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At least 793 records · Page 44Linked to original sources
PubMed1988

Lower gastrointestinal hemorrhage in renal transplant recipients.

A review of the literature and our own series revealed 38 patients with lower gastrointestinal (LGI) hemorrhage among 4086 renal transplant recipients (0.9%). These patients represent 30% of 128 patients with major colorectal complications in this group. Of the 32 patients whose treatment and outcome were reported, only 12 (38%) were treated operatively. The overall mortality rate was 72%. The causes of LGI hemorrhage included colitis from opportunistic infections (42%); pseudomembranous, ischemic, or uremic colitis (40%); and idiopathic ulcers of the colon (18%). Colonoscopic, gross, and histopathologic findings of a patient with massive LGI hemorrhage from a fungal ulcer of the colon are the focus of this study, as are the implications of such findings. We propose an algorithm for diagnostic and therapeutic management decisions. We emphasize prompt diagnosis and the importance of colonoscopy. We propose withdrawal of immunosuppression and early operative intervention if the patient survival rate is to improve.

Candidiasis↗
PubMed2005

[Localization of bleeding using 4-row detector-CT in patients with clinical signs of acute gastrointestinal hemorrhage].

PURPOSE: There is no gold-standard regarding the diagnostic work-up and therapy of an acute gastrointestinal (GI) hemorrhage. In most cases endoscopy provides the diagnosis but in a low percentage this modality is not feasible or negative. Purpose of this study was to evaluate the role of multi-phase Multi-Slice-Computertomography (MSCT) as a modality to diagnose and locate the site of acute GI hemorrhage in case of unfeasible or technically difficult endoscopy. MATERIALS AND METHODS: 58 patients, presenting with clinical signs of lower GI hemorrhage, were examined through a 24-month period. Preliminary endoscopy was either negative or unfeasible. Images were obtained with a four-detector row CT with an arterial (4 x 1 mm collimation, 0.8 mm increment, 1.25 mm slice width, 120 kV, 165 mAs) and portal venous series (4 x 2,5 mm collimation, 2 mm increment, 3 mm slice width, 120 kV, 165 mAs). Time interval between endoscopy and CT varied between 30 minutes and 3 hours. The results of the MSCT were correlated with clinical course and surgical or endoscopical treatment. RESULTS: 20 of the 58 patients (34 %) undergoing MSCT had a bleeding site identified, thus providing decisive information for the following intervention. In case of a following therapeutic intervention there was 100 % correlation regarding the bleeding site. In 38 of the 58 patients (66 %), a bleeding site was not identified by MSCT. Twenty of these 38 patients (53 %) were stable and required no further treatment. In 18 of these 38 patients further interventional therapy was required due to continuing hemorrhage and in all of those patients the bleeding site was detected by intervention. CONCLUSION: Compared to other diagnostic methods MSCT is a fast, widely-available and low-risk technique for the localization of active GI hemorrhage. The clinical use seems to be justified since in more than one third of the patients, MSCT demonstrates the site of bleeding and provides decisive information for further interventional therapy. Concerning those patients, in whom MSCT is negative (38 out of 58 patients), only every second patient requires any additional diagnostic work-up.

Acute Disease↗
PubMed1980

Acute gastrointestinal hemorrhage of small-bowel origin.

Of 305 patients with acute gastrointestinal (GI) bleeding, the site was found to be the small bowel in 16. In all cases the cause was proved at surgery or autopsy: diagnoses included vascular malformation, aorto-enteric fistula, primary or metastatic tumor, ulcer, tuberculous ileitis, and sarcoidosis. While it is uncommon for acute GI bleeding to originate in the small bowel, approximately one third of the patients with acute rectal bleeding in this series had a bleeding site in the small bowel.

Adult↗
PubMed1990

[Current possibilities in radiology for the diagnosis and therapy of gastrointestinal hemorrhage (roentgen diagnosis, nuclear medicine and interventional radiology)].

Especially in acute gastrointestinal bleeding, conventional x-ray examinations with barium sulfate contrast are obsolete. On the other hand, blood pool scintigraphy and selective angiography are efficient methods to localize bleeding sources that have not been identified by prior endoscopy. In the interval between acute bleeding episodes, only vascular or highly vascularised lesions--as aneurysms, angiomas and leiomyomas--can be demonstrated. In all other lesions, active bleeding during the examination is a prerequisite. Angiography has not only a diagnostic, but also a therapeutic potential. By preoperative hemostasis, the circulatory conditions of the patient can be stabilized and surgery can be performed with a lower mortality risk. In "poor risk" patients, transarterial therapy can replace surgical interventions.

Angiography↗
PubMed1996

[Aortoduodenal fistula as the cause of gastrointestinal hemorrhage].

