[PEMPHIGUS TREATED BY CORTICOIDS: HEMATEMESIS. ACTION OF INTRAVENOUS CORTICOTHERAPY ON THE HEMATEMESIS. ACTION OF SODIUM OXYFERRISCORBONE ON THE PEMPHIGUS].
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2,3-Diketogulonic Acid↗
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[HEMATEMESIS OF RARE CAUSES, OF DIFFICULT DIAGNOSIS, AND CRYPTOGENETIC HEMATEMESIS].
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Diagnosis, Differential↗
[Severe repeated hematemesis during chronic pancreatitis; gastrectomy as last resort; cure of the hematemesis].
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Gastrectomy↗
Clinical study of gastric cancer patients with complaint of hematemesis.
Eighteen gastric cancer patients with complaint of hematemesis, who underwent early endoscopic treatment for hemorrhage and received standby oncologic treatment after recovery, were retrospectively compared with 661 gastric cancer patients without complaint of hematemesis. Patients with hematemesis had a statistically high rate of type 2 gastric cancers. Stage I in patients with hematemesis was significantly less frequent than in patients without. Standby gastrectomy after early endoscopic treatment was performed on 17 (94.4%) of the patients with complaint of hematemesis. The resected specimens showed a significant association of hematemesis with serosal invasion, node metastases, and vascular invasion. However, there was no significant association of hematemesis and postoperative complications or prognosis. Our findings suggest that prognosis of gastric cancer patients with hematemesis has improved with the development of endoscopic diagnosis and treatment. For such patients, it is very important to decide on an oncologic treatment plan after endoscopic treatment and accurate assessment of the cancer stage.
Female↗
[Hematemesis. Extramural emergency].
Hematemesis is the cardinal sign of upper gastrointestinal bleeding. It is a sign related to numerous affections, with a prognosis depending on the underlying lesion, the degree of bleeding, the accompanying disease and other risk factors. Mortality rates are generally close to 10%, although if hematemesis is secondary to variceal bleeding, as high as 30%. 65% of hemorrhages subside spontaneously, but 25% bleed recurrently (after initial cessation) and in 10% bleeding persists. Three quarters of all renewed bleeding occurs within two days after the initial hemorrhage. If hematemesis occurs outside a hospital, rapid evaluation is required to assess the necessity of emergency transport and treatment. In the case of severe to moderate bleeding, life-support measures and rapid transport to the nearest hospital are of primary importance and all measures complicating diagnosis and treatment in the hospital should be avoided. Patients with mild hematemesis, stable cardiovascular parameters and no risk factors can be investigated and, if appropriate, treated, on an out-patient basis. If the cause of hematemesis cannot be found, aggressive, inpatient investigations are required at the first sign of second bleed. Endoscopy is the primary investigative procedure for hematemesis. The success rate is highest if endoscopy is performed within the first 36 hours of the onset of bleeding. There are indications that aggressive diagnosis and therapy, including endoscopic hemostatic interventions, can reduce hematemesis mortality.
Adult↗
Usefulness and validity of diagnostic nasogastric aspiration in patients without hematemesis.
STUDY OBJECTIVE: We estimate the test characteristics of nasogastric aspiration to diagnose upper gastrointestinal tract hemorrhage in patients without hematemesis. METHODS: In this retrospective cohort study, medical records from patients admitted to 2 urban hospitals between 1997 and 2002 for gastrointestinal tract bleeding without hematemesis were reviewed. Positive nasogastric aspiration results were classified by the severity of hemorrhage, and negative results were classified by the presence or absence of bile. The reference standard for nasogastric aspiration was the source of bleeding-upper versus non--upper gastrointestinal tract--from the hospital discharge summary. Confidence intervals (CIs) for proportions and likelihood ratios (LRs) were calculated. RESULTS: Of 333 eligible patients, 235 were offered nasogastric aspiration, and 220 accepted the test. Results of 220 attempts were distributed as follows: negative, 158 (72%), including 9 (4%) with bile; nasogastric aspiration aborted, 13 (6%); and positive, 49 (23%), including 4 (2%) that were strongly positive (> or =450 mL red blood). Test characteristics of nasogastric aspiration to detect upper gastrointestinal tract bleeding in 213 patients with a reference standard diagnosis were as follows: sensitivity 42% (95% CI 32% to 51%), specificity 91% (95% CI 83% to 95%), negative predictive value 64% (95% CI 56% to 71%), and positive predictive value 92% (95% CI 79% to 97%). The nasogastric aspiration accurately predicted the source of bleeding in 66% of patients (95% CI 59% to 72%). The likelihood ratio of a positive nasogastric aspiration was 11 (95% CI 4 to 30), and the likelihood ratio of a negative nasogastric aspiration was 0.6 (95% CI 0.5 to 0.7). CONCLUSION: In patients without hematemesis, a positive nasogastric aspiration, seen in 23%, indicates probable upper gastrointestinal tract bleeding (LR+ 11), but a negative nasogastric aspiration, seen in 72%, provides little information (LR- 0.6).
