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Results for “HEMORRHAGE, GASTROINTESTINAL”

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PubMed1991

[Surgical indications, choice of procedure and results in upper gastrointestinal hemorrhage].

Even today acute upper gastrointestinal bleeding carries a high mortality rate. To improve results it is important to define and operate on those patients in whom recurrent bleeding is expected. Whenever possible early elective surgery is recommended. To improve long-term results we propose definitive ulcer surgery even in patients presenting as emergencies. Implementation of this policy does not increase operative mortality.

Duodenal Ulcer↗
PubMed2000

Massive upper gastrointestinal hemorrhage due to cytomegalovirus infection in two patients with acquired immunodeficiency syndrome.

Massive upper gastrointestinal (GI) hemorrhage is a rare manifestation of GI cytomegalovirus (CMV) infection. A review of the English language literature yielded 21 well-documented cases of gastric ulcers due to CMV, and 7 of these 21 cases were complicated by significant GI bleeding. This report describes two cases of massive upper GI hemorrhage due to CMV infection in patients with acquired immunodeficiency syndrome (AIDS).

AIDS-Related Opportunistic Infections↗
PubMed2004

Hemosuccus pancreaticus: an uncommon cause of gastrointestinal hemorrhage. A case report.

CONTEXT: Pseudoaneurysms of peripancreatic arteries usually arise as a complication of acute and chronic pancreatitis. These pseudoaneurysms may either bleed intra abdominally following rupture or may erode into the adjacent hollow viscera and manifest as gastrointestinal bleeding. Pseudoaneurysms rarely communicate with the pancreatic duct and bleeding occurs from the ampulla of Vater in the form of hemosuccus pancreaticus. CASE REPORT: We report a patient with chronic pancreatitis who presented with hemosuccus pancreaticus. Contrast enhanced computerized tomography and angiography revealed bleeding from a left gastric artery pseudoaneurysm. Despite multiple attempts, embolization was unsuccessful due to arterial spasm. The patient was successfully managed at emergency surgery by excision of the pseudoaneurysm sac and ligation of the left gastric artery. CONCLUSION: Bleeding from visceral artery pseudoaneurysms rarely manifests itself as hemosuccus pancreaticus. Most cases can be managed by angio-embolization. However, in patients with recurrent bleeding or failed embolization, emergency surgery is required.

Aneurysm, False↗
PubMed1979

Gastric aspiration in localization of gastrointestinal hemorrhage.

We compared the findings from gastric aspiration for blood with the site of gastrointestinal (GI) hemorrhage ultimately identified by endoscopy or angiography in 1,190 patients whose cases were analyzed retrospectively and prospectively during a six-year period. Gastric aspirates were positive for blood in 837 patients. An upper GI site proximal to Treitz' ligament was identified in 93%, and none had a lower GI site. A negative aspirate was found in 353 patients; a lower GI site was identified in 60%, and 1% (three patients) had an upper GI site. In these three patients, hemorrhage occurred in clinical settings suggesting ulcer disease, and bleeding duodenal ulcers were found in all three. All of the other 180 patients with a bleeding duodenal ulcer had a positive gastric aspirate.

Aged↗
PubMed2004

Intraarterial platelet infusion for patients with intractable gastrointestinal hemorrhage and severe refractory thrombocytopenia.

Transarterial therapies used for the treatment of acute nonvariceal gastrointestinal (GI) hemorrhage have traditionally included vasopressin infusion and embolization. However, for patients with diffuse or multifocal hemorrhage and severe refractory thrombocytopenia, these options are suboptimal because platelet counts and coagulation parameters may not be adequate to allow for the formation of a stable clot. Herein two such patients treated with direct intraarterial (IA) infusion of platelets into the vascular territory supplying the hemorrhage are described. In both patients, after IA platelet infusion, blood product requirements were immediately reduced, bleeding from the GI tract resolved by clinical and laboratory criteria, and no significant bowel ischemia was seen.

Acute Disease↗
PubMed1990

Hemobilia presenting as lower gastrointestinal hemorrhage without pain or jaundice: a case report.

