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PubMed1999

Hepatocellular carcinoma complicated by gastrointestinal hemorrhage caused by direct tumor invasion of stomach.

A 65-year-old man with multiple hepatocellular carcinoma (HCC) underwent intra-hepato-arterial chemotherapy (IHAC) through an implantable port over a period of 10 months after transcatheter arterial embolization (TAE) had been performed three times. TAE was performed twice more, and radiotherapy (total dose, 30 Gy; given over a 3-week period) was given for progressive disease in the lateral segment of the liver. Three months after the radiotherapy had finished, the patient suddenly developed melena. Diagnostic imaging revealed gastrointestinal (GI) hemorrhage from HCC invading the stomach, and total gastrectomy and lateral segmentectomy of the liver were performed because the bleeding could not be controlled. The resected specimen disclosed a centrally necrotic tumor that had invaded the lesser gastric curvature and perforated into the lumen. Pathology examination revealed that the HCC had expansively invaded the gastric mucosa, resulting in exposure in the lumen. The possible mechanisms of direct GI invasion by HCC are briefly discussed, with a review of the literature. GI bleeding secondary to involvement by HCC is rare. The enteric radiation injury seems to have been largely responsible for the GI bleeding in this patient.

Aged↗
PubMed1991

[Diagnosis and management of lower gastrointestinal hemorrhage. Retrospective analysis of 233 cases].

In a retrospective analysis the diagnostic procedure was evaluated in patients with acute lower gastrointestinal bleeding. Bleeding sources were localized distally to the ligament of Treitz in 233 patients (1979-1988). Patients with hemorrhoidal bleeding were not included. Following exclusion of an upper gastrointestinal bleeding the diagnostic procedure was initiated with a recto-/colonoscopy. Lesions were detected in 77% of the treated patients (n = 136). Angiography localized the bleeding in 68%, in combination with colonoscopy the identification of the bleeding source reached 86.5% in the treated patients. Following scintigraphy the bleeding source was determined in 89.7% of these patients. The sensitivity of colonoscopy (0.93) was superior to the angiography (0.78) and to the scintigraphy (0.75). Apart from neoplasms and adenomas angiodysplasia and Meckel's diverticula were the most common sources of the bleeding in patients who underwent operation. In 61 patients endoscopic therapy was performed, however, 6.5% of these patients had to be operated on later because of persistent bleeding. All together 79 patients underwent operation, 31 for bleeding and 48 for other reasons. 12 patients died, 6 of them were operated on for the bleeding, the other for neoplasms.

Adolescent↗
PubMed1983

A technique for the preparation of Tc-99m red blood cells for evaluation of gastrointestinal hemorrhage.

Tc-99m labeled red blood cell (RBC) preparations are gaining wide acceptance in the diagnosis and localization of gastrointestinal bleeding. A major requirement of the radiopharmaceutical is that the percentage of Tc-99m attached to red cells in the injected dose must be extremely high, since free pertechnetate is secreted into the gastrointestinal tract and may obscure a bleeding site. We have developed a combined in vivo/in vitro labeling procedure which is simple and rapid, and which enables the administration of substantial amounts of RBC-bound Tc-99m and minimizes the amount of unbound technetium present. The technique is readily utilizable in any nuclear medicine clinic and requires no investigative pharmaceuticals.

Child, Preschool↗
PubMed1988

DSA in acute gastrointestinal hemorrhage: clinical and in vitro studies.

Selective intraarterial digital subtraction angiography (DSA) was used to examine 37 patients with acute gastrointestinal (GI) tract bleeding. Conventional screen-film angiography was used as an adjunct to DSA when a larger field of view was needed (five patients) and when bowel motion prevented the acquisition of adequate image quality with DSA (two patients). Conventional angiography was also performed in all cases in which there were negative DSA examinations. DSA reduced the mean examination time considerably (20% reduction overall), especially for cases involving embolization therapy (35% reduction). DSA was especially valuable in the upper GI tract, where it was used to rapidly locate and/or assist in the embolization of bleeding sites in 19 of 20 patients with positive angiograms. There were 12 true-negative DSA examinations and one false-negative examination due to the limited field of view (9 inches [22.9 cm]). Bowel and respiratory motion were not important problems in the upper GI tract. In the lower GI tract, the usefulness of DSA was severely limited by the small field of view and the misregistration artifact caused by bowel motion. In an in vitro study, DSA and conventional angiography were compared as to their ability to depict several rates of extravasation of contrast material in a model of GI bleeding. DSA tended to be more sensitive for the detection of simulated extravasation (P less than .07).