Aged↗
Traumatic pseudoaneurysm of the pharyngeal artery: An unusual cause of hematemesis and hematochezia after craniofacial trauma.
BACKGROUND: Traumatic aneurysms of the internal maxillary artery are extremely rare. We report a case of traumatic pseudoaneurysm of the pharyngeal artery, a branch of the internal maxillary artery, presenting with hematemesis and hematochezia. CASE DESCRIPTION: An 18-year-old man presented with deep drowsy consciousness after a motor vehicle accident, in which he had a severe craniofacial injury. Three days later, he had hematemesis and hematochezia with a marked decrease in circulating hemoglobin level. External carotid arteriography performed to rule out vascular injury revealed active leakage from a false aneurysm of the pharyngeal artery. The lesion was successfully obliterated by superselective endovascular embolization. CONCLUSIONS: In patients with craniofacial injury associated with multiple traumas, traumatic pseudoaneurysm of the pharyngeal artery should be suspected as one of the possible causes of hematemesis and hematochezia. Selective endovascular embolization with cerebral angiography is an effective modality for the treatment and diagnosis of this lesion.
Accidents, Traffic↗
Hepatitis and hematemesis complicating nicotinic acid use.
Nicotinic acid has a proven efficacy in the treatment of hypercholesterolemia. Therapeutic use of this water-soluble B vitamin has resulted in a survival benefit among patients enrolled in the Coronary Drug Project. Conversely, nicotinic acid has been associated with a high side-effect profile when used at therapeutic doses. Nevertheless, there are no previously reported cases of hematemesis temporally associated with nicotinic acid use. The authors report the case of a previously healthy 20-year-old man who developed hematemesis and hepatitis 1 week after self-initiating the daily consumption of 6 g of nicotinic acid. Supportive therapy and discontinuing nicotinic acid resulted in rapid clinical improvement in this patient. The clinical circumstances suggest a possible causal relationship between nicotinic acid consumption and his presenting problems. The use of large doses of nicotinic acid may be rapidly complicated by hematemesis and hepatitis.
Adult↗
[Treatment of hematemesis and hematochezia in elderly patients].
Hematemesis and hematochezia (melena) in elderly patients are serious symptoms which should be carefully handled since they can lead to death without suitable treatment. In elderly patients the advance of arteriosclerotic changes throughout the body decreases blood flow and function in various organs. When these arteriosclerotic changes become prominent in the gastric vascular structure, bleeding from gastric ulcers tends to easily occur and it can be difficult to stop. A large amount of bleeding can cause irreversible shock due to the decreased cardiopulmonary function, and diminished hepatorenal capacity would also be a decisive factor in determining the outcome of the state of shock. Once hemorrhage happens, it is of great importance to properly evaluate the general conditions of the patient and to perform adequate measures with special emphasis on the pathophysiological characteristics of elderly patients. In recent years the causes of bleeding in the gastrointestinal (GI) tract have changed, and various new medical methods to control hemorrhage, such as endoscopic sclerotherapy, have been developed and widely applied in elderly patients. The present lecture describes clinical aspects, including these up-to-date topics, which are closely based on daily practices. During the past 6 years (from 1984 through 1989) we have experienced in our affiliated hospitals, 1,611 patients who developed hematemesis or/and hematochezia, out of which 554 patients were aged more than 65. The pathogenesis, treatment and outcome of these patients were analyzed in detail. With regard to the cause of hematemesis in elderly patients, gastric ulcer ranked top (47%).(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Hematemesis as the initial complication of pancreatic adenocarcinoma directly invading the duodenum: a case report.
