Source Of Bleeding Research Articles

Renal dysfunction contributes to deteriorated survival outcomes in patients with upper and lower gastrointestinal bleeding: insights from a cohort study of 1160 cases

Both acute kidney injury and chronic kidney disease are risk factors for many outcomes of gastrointestinal bleeding (GIB). These are associated with higher mortality, longer hospitalisation, and greater need for transfusion in case of overt GIB. Our study aimed to further evaluate the role of kidney function in several clinical outcomes of GIB patients. The Hungarian Gastrointestinal Bleeding Registry collected data on all-cause GIB between 2019 and 2022. A multi-level data-validation system provided high-quality data, which was retrospectively analysed. Numerous primary (in-hospital mortality, discharge, need for endoscopic intervention, in-hospital rebleeding, length of hospitalisation, need for emergency surgery, need for endoscopic examination and need for intensive care unit) and secondary (detection of Helicobacter pylori (H. pylori), recognition of cancer as the source of bleeding, need for any kind of transfusion or clotting factor, anticoagulation therapy) outcomes were observed. Descriptive statistical tools were used to summarize our data. Among others, estimated glomerular filtration rate (eGFR) (ml/min/1.73 m2) was used as continuous variable, mean, standard deviation, median, interquartile range and minimum/maximum values were calculated. Reduced kidney function was associated with in-hospital mortality (eGFR: 42.63 ± 28.78 ml/min/1.73 m2 vs. 57.08 ± 26.62 ml/min/1.73 m2, p < 0.001), need for red blood cells (RBC) transfusion (eGFR: 51.98 ± 27.90 ml/min/1.73 m2 vs. 60.11 ± 25.06 ml/min/1.73 m2, p < 0.001) and clotting factor supplementation (eGFR: 47.40 ± 27.41 ml/min/1.73 m2 vs. 56.68 ± 27.02 ml/min/1.73 m2, p < 0.001). Better eGFR values at admission were associated with discharge home after proper treatment, compared to any other outcome of the admission (eGFR: 58.12 ± 25.56 ml/min/1.73 m2 vs. 50.23 ± 29.69 ml/min/1.73 m2, p < 0.001), H. pylori positivity (eGFR: 59.63 ± 25.24 ml/min/1.73 m2 vs. 52.76 ± 25.44 ml/min/1.73 m2, p = 0.021) and the need for endoscopic intervention (eGFR: 58.65 ± 26.61 ml/min/1.73 m2 vs. 54.31 ± 27.64 ml/min/1.73 m2, p = 0.008). At admission, patients with better eGFR than 36.64 ml/min/1.73 m2 were discharged to their homes, mortality was higher with eGFR worse than 25.96 ml/min/1.73 m2, more RBC transfusion was needed if eGFR was lower than 49.61 ml/min/1.73 m2. Regulation of anticoagulation was examined extensively. Impaired kidney function at admission results higher in-hospital mortality in overt all-cause GIB and increases the need of RBC transfusion.

Endovascular management of carotid blowout syndrome

ABSTRACT Objectives To evaluate success, complications and efficacy for endovascular management for carotid blowout syndrome. Methods Images were evaluated for contrast extravasation, vessel wall irregularity, pseudoaneurysm/aneurysm formation. Hemostatic results in the immediate postprocedural period and procedure related infarcts were assessed. Results Total of 20 lesions in 21 patients were detected on digital subtraction angiography (DSA). In a case of esthesioneuroblastoma with active bleeding, DSA failed to show vascular abnormality. There was active contrast extravasation in 7 cases. Treatment modalities included covered stent placement (n = 3), pseudoaneurysm/aneurysm embolization (n = 4), parent artery occlusion (n = 13) and PVA injection (n = 1) in the immediate postoperative period was achieved in all except one case. During the post-procedural period, 6 patients (28.6%) suffered from cerebral ischemia. Rebleeding episodes were encountered in 10 cases (47.6%) after a mean duration of 35 days which responded to tamponade in 4 cases. Diagnostic DSA was performed in 5 of the cases, which failed to identify bleeding source in 2 and remaining 3 cases were treated by endovascular means. A case with massive hemorrhage 1-hour after endovascular treatment died before any intervention could be performed. Conclusion Endovascular treatment can achieve immediate hemostasis to prevent otherwise a highly morbid and mortal complication. However, rebleeding rates are high and cerebral ischemia with or without neurologic deficit occur in a non-negligible percentage of patients.

