic criteria with clinical, biological, ultrasound and endoscopic data or the histological criteria. Gastrointestinal hemorrhage was present in 28.9% of the patients with an average age of 38.7 years and a sex ratio of 1.4. It revealed the cirrhosis in 82% of the cases, whether alone in 45.2% or associated with other complications in 36.8%. Previous bleeding episodes were found in 76 cases (9.6%). Gastrointestinal hemorrhage is the first cause of death among our cirrhotic patients with an overall mortality of 29.4%. The gastrointestinal hemorrhage was significantly associated with the young age (< 40 years). On the other hand, the clinical and biological parameters did not seem predictive of bleeding. The risk of hemorrhage was positively correlated with the presence of esophageal varices and their stage, the gastric varices and the portal gastropathy. The other lesions (watermelon stomach and erosive gastritis) did not seem to play a role in gastrointestinal hemorrhage. However the CHILD-PUGH classification was a poor predictor of either first hemorrhage or re-bleeding in this present study. We conclude that gastrointestinal hemorrhage is frequent among cirrhotic patients in our country. It constitute in this study the first cause of death in this population. instrumental treatment methods might prevent most of gastrointestinal hemorrhages in patients with high risk.

Adult↗
PubMed1994

Striking prevalence of over-the-counter nonsteroidal anti-inflammatory drug use in patients with upper gastrointestinal hemorrhage.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are a well-established cause of gastrointestinal disease. There appears to be an association with peptic ulcer disease complications, specifically ulcer-related bleeding. Studies addressing this relationship have primarily evaluated prescription use of these agents. There has been little study of over-the-counter NSAID use in patients with either ulcer or nonulcer-related upper gastrointestinal hemorrhage. METHODS: Consecutive patients with upper gastrointestinal hemorrhage evaluated by a gastroenterology consultative service at a large inner-city hospital from August 1, 1990 to July 31, 1992 were identified. The use of any prescription or over-the-counter NSAID during the week before admission was prospectively assessed. Computerized pharmacy records were available for confirmation of prescription drug use. RESULTS: During the 2-year period of study, 421 patients were evaluated for upper gastrointestinal hemorrhage. The mean age of the patients was 50 years and the majority were male and black. The most common cause of bleeding was peptic ulcer disease, identified in over 50% of patients. Use of an over-the-counter aspirin or nonaspirin NSAID was reported in 145 patients (35%) and 36 patients (9%), respectively, during the week before admission. Prescription use of a nonaspirin NSAID or aspirin was reported in 56 patients (14%) and 27 patients (6%), respectively. The overall prevalence of NSAID use during the week before admission was 56% (95% confidence interval, 51.2% to 60.8%). The use of any NSAID was significantly associated with gastric compared with duodenal ulcer hemorrhage, and ulcer-related bleeding compared with variceal hemorrhage. CONCLUSIONS: Over-the-counter NSAID use is frequent in our patient population and exceeds prescription use. Although ulcer-related bleeding was significantly associated with use of these drugs, NSAIDs were commonly used in patients with nonulcer-related upper gastrointestinal hemorrhage as well. Over-the-counter NSAID use may represent a more important cause of peptic ulcer disease and ulcer-related hemorrhage than previously appreciated.

Adult↗
PubMed1991

[Ulcerous and non-ulcerous gastrointestinal hemorrhage in children].

The authors analyze the causes of gastrointestinal hemorrhages in 64 children aged 11 months to 15 years. 45 children had ulcerous and 19 non-ulcerous hemorrhages. The presence of gastrointestinal hemorrhages is an absolute indication for emergency esophagogastroduodenoscopy which appeared helpful in visualization of the source of hemorrhage in 60 out of the 64 patients (93.7%). 8 children underwent surgery, whereas in the remaining ones, hemorrhage was arrested by conservative treatment methods.

Adolescent↗
PubMed2005

Transcatheter embolization of acute non-variceal gastrointestinal hemorrhage.

OBJECTIVE: To determine the efficacy and safety of transcatheter embolization of nonvariceal gastrointestinal hemorrhage. DESIGN: Descriptive analytical study. PLACE AND DURATION OF STUDY: Radiology Department, The Aga Khan University Hospital, Karachi, Pakistan, from October 1999 to August 2004. SUBJECTS AND METHODS: The study included 27 patients who underwent angiography for suspected gastrointestinal hemorrhage. The presumptive diagnosis was based on the findings of endoscopy in 08 patients, scintigraphy in 05 patients and on clinical findings only in 14 patients. Nine patients had gastroduodenal hemorrhage, 04 patients had hemobilia and 14 patients had lower gastrointestinal bleeding. Five patients had comorbidities. One patient had uremia, 2 had hepatitis C, 1 had cirrhosis and 1 had coagulopathy. Technical success, clinical success, complications and patient survival were assessed. RESULTS: Nine patients had upper gastrointestinal hemorrhage, 4 patients had hemobilia and 14 patients had lower gastrointestinal bleeding. Etiology of bleeding was known in 15 patients and unknown in 12 patients. Clinical success was achieved in 23 (85.18%) of 27 patients. Two patients had early rebleeding. One of these was managed surgically and recovered. The other had severe coagulopathy and was unfit for surgery. Two patients had bowel infarction, one of these was managed surgically and recovered and the other died of complication of procedure. One patient had small splenic infarcts and was managed conservatively. Overall 85.18% success was achieved for the embolization procedure. Two of 27 patients died. One patient died because of recurrence of bleeding and other died because of infarction of right hemi-colon which occurred as complication of embolization. CONCLUSION: Transcatheter embolization is effective and safe in patients with nonvariceal gastrointestinal hemorrhage.

Embolization, Therapeutic↗