Pancreatic carcinoma is a debilitating disease and carries a poor prognosis. It is a rare cause of upper gastrointestinal bleeding, even though pancreas, stomach, duodenum and jejunum are adjacent organs. The incidence of pancreatic adenocarcinoma directly invading the gastrointestinal tract leading to gastrointestinal hemorrhage is very low, and most of them present with melena and hematochezia. Here, we describe one unique case manifesting characteristically severe and unremitting hematemesis as an initial presentation of pancreatic adenocarcinoma. This tumor directly invaded the duodenal mucosa as a bleeding protruding tumor mass. Our MEDLINE search has confirmed that this is the first reported case with an initial manifestation of hematemesis from pancreatic adenocarcinoma in Asians. Pancreatic adenocarcinoma directly invading duodenum complicated by hemorrhage can be a rare cause of hematemesis, and clinicians should be reminded of it while they are making differential diagnosis.
Adenocarcinoma↗
Pancreatic cancer presenting with hematemesis from directly invading the duodenum: report of an unusual manifestation and review.
Pancreatic cancer is a rare cause of gastrointestinal bleeding, and it is extremely rare for hematemesis to be the initial manifestation of invasive pancreatic cancer. We report the case of a 67-year-old man with hematemesis who was found to have invasive pancreatic cancer with a bleeding duodenal ulcer. The patient was not icteric, but repeated sudden hematemesis. An urgent pancreatoduodenectomy was performed with a favorable outcome. Microscopic examination revealed that an adenocarcinoma originating from the pancreatic head extended to the muscularis propria of the duodenum. Furthermore, an exposed vessel and narrow fistula were found. The diagnosis, pathological findings, preoperative events, and postoperative outcome in this unusual case are reviewed.
Adenocarcinoma↗
[A case of juvenile esophageal cancer with hematemesis].
We here report a case of juvenile esophageal cancer which developed with a chief complaint of hematemesis. The case was a 36-year-old male patient who was admitted to the hospital because of dysphagia and repeated hematemesis episodes. Through various imaging studies, the patient was diagnosed as having advanced esophageal carcinoma. Since it was considered to be impossible to perform a curable surgical treatment, we tried, using a Laser apparatus, to alleviate the stenosis of the esophageal lumen and to control the bleeding from the cancerous lesion. However, an operation was finally performed after observing that the Laser therapy had not been so effective. Hematemesis is an uncommon symptom among primary complaints of esophageal cancer. The present case developed a protuberant cancerous mass which considerably obstructed the esophageal lumen. It is speculated that the patient repeatedly vomited blood which had gradually originated from ruptured capillary vessels in the tumor and had accumulated in the esophageal lumen. The histological type of the cancer was poorly-differentiated squamous cell carcinoma which partially contained an undifferentiated element. This histological nature might have accelerated the growth of the esophageal cancer in the present case.
Adult↗
ED predictors of upper gastrointestinal tract bleeding in patients without hematemesis.
OBJECTIVES: In patients with gastrointestinal (GI) tract bleeding, the bleeding source is uncertain in the absence of hematemesis. We sought to identify clinical variables predictive of an upper GI bleeding source. METHODS: This retrospective cohort study involved patients admitted via the ED for GI tract bleeding without hematemesis, who underwent confirmatory testing. We used logistic regression analysis to identify clinical variables independently associated with an upper GI source. RESULTS: Among 325 patients, odds ratios for the strongest predictors were as follows: black stool, 16.6 (95% confidence interval [CI], 7.7-35.7); age less than 50 years, 8.4 (95% CI, 3.2-22.1); and blood urea nitrogen/creatinine ratio 30 or greater, 10.0 (95% CI, 4.0-25.6). Seven (5%) of 151 with none of these factors had an upper GI tract bleed, versus 63 (93%) of 68 with 2 or 3 factors. CONCLUSION: Black stool, age less than 50 years, and blood urea nitrogen/creatinine ratio of 30 or greater independently predict an upper GI tract bleeding source.