Major Bleeding in the Emergency Department: A Practical Guide for Optimal Management

Major bleeding is a life-threatening condition with high morbidity and mortality. Trauma, gastrointestinal bleeding, haemoptysis, intracranial haemorrhage or other causes of bleeding represent major concerns in the Emergency Department (ED), especially when complicated by haemodynamic instability. Severity and source of bleeding, comorbidities, and prior use of anticoagulants are pivotal factors affecting both the clinical status and the patients’ differential response to haemorrhage. Thus, risk stratification is fundamental in the initial assessment of patients with bleeding. Aggressive resuscitation is the principal step for achieving haemodynamic stabilization of the patient, which will further allow appropriate interventions to be made for the definite control of bleeding. Overall management of major bleeding in the ED should follow a holistic individualized approach which includes haemodynamic stabilization, repletion of volume and blood loss, and reversal of coagulopathy and identification of the source of bleeding. The aim of the present practical guide is to provide an update on recent epidemiological data about the most common etiologies of bleeding and summarize the latest evidence regarding the bundles of care for the management of patients with major bleeding of traumatic or non-traumatic etiology in the ED.

Abdominal hemorrhage and vascular fragility associated with neurofibromatosis type 1.

We report a case of recurrent abdominal bleeding associated with vascular fragility in a 67-year-old woman with neurofibromatosis type 1 (NF-1). Computed tomography (CT) scan revealed hemorrhagic ascites and a pseudoaneurysm of the sigmoid colon artery, which was suspected to be the source of bleeding. Emergency laparotomy confirmed extremely fragile vessels, requiring repeated surgeries for recurrent bleeding. The patient was diagnosed with NF-1 vasculopathy, a rare vascular complication of this autosomal dominant disorder. NF-1, which affects 1 in 3000-5000 individuals, is associated with reduced life expectancy due to malignancies and vascular diseases, including NF-1 vasculopathy. This condition involves structural vascular abnormalities and increased fragility affecting vessels of all sizes. Recognition of this fragility is critical during invasive procedures, such as interventional radiology or surgery, to reduce the risk of bleeding and ensure optimal management. This case highlights the importance of considering NF-1 vasculopathy in patients with abdominal bleeding and adopting tailored strategies to address its challenges.

Telling Ghost Stories Around a Bonfire-A Literature Review of Acute Bleeding Secondary to Pancreatitis.

Bleeding is a rare but serious complication of pancreatitis, significantly increasing morbidity and mortality. It can arise from various sources, including erosion of blood vessels by inflammatory processes, formation of pseudoaneurysms, and gastrointestinal bleeding. Early diagnosis and timely intervention are crucial for patient survival. Imaging modalities such as computed tomography and angiography are essential for identifying the bleeding source, where endoscopy may help in detecting and treating intraluminal hemorrhage. Management strategies for patients with extraluminal bleeding may involve angioembolization or surgical intervention, depending on the severity and location of the bleeding. While advances in diagnostic and therapeutic techniques have improved outcomes, bleeding in pancreatitis remains a challenging clinical problem requiring a multidisciplinary approach. This review aims to focus its attention specifically on the bleeding complications of pancreatitis.

Prognostic relevance of CT-defined body composition in patients with acute bleeding undergoing endovascular embolization.

Body composition assessment includes the parameter skeletal muscle mass, subcutaneous and visceral adipose tissue (SAT and VAT). The purpose of this study was to elucidate associations of body composition parameters with mortality in patients with acute bleeding undergoing transarterial embolization (TAE). A mixed cohort of patients from 2018 to 2022 with acute bleeding requiring treatment with a TAE was retrospectively evaluated. In every case, the triphasic computed tomography (CT) to diagnose the source of bleeding was used to calculate the body composition parameters. A total of 251 patients (93 female, 37.1%) with a mean age of 65.5 ± 14.3 years, 30-d mortality of 40.2%, and 24-h mortality of 7.6% were included in the analysis. In the Cox regression analysis, no statistically significant correlations were found between the body composition parameters and 24-hour or 30-day mortality. In the subgroup analysis of patients aged older than 65 years, SMI was associated with short-term 24-hour mortality HR of 0.95 (95%CI 0.90;0.99, p = 0.035). The present study demonstrated the prognostic impact of clinical, laboratory, aniography-related, and CT-defined body composition in patients with acute hemorrhage undergoing endovascular therapy. Although the overall effect of CT-defined body composition appears to be small, skeletal muscle index was a prognostic factor in the age group over 65 years. This is a large single center study to investigate the prognostic relevance of CT-defined body composition in patients undergoing TAE. The effect is overall small but might be further investigated in older patients in further trials.

