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PubMed2004

Microcatheter embolization of lower gastrointestinal hemorrhage: an old idea whose time has come.

Early attempts of using embolization for lower gastrointestinal hemorrhage were fraught with complications, most notably ischemic colitis or bowel infarction. Embolotherapy was eventually abandoned in favor of catheter-directed vasoconstriction (i.e., vasopressin infusion). This latter therapy is time and labor intensive. With the advent of microcatheter technology, superselective embolization emerged and is rapidly becoming the endovascular therapy of choice for patients with severe lower gastrointestinal hemorrhage refractory to medical management. Numerous studies on the subject have consistently reported high clinical success with low ischemic complications. This article will review the current status of co-axial microcatheter embolization with an emphasis on the technical aspects of the procedure.

Catheterization, Peripheral↗
PubMed1999

Using CO2-enhanced arteriography to investigate acute gastrointestinal hemorrhage.

OBJECTIVE: The objective of the study was to compare the efficacy of CO2-enhanced arteriography with that of arteriography enhanced with standard iodinated contrast material in the detection of gastrointestinal hemorrhage. CONCLUSION: For acute gastrointestinal hemorrhage, we did not find an advantage to using CO2 to show active bleeding. In fact, CO2 was inferior to iodinated contrast material in revealing nonbleeding vascular anomalies.

Acute Disease↗
PubMedDate not supplied

Idiopathic colonic varices: an unusual cause of massive lower gastrointestinal hemorrhage.

Varices of the entire colon are very rare. This rare cause of massive lower gastrointestinal hemorrhage is almost invariably associated with cirrhosis of the liver and consequent hypertension or portal venous obstruction. We report about a patient with massive lower gastrointestinal bleeding from extensive colonic varices. Despite extensive investigation and a follow-up of 3 years, the etiology of the colonic varices could not be determined. Only a few cases of apparent idiopathic (familial or non-familial) colonic varices have been described. Recognition of this abnormality is important, however, because colonic varices may be the cause of recurrent, frequently massive lower gastrointestinal hemorrhage. A misleading endoscopic diagnosis can lead to inappropriate biopsies, resulting in major bleeding.

Colon↗
PubMed1985

Early clinical signs identify low-risk patients with acute upper gastrointestinal hemorrhage.

Early identification of patients at low risk for poor outcome after acute upper gastrointestinal hemorrhage would allow reduction of diagnostic and therapeutic interventions. We identified six early predictors of good outcome: age less than 75 years, no unstable comorbid illness, no ascites found on physical examination, normal prothrombin time, and, within an hour after presentation, systolic blood pressure of 100 mm Hg or greater and nasogastric aspirate free of fresh blood. Presence of all six predictors defined the low-risk population. Among 162 patients in the development and retrospective validation phases of our study, all 74 low-risk patients had good outcomes. A prospective validation study of 111 patients further established the accuracy of our predictive method; only two of 52 low-risk patients had poor outcomes. Application of our method should allow more selective management of patients with acute upper gastrointestinal hemorrhage.

Acute Disease↗
PubMed1996

Systemic antibiotic prophylaxis after gastrointestinal hemorrhage in cirrhotic patients with a high risk of infection.