The aortoenteric fistula is one of the rare causes of gastrointestinal bleeding. A 73 year old patient presented with a secondary fistula after implantation of a synthetic graft. The diagnosis was confirmed by endoscopy. At elective laparotomy, a communication between the graft and the duodenum was discovered. Principally the combination of gastrointestinal bleeding and aortic graft is always suspicious of an aortoenteric fistula. The treatment must be surgical.

Aged↗
PubMed2001

Superselective arterial embolization for the treatment of lower gastrointestinal hemorrhage.

PURPOSE: To evaluate the technical feasibility, efficacy of hemostasis, recurrent bleeding, and ischemia resulting from superselective embolization of acute lower gastrointestinal (GI) hemorrhage. MATERIALS AND METHODS: Fifty-two superselective mesenteric artery catheterization procedures were undertaken in 48 patients with angiographic evidence of lower GI bleeding. Embolization was performed only if the arterial recta leading to the bleed could be successfully catheterized (n = 39). The lesions treated were located in the colon (n = 33) and jejunum (n = 6). In 28 of 39 procedures, embolization was achieved by delivering polyvinyl alcohol (PVA) particles (150-500 microm) through a microcatheter. Microcoils were used as the sole embolic agent in four procedures and a combination of microcoils and PVA particles were used in another four. Gelfoam particles were used in three of our earliest procedures. Of the 35 patients who underwent embolization, 25 were evaluated for objective evidence of ischemia by endoscopy (n = 16) and/or histologic evaluation of the surgical specimen (n = 9); the remaining 10 patients were followed clinically. RESULTS: Embolization was successful in 39 procedures involving 35 patients. Immediate hemostasis was achieved after embolization in all but two patients. Recurrent bleeding occurred in 12 other patients, eight patients underwent surgery, three were managed medically, and one underwent successful repeat embolization. Of the 25 patients evaluated for ischemia, mucosal ischemia was demonstrated in six (24%), but they remained asymptomatic and developed no sequelae as a result of ischemic changes on long-term follow-up. There was no incidence of clinically significant intestinal ischemia. Embolization alone was the definitive treatment in 44% patients (21 of 48). Reasons for unsuccessful superselective catheterization (27%) were small vessel spasm, cessation of bleeding, and vessel tortuosity. CONCLUSION: Superselective embolization is a feasible, safe, and effective technique for treating acute lower GI hemorrhage.

Adult↗
PubMed2005

Risk of upper gastrointestinal hemorrhage in warfarin users treated with nonselective NSAIDs or COX-2 inhibitors.

BACKGROUND: Little is known about the risk of upper gastrointestinal (GI) hemorrhage during the concomitant use of warfarin and selective cyclooxygenase (COX)-2 inhibitors. We examined the association between the concomitant use of warfarin and nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) or selective COX-2 inhibitors in older adults hospitalized for upper GI hemorrhage. METHODS: This nested case-control analysis of multiple linked health care databases conducted over 1 year identified a cohort of patients in Ontario, Canada, who were older than 66 years and continuously prescribed warfarin. Case patients were those admitted to the hospital with upper GI hemorrhage while taking warfarin. We compared their prescription records prior to hospitalization with those of age- and sex-matched controls who were also receiving warfarin (the control-case ratio was 4:1). Odds ratios (ORs) for the risk of hospitalization for upper GI hemorrhage while concomitantly using warfarin and celecoxib, rofecoxib, or nonselective NSAIDs were determined. RESULTS: During the study period, we identified 98 821 elderly patients continuously receiving warfarin. Of those, 361 (0.3%) were admitted to the hospital with upper GI hemorrhage. After adjusting for other potential confounders, case patients were significantly more likely to be also taking nonselective NSAIDs (OR, 1.9; 95% confidence interval [CI], 1.4-3.7), celecoxib (OR, 1.7; 95% CI, 1.2-3.6), or rofecoxib (OR, 2.4; 95% CI, 1.7-3.6) prior to hospitalization relative to controls. CONCLUSIONS: Patients taking warfarin concomitantly with selective COX-2 inhibitors have an increased risk of hospitalization for upper GI hemorrhage. The risk appears similar to that of patients simultaneously taking warfarin and nonselective NSAIDs.

Age Distribution↗
PubMed1992

Endoscopic intervention: a useful alternative to operation in the treatment of upper gastrointestinal hemorrhage.