Characteristics of Gastrointestinal Bleeding While Taking Direct Oral Anticoagulants in Patients with Nonvalvular Atrial Fibrillation and Differences Among Drugs-A Single-Center Retrospective Cohort Study.

Introduction: Direct oral anticoagulants (DOACs) are frequently used to prevent embolism in atrial fibrillation. Gastrointestinal bleeding is frequent, but its drug-specific characteristics remain unclear. This study examined the frequency and characteristics of gastrointestinal bleeding in patients with nonvalvular atrial fibrillation for different DOACs. Methods: The present study included 978 patients receiving treatment with DOACs for nonvalvular atrial fibrillation between 2011 and 2018 and examined the frequencies of clinically significant events including major cardiovascular and cerebrovascular events, hemorrhagic events, or death during the first 5 years of prescription. Gastrointestinal bleeding was evaluated for the frequency, source and severity of gastrointestinal bleeding by DOAC type. Results: The median age of subjects was 73 years (interquartile range, 65-80 years), and 622 (64%) were male. The overall observation period was 2499 person-years. During this period, 102 (4.1/100 person-years) major cardiovascular events and 107 (4.3/100 person-years) clinically significant bleeding were reported, including 60 cases (2.4/100 person-years) of gastrointestinal bleeding and 37 cases (1.5/100 person-years) of all-cause mortality. Gastrointestinal bleeding accounted for more than half of all bleeding events among DOAC users, and bleeding from the lower gastrointestinal tract was more common than that from the upper gastrointestinal tract, particularly with dabigatran. No significant difference was seen in the rate of gastrointestinal bleeding by drug type. Peptic ulcer accounted for half of the events of upper gastrointestinal bleeding, all of which were severe. Conclusions: Gastrointestinal bleeding is frequent among patients taking DOACs, especially from the lower alimentary tract. The tendency was more pronounced with dabigatran. In the upper gastrointestinal tract, severe peptic ulcer bleeding is common and requires caution.

The Intersection of Trauma and Immunity: Immune Dysfunction Following Hemorrhage.

Hemorrhagic shock is caused by rapid loss of a significant blood volume, which leads to insufficient blood flow and oxygen delivery to organs and tissues, resulting in severe physiological derangements, organ failure, and death. Physiologic derangements after hemorrhage are due in a large part to the body's strong inflammatory response, which leads to severe immune dysfunction, and secondary complications such as chronic immunosuppression, increased susceptibility to infection, coagulopathy, multiple organ failure, and unregulated inflammation. Immediate management of hemorrhagic shock includes timely control of the source of bleeding, restoring intravascular volume, preferably with whole blood, and prevention of ischemia and organ failure by optimizing tissue oxygenation. However, currently, there are no clinically effective treatments available that can stabilize the immune response to hemorrhage and reinstate homeostatic conditions. In this review, we will discuss what is known about immunologic dysfunction following hemorrhage and potential therapeutic strategies.

RESULTS OF APPLICATION OF THE PROTOCOL FOR THE PREVENTION OF BLEEDING IN CARDIAC SURGICAL PATIENTS WITH PATHOLOGY OF THE AORTIC VALVE AND AORTIC ROOT