In cirrhotic patients with gastrointestinal hemorrhage, bacterial infections are frequent and play a significant role in mortality. We have previously found that patients with a Child-Pugh's class C or a rebleeding are a subgroup of cirrhotic patients with a high risk of infection. The aims of the study were (1) to validate these indicators and (2) to assess the effectiveness of a systemic antibiotic treatment in preventing bacterial infections in bleeding cirrhotics with a high risk of infection. One hundred and nineteen bleeding cirrhotic patients were divided into 3 groups. Patients with a Child-Pugh's class A-B and no rebleeding (i.e., with a low risk of infection) constituted group 1 (n = 55). Patients with a high risk of infection were randomly allocated to serve as controls (group 2, n = 34) or to receive the ciprofloxacin and a combination of amoxicillin and clavulanic acid for 3 days after hemorrhage (group 3, n = 30). This antibiotic prophylaxis was administered first intravenously and then orally when the bleeding was controlled. The study period was defined as 10 days after hemorrhage. Incidence of bacterial infections was significantly higher in patients from group 2 than in patients from group 1 (52.9% vs. 18.2%; P < .001). Moreover, infections were more severe in group 2: a sepsis syndrome or a septic shock developed in 66.7% of infected patients from this group, but in only 20% of infected patients from group 1. Incidence of bacterial infections was much lower in patients from group 3 than in those from group 2 (13.3% vs. 52.9%; P < .001). Eight patients from group 2 (23.5%) and 4 patients from group 3 (13.3%) died during the first four weeks (P-not significant). Septic shock was the cause of death in 3 patients from group 2 and in only 1 patient from group 3. The cost of antibiotic therapy, including antibiotic prophylaxis in group 3, was $208 +/- $63 per patient in group 2 and $167 +/- $42 per patient in group 3 (P < .05). We conclude that (1) patients with a Child-Pugh's class C and/or a rebleeding are a subgroup of cirrhotic patients with a high risk of infection after gastrointestinal hemorrhage and that (2) in these patients, a prophylactic treatment with systemic antibiotics is very effective in preventing bacterial infections.

Antibiotic Prophylaxis↗
PubMed1977

Gastrointestinal hemorrhage. An unusual complication of total anomalous pulmonary venous drainage.

A newborn boy had exsanguinating gastrointestinal hemorrhage in in the first week of life secondary to an unusual form of infradiaphragmatic pulmonary venous drainage. Autopsy and postmortem angiograms demonstrated huge esophageal varices as the course of the uncontrolled bleeding. The occurrence of massive gastrointestinal hemorrhage should be considered to be a rare but possibly lethal complication in patients with total anomalous pulmonary venous drainage (TAPVD) type III and IV.

Abnormalities, Multiple↗
PubMed1989

Splenosis. A cause of massive gastrointestinal hemorrhage.

Splenosis is the autotransplantation of splenic tissue following surgery or trauma. While it has been reported to cause a number of complications, splenosis is most commonly an incidental finding at laparotomy or on imaging studies. In our study, a case of massive, acute gastrointestinal hemorrhage occurred secondary to splenosis involving the small bowel. While there are several reports of self-limited gastrointestinal hemorrhage secondary to splenosis involving the gastric fundus, we are aware of no reports of massive, acute intestinal bleeding caused by this condition. Splenosis should be considered in the differential diagnosis of gastrointestinal hemorrhage in patients who have experienced prior splenic trauma or splenectomy.

Adult↗
PubMed1990

[Acute gastrointestinal hemorrhage after placement of a peritoneojugular shunt].

Since 1984 the peritoneovenous (LeVeen) shunt has been installed in 33 patients (10 females 30.3%, and 23 males 69.7%), with the average age of 54 +/- 8 years all in the oedema--ascitic decompensation phase of their primary illness. The control group consisted of 39 patients with identical etiology and primary illness stadium, sex and age structure and duration of primary illness, all treated with medicament - diet therapy. All the operated patients and those treated with medicament--diet regime died. Their autopsy findings were confronted. The aim of this study was to indicate the type and frequency of digestive hemorrhage in this population on our own clinical--patient material. Gastrointestinal hemorrhage was the cause of death in 8 (24.24%) patients out of the group operated on, and 6 (15.3%) from the control group. The isolated rupture of esophageal varices was the cause of death in one (3.03%) patient out of the group operated on, and in 5 (12.12%) patients from the control group, the rupture of esophageal varices with toxic vasculitis in 3 (0.09%) patients from the group operated on, and not in one out of the control group; rupture of esophageal varices associated with toxic vasculitis and disorders of the hemostatic mechanism appeared in 4 (12.12%) of patients from the group operated on, and in 1 (2.56%) of the control group. On the basis of the presented it can be concluded that gastrointestinal hemorrhage is a significantly more frequent cause of death in the group operated on than in the control group, and that hemorrhages are of an all the more complex etiology when the flow-in of ascites into circulation is greater. Hemodilution and endotoxins are to blame for their occurrence and it is necessary to preoperatively conduct, beside the control of the hemostatic mechanism, also the test of ones own ascitic burdening and to determine the level of endotoxin in the ascites.