Acute Disease↗
PubMed1976

Mallory-Weiss syndrome. Characterization of 75 Mallory-weiss lacerations in 528 patients with upper gastrointestinal hemorrhage.

Seventy-five Mallory-Weiss lacerations were visualized endoscopically in 58 of 528 patients evaluated acutely for upper gastrointestinal bleeding. The Mallory-Weiss mucosal laceration is more common than generally recognized, is usually associated with hiatal hernia and a prodrome of retching or vomiting, and the ingestion of alcohol or acetylsalicyclic acid, or both. The lacerations are most commonly gastric and are associated with other mucosal lesions which may in fact be the instigating cause of the retching and vomiting. Although blood loss may be considerable, 90% or more patients with this lesion can be managed nonsurgically with appropriate blood component replacement and occasional use of systemic pitressin. There was one fatality in this series of 58 patients with Mallory-Weiss lacerations.

Female↗
PubMedDate not supplied

[The treatment of acute gastrointestinal hemorrhages at a specialized hospital].

A differential approach to surgical interventions corresponding to the system of treatment of patients with gastrointestinal bleedings developed by the authors gave considerably less lethality in patients with bleedings caused by acute gastric and duodenal ulcers and by the Mallory-Weiss syndrome. General lethality among these patients was 3.3% and 5.1% correspondingly. This system was most effective at large specialized centers for treatment of patients with acute gastrointestinal bleedings. However many of its principles are easy for a great number of practical surgeons.

Acute Disease↗
PubMed1992

[Aorto-enteric fistula as a cause of massive gastrointestinal hemorrhage].

The authors describe a rare complication following femoral reconstruction operations, i.e. an aorto-enteral fistula associated with massive gastrointestinal haemorrhage. They draw attention to limited diagnostic possibilities and sometimes the necessity to perform urgent laparotomy. The diagnosis is facilitated by endoscopy, CT, sonography and aortography. Endoscopy can determine the site of haemorrhage, not its cause. At present when there is a high number of vascular reconstruction operations, this possibility should be taken into account. The authors recommend to prevent this complication by inserting a transplant from the omentum between the intestinal wall and the prosthesis, or possibly to cover the wound by preaortal adipose and lymphatic tissue and to stitch the peritoneum to prevent direct contact. To resolve complications direct stitch may be used, a patch. More frequently it is, however, necessary to exchange the entire prosthesis and sometimes to ensure nurture by an extra-anatomical bypass. In urgent situations clamping of the aorta may be of temporary assistance.

Aged↗
PubMed1990

[Mallory-Weiss syndrome as etiologic factor of upper gastrointestinal hemorrhage. A review of 142 cases].

The diagnosis of Mallory-Weiss syndrome was made in 142 patients with upper gastrointestinal haemorrhage by early endoscopy. These patients represent 5.16% of all patients with haemorrhage treated in our unit over a period of ten years. Emergency surgery was needed in 13 due to persistent haemorrhage. In the remaining 129, conservative management sufficed to stop the bleeding. All patients receiving medical therapy survived while one of the surgically treated patients died of pulmonary thromboembolism in the early postoperative period.

Adolescent↗
PubMed1986

[Significance of emergency endoscopy in severe upper gastrointestinal hemorrhage].

312 of a total of 543 emergency endoscopies were carried out in patients with severe haemorrhage of the upper gastrointestinal tract. This was defined as a haemorrhage of such severity that at least 2 of the following 3 criteria were present: a shock index greater than 1, an erythrocyte count of less than 3 million/mm3, and a transfusion requirement of three or more 500 ml bags of blood. The source of the bleeding was exactly located in 247 endoscopies, and accurate diagnoses were established in 94.4% of the cases examined. The most frequent source of bleeding was oesophageal varices, followed by duodenal ulcers. In 20.2% of these cases, further sources of potential haemorrhage were found in the upper gastrointestinal tract. Endoscopic diagnosis resulted in immediate, specific therapy in 286 cases. Treatment was given within the first 24 hours in every case. 24.7% of our patients had to undergo laparotomy immediately after endoscopy. 30.4% were given H2 receptor inhibitors, and 35.6% underwent endoscopic haemostasis. The mortality rate in these patients was 29.5%. These results indicate that emergency endoscopy is an important aid to decision-making in cases of severe haemorrhage of the upper gastrointestinal tract.

Acute Disease↗