Adult↗
Esophageal tuberculosis: a rare presentation with massive hematemesis.
A 43-year-old female presented with massive hematemesis. Esophagoscopy showed an ulcer 22 to 25 cm from the incisor with active bleeding. A thoracotomy and primary closure of the ulcer was performed. Massive hematemesis recurred 8 days later, resulting in hypovolemic shock. The thoracic esophagus was resected and histological examination showed granuloma with central caseous necrosis. Combined chemotherapy was given for 10 months. At 6 months after the subtotal esophagectomy, the esophagus was reconstructed using the right-side colon.
Adult↗
Esophagitis in infants with hypertrophic pyloric stenosis: a source of hematemesis.
This study was undertaken to clarify the source of blood in the vomitus of patients with hypertrophic pyloric stenosis (HPS). Twenty-one infants with HPS were examined. Hematemesis was noted in 14 infants. Esophagogastric endoscopy showed a 100% incidence of esophagitis and in one patient gastric erosion was also observed. Histological study of the esophageal mucosa showed evidence of esophagitis in 18 patients (85.7%). Preoperative pH monitoring showed gastroesophageal reflux (GER) in all infants. Excessive acid exposure (> or = 7%) was significantly correlated with the grade of esophagitis and the incidence of hematemesis, whereas acid exposure time was shorter in the cases without histological esophagitis. These results suggested that the source of bleeding in HPS is the esophageal mucosa affected by esophagitis secondary to excessive acid reflux. Although there is obvious massive gastroesophageal reflux in HPS, it is too difficult to evaluate the lower esophageal sphincter function in HPS.
Esophagitis, Peptic↗
[AIDS and non Hodgkin's malignant lymphoma disclosed by massive hematemesis].
A 40-year-old man was admitted for a major haemorrhage from the upper gastro-intestinal tract. An emergency gastrectomy was performed to control the bleeding. The histopathological study revealed a non-Hodgkinian lymphoma associated with an AIDS, which had remained unknown. The postoperative period was complicated by several infections. The patient died 2 1/2 months after the hematemesis. Such major haemorrhage from the upper gastro-intestinal tract as the presenting symptom of AIDS is very rare, although this has been described during the course of the disease. This case illustrates the importance in reminding operating theater staff (anaesthetists, surgeons, nurses) of the risk of viral contamination when treating a young patient with hematemesis and the necessity of wearing gloves, face masks and glasses.
Acquired Immunodeficiency Syndrome↗
Primary malignant melanoma of the esophagus presenting with massive hematemesis.
A 66-year-old Japanese man was admitted to our hospital, presenting with massive hematemesis. Emergency endoscopy revealed a bleeding tumor at the esophagogastric junction. The endoscopic appearance of the tumor was that of a Borrmann 2-like tumor, with a brownish-black discoloration. Bioptic histology confirmed the diagnosis of malignant melanoma. Atypical melanocytes with junctional changes were also found at a small pigmented patch in the lower esophagus, separate from the gross tumor. Melanocytosis was noted in the adjacent esophageal epithelium in the resection specimen following surgery. No primary lesion was found elsewhere, even in the patient's skin. These pathologic findings support the possibility of multicentric occurrence of malignant melanoma in esophageal melanocytosis. The patient is alive 11 months later, with multiple liver metastases. Massive hematemesis is an unusual presentation of primary malignant melanoma of the esophagus.
Aged↗
Epistaxis as a cause of hematemesis and melena.
Epistaxis was diagnosed in 10 patients with apparent upper gastrointestinal bleeding, comprising a 0.55% incidence of hematemesis and melena in the population studied. A sufficient amount of blood can be swallowed during epistaxis to cause hematemesis and melena. Recent facial trauma or epistaxis, absence of a history of chronic dyspepsia, and impairment of blood coagulation emerge as strong indicators of the diagnosis and should lead to a careful examination of the nose and nasopharynx for the source of bleeding.
Adult↗