Purpose of the study: to evaluate the results of using a protocol for the prevention of bleeding in cardiac surgical patients with pathology of the aortic valve and aortic root to optimize tactics for preventing bleeding.Materials and methods: the first group included 185 cardiac surgical patients with pathology of the aortic valve and aortic root, who underwent surgery on the aortic valve, during the treatment of which a bleeding prevention protocol was applied. The second group consisted of 237 cardiac surgical patients with pathology of the aortic valve and aortic root who underwent surgery on the aortic valve, during whose treatment a bleeding prevention protocol was not used. Data were collected on the management tactics of the preoperative, intraoperative and postoperative periods, such as:– anamnestic data, results of echocardiographic examination, laboratory data: preoperative level of hemoglobin, fibrinogen;– intraoperative level of hemoglobin, fibrinogen, dose of transfused cryoprecipitate, thromboelastometry data, intraoperative blood loss;– drainage discharge during 1 day of the postoperative period, frequency of bleeding, resternotomy, and deaths.Study results: In the second group of patients, the number of cases of intraoperative hypofibrinogenemia was almost 5 times greater than in group 1; out of 237 patients, 62 (26.2%) had a critically low level of fibrinogen. Fibrinogen hemodilution coagulopathy (intraoperative hypofibrinogenemia) was associated with resternotomy: Х2 = 63.375, p = 0, df = 1, HR = 11.686, 95% CI: 5.61-24.33. Complications associated with bleeding were more common in the second group of patients – 44 (18,6%) cases out of 237 operated patients, Х2 = 10,6; р = 0,001, Х2Yates = 9,693; р = 0,002, RR = 2,453, 95% CI: 1,39-4,34. In the first group, there were only 14 (7,6%) cases of complications associated with bleeding out of 185 operated patients. Significant differences were also found in the frequency of resternotomies: in group 1 – 3 (1.6%) cases, in group 2 – 28 (11.8%) Х2 = 15,859; р = 0 (Х2Yates = 14,397, р = 0; р (F) = 0; RR = 7,286, 95% CI: 2,25-23,59). Of 185 operations in group 1, only 3 cases of resternotomy were observed, which corresponds to 1.6% of all patients in group 1. Upon repeated inspection of the surgical wound, surgical sources of bleeding were identified in all 3 cases. Of the 237 operations in group 2, there were 28 cases of repeated revision of the surgical wound. Of the 28 resternotomies, only in 15 cases a surgical source of bleeding was identified, therefore, the remaining 13 cases of bleeding occurred due to coagulopathy. In group 1, there were no cases of resternotomy performed due to hypocoagulable bleeding. A statistically significant association was found between preoperative anemia and resternotomy (x2, p = 0.039, RR = 2.03, 95% CI: 1-4).Conclusions:1) intraoperative hypofibrinogenemia increases the risk of resternotomy 11 times (x2 = 63.375, p = 0, df = 1, RR = 11.686, 95% CI: 5.61-24.33);2) preoperative anemia doubles the risk of resternotomy (p = 0,039, ОR = 2.03, 95% CI: 1-4);3) when using the bleeding prevention protocol, intraoperative hypofibrinogenemia occurs 5 times less often;4) when using the bleeding prevention protocol, complications associated with bleeding are 2.5 times less common: Х2 = 10,6; р = 0,001, Х2Yates = 9,693; р = 0,002, RR = 2,453, 95% CI: 1,39-4,34;5) when using a bleeding prevention protocol, the risk of resternotomy is reduced by 7 times: Х2 = 15,859; р = 0 (Х2Yates = 14,397, р = 0; р (F) = 0; RR = 7,286, 95% CI: 2,25-23,59).

Multidisciplinary Expert Guidance for the Management of Severe Bleeding on Oral Anticoagulation: An Algorithm for Practicing Clinicians.

Bleeding complications associated with oral anticoagulant (OAC) frequently lead to emergency department visits and hospitalization. Short-term all-cause mortality after severe bleeding is substantial ranging from approximately 10% for gastrointestinal bleeding (the most frequent single site) to approximately 50% for intracranial bleeding. A protocol for multidisciplinary approach to bleeding is needed to (i) ensure rapid identification of patients at risk of adverse outcomes, (ii) optimize delivery of supportive measures, (iii) treat the source of bleeding, and (iv) administer anticoagulant reversal or hemostatic therapies judiciously for patients most likely to benefit. We convened a multidisciplinary panel of experts (emergency medicine, gastroenterology, general internal medicine, hematology, neurology, pharmacy, thrombosis) to review the literature and provide practical guidance including a corresponding algorithm for use at the point of care to assist clinicians in the management of patients with acute severe OAC-related bleeding.

Biphenotypic sinonasal sarcoma in a toddler: a case report and literature review.