Hemorrhage of the upper gastrointestinal tract (UGI) remains a serious clinical problem. Age of the patient, the presence of shock, transfusion requirements and concurrent serious illnesses are predictors of outcome. Operative intervention is promulgated if a visible vessel in an ulcer crater is identified because most will rebleed. From 1986 to 1988, 40 patients with 46 actively bleeding upper gastrointestinal lesions were treated with endoscopic intervention (EI). The Nd:YAG (neodymium yttrium aluminum garnet) laser using the noncontact method was used exclusively. All patients had orthostatic hypotension on admission and had serious intercurrent illnesses. Admission hematocrit ranged from 13 per cent to 36 per cent (median, 24%) and patients had been transfused an average of 4 units of blood before EI. Gastric and duodenal ulcers were the most common bleeding sites. All gastric and duodenal ulcers had visible vessels and 19 were actively bleeding. Endoscopic intervention was initially successful in 35 of 40 (87.5%) patients. The five patients who did not respond required urgent operation with a mortality rate of 40 per cent. Four patients rebled after EI but responded to repeat EI. The mortality rate in the EI group was 8.6 per cent. These results suggest that EI is a useful alternative in UGI bleeding for a select group of those patients at high risk for operative intervention.

Adult↗
PubMed1996

Utility of routine admission chest radiographs in patients with acute gastrointestinal hemorrhage admitted to an intensive care unit.

PURPOSE: To determine the diagnostic yield of routine admission chest radiographs in patients with acute gastrointestinal (GI) hemorrhage and clinical predictors of radiographic abnormalities. PATIENTS AND METHODS: The study was a retrospective series of 202 adult patients with GI hemorrhage admitted to intensive care units at an academic medical center. Routine admission chest radiographs were obtained in 161 patients. These radiographs were reviewed by a study radiologist blinded to the study purpose. The radiologist scored radiographic abnormalities into categories of "minor" or "major," "new" or "previously known," and "with an intervention" or "without an intervention." Nominal logistic regression explored the data for clinical features that identified patients with major new radiographic abnormalities with or without an intervention. RESULTS: Minor radiographic abnormalities were noted in 23 (14.3%) patients, of whom 17 (10.6%) patients had "new" (previously unknown) abnormalities. No minor abnormality prompted a therapeutic or diagnostic intervention. Major radiographic abnormalities were detected in 21 (13.0%) patients, of whom 19 (11.8%) had new findings. Major new findings prompted interventions in only 9 (5.6%) of patients. A history of lung disease and an abnormal lung physical examination predicted major new radiographic findings (P = 0.0001, sensitivity 79%, negative predictive value 96%). These variables also identified major new abnormalities that prompted interventions (P = 0.007, sensitivity 89%, negative predictive value 99%). Use of the logistic regression model to select patients for admission chest radiographs decreased charges from $1,068 to $580 for each detected major new radiographic abnormality and from $2,254 to $1,087 for major new radiographic abnormalities that prompted an intervention. CONCLUSION: These data indicate that routine chest radiographs have a low yield in detecting major new radiographic abnormalities in patients with acute GI hemorrhage. Clinical criteria, available at the time of admission, may be useful for selecting patients for chest radiographic evaluations.

Acute Disease↗
PubMed2005

Ineffectiveness of routine abdominal radiography in patients with gastrointestinal hemorrhage admitted to an intensive care unit.

GOALS: To determine the utility of plain abdominal radiography in the initial evaluation of acute gastrointestinal (GI) hemorrhage in a medical intensive care unit. BACKGROUND: Plain abdominal radiographs are frequently used in the routine evaluation of patients with GI bleeding. The utility of these studies in the intensive care unit setting is unclear. STUDY: The study was a retrospective chart review of 71 adult subjects admitted to a medical intensive care unit with the diagnosis of GI bleeding. Subjects were excluded if they presented with peritoneal signs, received an abdominal CT scan in the 24 hours prior to admission, or were chronically treated with immunosuppressive medication. Subjects were divided into two cohorts based on whether or not they underwent plain abdominal radiography during the first hospital day. The primary study endpoints were hospital mortality, intensive care unit length of stay, and whether or not radiographic findings altered clinical management. RESULTS: Of the 71 patients admitted with a diagnosis of GI bleeding (mean age 65.8 +/- 14.5 years, 73.2% male), 56 (79%) had a plain abdominal radiograph performed. Subjects who had a plain film did not differ significantly from those who did not in age, gender, degree of anemia, degree of coagulopathy, or in severity of illness as measured by Acute Physiology and Chronic Health Evaluation (APACHE II) score. There was no statistically significant difference in hospital mortality or intensive care unit length of stay between patients who received plain films and those who did not. In no subject (0%; 95% confidence interval, 0%-5.4%) did abdominal radiography reveal an abnormality that altered clinical management. CONCLUSIONS: Based on our observations, plain films of the abdomen do not appear to alter clinical outcomes or management decisions for patients with GI bleeding and normal abdominal examinations who are admitted to the intensive care unit.

Aged↗
PubMed1977

Massive upper gastrointestinal hemorrhage in the elderly.

Sixty-six elderly patients with massive upper gastrointestinal bleeding were retrospectively analyzed. This study supports the concept of vigorous resuscitation, early diagnosis with fiberoptic endoscopy, and prompt surgical intervention in patients with continued bleeding. When this approach was utilized in a community hospital, operative mortality was reduced to 5 per cent.

Aged↗