Acute Disease↗
PubMed1996

Prevalence, etiology, and prognostic significance of upper gastrointestinal hemorrhage in diabetic ketoacidosis.

We reviewed the discharge records of all diabetic ketoacidosis hospitalizations over 30 months for the presence of clinically significant upper gastrointestinal hemorrhage. Of 284 hospitalizations in 193 patients, hemorrhage occurred in 26 hospitalizations (9%) in 25 patients (13%). None required invasive therapy to achieve hemostasis, and there were no bleeding recurrences and no deaths due to bleeding. Endoscopy in eight revealed esophagitis in all (five had erosions or ulcerations), one Mallory-Weiss tear, five with gastritis (mild in four), four with duodenitis (one erosive), one duodenal ulcer, and no gastric ulcers. Hemorrhage patients had a longer diabetes duration (14.85 vs 9.16 years, P < 0.02), and more nephropathy (40% vs 11%, P < 0.001), retinopathy (28% vs 12%, P < 0.03) and gastroparesis (36% vs 10%, P < 0.002) than those without hemorrhage. Ulcer medication (42% vs 23%, P < 0.03) or anticoagulant (12% vs 1%, P < 0.005) but not nonsteroidal antiinflammatory drug usage (12% vs 12%) was higher in the hemorrhage group. Admission glucose (P < 0.02), BUN (P < 0.04), and creatinine (P < 0.02) levels were higher in hemorrhage patients, but arterial pH, serum ketones, hemoglobin, platelet count, and coagulation values were not. Hemorrhage patients required more blood transfusions (27% vs 10%, P < 0.003) and intensive care unit admissions (69% vs 43%, P < 0.009). Total (15% vs 3%, P < 0.003) and intensive care unit mortality (22% vs 6%, P < 0.026) were higher in the hemorrhage group. We conclude that upper gastrointestinal hemorrhage complicates 9% of diabetic ketoacidosis hospitalizations. Blood transfusion may be required, but the bleeding is self-limited and not severe. The most common lesion is erosive esophagitis. Hemorrhage correlates with glucose level, admission to the intensive care unit, duration of diabetes, the presence of diabetic complications, and portends a high non-bleeding-related mortality.

Adult↗
PubMed1990

Postoperative gastrointestinal hemorrhage in biliary atresia.

During the past 9 years, we have treated 23 patients with gastrointestinal hemorrhage following corrective surgery for biliary atresia. Ulcers or erosions of the stomach, duodenum or intestinal wall were observed endoscopically in 20 cases. In other 3 cases, bleeding point was not determined endoscopically, but massive bleeding was recognized frequently. Ten patients bled within 6 months of surgery, and the incidence of bleeding was also seen even after the age of 10 years. A history of cholangitis, the presence of jaundice and the use of cholagogues were related to the postoperative gastrointestinal bleeding. Serum concentrations of gastrin and gastric inhibitory polypeptide showed high values after surgery in almost half the biliary atresia patients examined, however, no clear relationship between the concentration of these factors and gastrointestinal hemorrhage was established.

Biliary Atresia↗
PubMedDate not supplied

Gastrointestinal hemorrhage in hepatocellular carcinoma: management with transheptic arterioembolization.

Gastrointestinal hemorrhage in patients with hepatocellular carcinoma is common and a major contributor to mortality. These patients tend to have a very poor prognosis. This report describes five such cases in which gastrointestinal bleeding was one of the presenting problems and required urgent management. The causes of massive intermittent gastrointestinal bleeding were variceal (two cases), direct invasion of the duodenum (one case), transverse colon (one case), and stomach (one case). All five patients were inoperable because of locally advanced disease, poor general condition, or comorbid disorders and were managed with angioembolization. After transcatheter embolization, the bleeding stopped completely in two patients and was reduced significantly in the remaining three. We report the role of transhepatic arterioembolization in the management of gastrointestinal bleed in such patients, and we recommend its use more often in similar situations.

Adult↗