Biphenotypic sinonasal sarcoma (BSNS) is an extremely rare malignant tumor characterized by neural and myogenic differentiation. No documented cases of BSNS have been reported in toddlers. A 1-year-11-month-old girl presented with significant unilateral nasal bleeding. Identification of the bleeding source during the initial assessment was particularly challenging given the patient's agitated state. Subsequent exploration under anesthesia revealed an exophytic tumor arising from the middle turbinate. Afterwards, the patient underwent tumor excision via transnasal endoscopy, with no immediate complications. Immunohistochemistry confirmed a diagnosis of BSNS. No signs of recurrence or distant metastasis were observed over a two-year follow-up period. Massive, persistent nasal bleeding due to sinonasal malignancies in very young children is exceedingly uncommon. For young patients with recurrent or atypical epistaxis, clinicians should consider a neoplastic origin, given the difficulty in pinpointing the bleeding source. This case aims to remind physicians to include such rare malignancies in differential diagnoses, stressing the need for heightened awareness during pediatric assessments.

Rare nephrostomy complication mimicking rupture of abdominal aortic aneurysm: a case report

Percutaneous nephrostomy (PCN) is a routine procedure in urology with up to 99% success rate and less than 6% of total complications dominated by minor cases. This was a case report of a 59-year-old male patient with an unusual major bleeding complication after PCN that mimicked a ruptured abdominal aortic aneurysm. The laparotomy exploration identified the bleeding source from the right lobar artery, thus renorrhaphy was performed. Proper visualization of anatomic layout, color Doppler imaging, and selecting a guiding method and technique could reduce bleeding complications following PCN.

Optimized imaging for suspected acute organ bleeding

Contrast-enhanced computed tomography (CT) is the standard procedure for diagnosing acute organ bleeding. It provides rapid, precise and comprehensive visualization of the bleeding situation, which is crucial in emergency situations. The examination is usually conducted in three phases: native, arterial and venous. These phases enable the precise identification and localization of the source of bleeding. The CT imaging is not only used to confirm the diagnosis but also aids in planning further treatment, facilitating targeted preparation for interventional radiologists, surgeons and endoscopists. The possibilities for use of the technique in CT have significantly advanced in recent years. High-resolution CT scanners provide detailed images, which are particularly useful for detecting small bleedings and traumatic injuries. Multi-energy CT provides additional advantages by enabling virtual native examinations and mono-energetic image reconstructions, which enhance the visibility of iodine-based contrast agents. These technologies improve the sensitivity for detecting bleeding and enable a better characterization of the source of bleeding. To optimize the CT diagnostics for bleeding, the use of ahighly concentrated iodine contrast agent with afast injection rate is recommended. Additionally, imaging data should be reconstructed with aslice thickness of 1-3 mm to achieve optimal diagnostic results. Multiplanar reconstructions are essential in all cases to ensure comprehensive imaging information. The combination of these advanced techniques and settings leads to improved diagnostics and treatment of acute organ bleeding.

Meckel's diverticulum as a cause of gastrointestinal bleeding.

Meckel's diverticulum, the most common congenital anomaly of the gastrointestinal tract, is often asymptomatic. Lack of complete resorption of the omphalomesenteric duct is an important cause of Meckel's diverticulum. Gastrointestinal (GI) bleeding is a major complication of Meckel's diverticulum. Herein, we reported a case of obscure gastrointestinal bleeding secondary to Meckel's diverticulum in small intestine detected by double-balloon enteroscopy. A 32-year-old male was admitted to the Department of Gastroenterology due to a 4-year history of intermittent hematochezia. Half a month before this admission, abdominal computed tomography scans showed high density in intestinal tract, and magnetron capsule endoscopy showed dark red blood from the end of the ileum to the ascending colon, but did not identify the source of bleeding. At this admission, hemoglobin concentration was 117 g/L. Double-balloon enteroscopy via anal route was performed, and found a large diverticulum in the middle part of the ileum, which was marked by two metal clips, with a superficial ulcer on its inner wall. Thus, Meckel's diverticulum was diagnosed. Subsequently, he underwent surgery. During surgery, a small intestinal diverticulum with a size of about 5.0cm×2.0cm was located nearly 120cm away from the ileocecal part. Small intestinal diverticulectomy was performed. He did not develop any recurrent hematochezia during follow-up.