Hemobilia is a rare source of gastrointestinal (GI) hemorrhage. When hepatobiliary bleeding presents as GI bleeding, a history of preceding blunt abdominal trauma is reported in approximately 50% of cases. Often three to four weeks have elapsed between the injury and presentation, and as long as twelve weeks has been reported. Symptoms may suggest either upper or lower GI blood loss. Traumatic hemobilia is commonly associated with cavitary injuries to the liver, and is classically characterized by a triad of findings: GI bleeding, biliary colic, and jaundice. This report describes a patient with traumatic hemobilia, who had neither a significant hepatobiliary injury, nor the classic triad of findings.

Adult↗
PubMedDate not supplied

Gastrointestinal hemorrhage from a small bowel polypoid hemangioma.

OBJECTIVES: Occult gastrointestinal bleeding can originate from the foregut, midgut, or hindgut. The evaluation of the foregut and hindgut are well established. Cases that involve bleeding from the midgut present a much more significant challenge in terms of detection and treatment. Methods of evaluation include small bowel endoscopy, arteriography, and gastrointestinal contrast studies. The differential diagnosis includes arteriovenous malformations, angiodysplasia, ulcers, and small bowel tumors. We will demonstrate that both the evaluation and treatment of these lesions may be accomplished using minimally invasive techniques. METHODS: A case of occult gastrointestinal bleeding from a polypoid hemangioma located in the distal jejunum is presented. Diagnosis and treatment was accomplished using angiographic localization with laparoscopic resection. RESULTS: Laparoscopic small bowel resection after angiographic localization was successful in removing the jejunal polypoid hemangioma. The patient experienced no further gastrointestinal bleeding. CONCLUSIONS: We will discuss the technique of localization and treatment used in this unusual case. A laparoscopic approach is an appropriate and beneficial treatment modality in a bleeding midgut lesion provided the lesion can be localized preoperatively and an oncologic resection is maintained.

Diagnosis, Differential↗
PubMed2003

[The aims of endoscopy in upper gastrointestinal hemorrhage].

FOR DIAGNOSIS AND FOR TREATMENT: Endoscopy for upper gastrointestinal haemorrhage has a double objective. It is difficult and to be optimal, it must be conducted at the right time and in the best technical conditions as possible. Depending on the etiology, identification of the cause of bleeding precedes the choice of the haemostatic method to be used, preferentially injections of adrenaline in the case of bleeding ulcers and elastic ligature in the case of ruptured oesophageal varicose veins. In general the aim of endoscopic treatment is to stop the haemorrhage and to reduce as far as possible the risk of recurrent haemorrhage, which represents a factor of high deathrate.

Endoscopy↗
PubMed1989

[Gastrointestinal hemorrhage after removal of brain tumors].

The diagnosis of gastrointestinal bleeding after the removal of a brain tumor is very difficult due to the severity of the state of the patients. Treatment of the bleeding is effective only in influencing both its source and the higher vegetative centers.

Adult↗
PubMed1983

[Acute upper gastrointestinal hemorrhage: prevention of complications through intensive care].

During acute gastrointestinal haemorrhage patients with coexistent multimorbidity are at excessive risk. It seems to be reasonable to identify predominant cardiopulmonary risk factors and those risks induced by recurrent bleeding. Invasive haemodynamic monitoring and application of a pulmonary risk score could reduce the overall mortality in patients at higher risk. Intensive care management should preserve timing of elective surgical intervention in selected patients.

Aged↗
PubMed1997

Esophagitis is a major cause of upper gastrointestinal hemorrhage in the elderly.

BACKGROUND: The risk of death in patients presenting with upper gastrointestinal (UGI) hemorrhage increases with age. Our aims were to define the background characteristics, causes, course, and outcome in patients aged > or = 80 years admitted to hospital because of acute UGI bleeding (n = 115) in relation to patients aged 60-69 years admitted for the same reason (n = 133). METHODS: A prospective, longitudinal study with a nested case-control analysis was carried out. RESULTS: In the elderly patients there was a female preponderance and a significantly higher prevalence of atherosclerotic cardiovascular disease. By contrast, use of tobacco and alcohol, diabetes mellitus, and chronic liver disease were significantly commoner in the controls. The use of nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, anticoagulants, and corticosteroids was similar in the two groups. Esophagitis was the cause of bleeding in 21.1% of the elderly, as compared with 3.3% in the controls. The relative risk of developing esophagitis in the elderly was increased and was independent of gender, smoking, alcohol consumption, use of NSAIDs, aspirin, or corticosteroids, diabetes mellitus, atherosclerotic cardiovascular disease and liver disease. (Adjusted odds ratio, 18.1; P = 0.0002). The rates of persistent or recurrent bleeding and emergency surgery to control bleeding were similar. However, the mortality in the elderly was higher (13 versus 6.1%; P = 0.09). CONCLUSIONS: Age > or = 80 years is an independent determinant of esophagitis, a major cause of UGI bleeding in the elderly.

Age Factors↗
PubMed2001

Arterial embolotherapy for upper gastrointestinal hemorrhage: outcome assessment.

PURPOSE: To identify predictors of clinical outcome after arterial embolotherapy for upper gastrointestinal (UGI) hemorrhage. MATERIALS AND METHODS: Seventy-five consecutive patients (mean age, 62.5 y) underwent arterial embolization for acute UGI hemorrhage. Bleeding was detected at endoscopy and angiography in 22 patients, at endoscopy alone in 29 patients, and at angiography alone in 24 patients. As such, embolization was directed by angiography in 46 patients (61.3%) and by endoscopy (referred to as "blind" embolization) in 29 patients (38.7%). The embolic agents used were metallic coils, polyvinyl alcohol particles (size range, 355-710 microm), gelatin sponge, and tissue adhesive. Predictors of bleeding recurrence and mortality were analyzed with logistic regression and Cox models, respectively. RESULTS: The technical success rate of embolization was 98.7%. Primary clinical success was achieved in 57 patients (76%). Secondary clinical success occurred in five additional patients (82.5%) after repeat embolization. There were four (5.3%) complications: two cases of self-resolving duodenal ischemia, one hepatic infarct, and one inguinal hematoma. The periprocedural mortality rate was 34.6% (26 of 75), mostly related to underlying illness. Early recurrence of bleeding (within 30 days of embolization) was associated with coagulation disorders (international normalized ratio >1.5, partial thromboplastin time >45 seconds, or platelet count <80,000/microL; odds ratio, 19.46; P = .001) and with the use of coils as the only embolic agent (odds ratio, 7.73; P = .01). Cirrhosis and cancer shortened the overall survival of patients after embolic therapy. The mean patient follow-up time was 34.5 months. CONCLUSION: Arterial embolotherapy for UGI hemorrhage is safe, effective, and durable. Coagulopathy and the use of coils as the only embolic agent were associated with a higher risk of early bleeding recurrence.

Blood Coagulation Disorders↗
PubMed1993

[Gastrointestinal hemorrhage: how much evaluation is necessary?].

For this study data from a total of 362 patients covering a time period of 10 years (1979-1989) were analyzed. Referal to the medical outpatient clinic of Zurich occurred in over 90% of the cases for evaluation of incidental iron deficiency anemia or suspected of gastrointestinal bleeding because of melanea/hematemesis. The evaluation comprised endoscopy, in part radiography of the upper intestinal tract and rarely angiography and scintigraphic tracer studies. 95 patients (26%) had benign lesions in the gastro-intestinal tract, 88 patients (26%) had endoscopy without abnormal findings. Iron deficiency was thought to be due to hypermenorrhea in 45 patients (13%) and to other non-gastrointestinal causes in 43 patients (13%) by exclusion. A malignancy of the gastrointestinal tract was found in 25 patients (7%): 18 carcinomas of the colon, 6 carcinomas of the stomach and 1 metastasis of a melanoma to the coecum. In 80% of the patients with malignancies occult fecal blood was detected. In 154 patients (42%) extensive diagnostic investigation including sometimes even repeated endoscopy could not disclose the cause of blood loss. 88 (24%) of these patients had slight iron deficiencies (hemoglobin > 10 g/dl, hemoccult-test positive in 65% of cases), 66 (18%) had severe iron-deficiencies (hemoglobin < 10 g/dl, hemoccult-test positive in 90% of cases). Selective small bowel radiography was performed in 36 patients without any positive findings. Patients with gastro-intestinal bleeding of undetermined etiology present a diagnostic challenge for the general practitioner.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