Typical causes and clinical presentations of traumatic and nontraumatic soft tissue and organ haemorrhage in emergency departments

Acute bleeding often occurs in awide variety of forms in clinical emergency medicine. In traumatic bleeding, soft tissue injuries to the head or extremities are common, while severe bleeding is less common in chest injuries or pelvic trauma. In nontraumatic emergencies, gastrointestinal bleeding is the leading cause, but many other bleeding entities are possible. Structured management helps to detect the critically ill patient, identify the possible source of bleeding and provide appropriate radiological diagnostics and therapy. Clinical examination, blood gas analyses and emergency ultrasound are crucial in the initial phase of diagnosis. Initially, symptomatic therapy is usually indicated to stabilize the patient, and then interventional or surgical care is indicated in the course of the disease, depending on the location of the bleeding. Volume and catecholamine therapy, coagulation management and emergency transfusion are important components of interdisciplinary emergency care, in addition to primary bleeding control, especially in the case of open injuries.

Endovascular treatment of postoperative gastrointestinal bleeding

Objective. To analyze the results of endovascular treatment of postoperative gastrointestinal bleeding. Materials and methods. During the period 2014–2024, 328 endovascular interventions were performed in 297 patients with postoperative gastrointestinal bleeding. The most common was vesicovaginal bleeding after pancreatic surgery. A total of 304 embolizations were performed and 24 stent grafts were installed. Results. In 253 (85.2%) patients, it was possible to diagnose the source of bleeding angiographically, and the bleeding was stopped with the help of embolization devices and stent grafts. In 44 (14.8%) patients, it was not possible to accurately diagnose the source of bleeding, and they underwent prophylactic embolization of the most likely source of bleeding. In 12 patients, embolization was repeated: in 6 patients it was performed twice, in 5 patients – three times, and in 1 patient – four times. In 16 (5.4%) patients, including 15 after prophylactic embolization, endovascular hemostasis was ineffective and they required surgical intervention. Conclusions. Endovascular treatment due to its minimal invasiveness, the possibility of repeated use, and the combination of diagnostic and therapeutic stages is the primary method in the treatment of postoperative gastrointestinal bleeding.

Gastric glomus tumor with uncertain malignant potential: case report of a rare cause of upper gastrointestinal bleeding

BackgroundGlomus tumors (GTs) are mesenchymal neoplasms that are typically benign. Gastric GTs are uncommon and occur mainly in the upper gastrointestinal tract. Malignant gastric GTs are extremely rare, constituting less than 1% of gastric tumors. Because their features are similar to those of other tumors found in the same gastrointestinal region, such as stromal tumors, leiomyomas, lymphomas, and lipomas, the diagnosis is challenging.Case PresentationA 52-year-old male patient presented with fatigue and melena. The initial endoscopic examination did not locate any source of bleeding. Six months later, pan-gastroscopy, performed due to progressive microcytic anemia, revealed a 40 × 30 mm polypoid lesion with deep ulcerations; histopathological analysis confirmed that it was a gastric GT with expression of alpha-actin and cadherin 17 and a Ki-67 index of 20%. The patient delayed surgical therapy until his symptoms worsened. Laparoscopic sleeve resection revealed a 65 × 45 × 25 mm tumor, and secondary immunohistochemical analysis revealed extensive spread into the mucosa and subserosa. Focally, the tumor bulged into some large veins. Genetic examination with RNA isolation further supported the histopathological diagnosis of gastric GT with uncertain malignant potential.ConclusionsThis case underscores the diagnostic challenges posed by gastric GTs because they are rare and their clinical features are similar to those of other gastric tumors. Thorough histopathological and molecular analysis is essential for an accurate diagnosis. Surgical intervention remains the primary therapeutic approach. This case also emphasizes the need for long-term follow-up due to the potential for recurrence and malignancy.

Endoscopic resection of a juvenile jejunum polyp which caused recurrent intestinal bleeding in a 12-month-old child: clinical observation

BACKGROUND: To verify a source of obscure gastrointestinal bleeding leading to iron deficiency anemia is a challenging diagnostic problem. Intestinal polyps can be one of such sources. Sporadic juvenile intestinal polyps are extremely rare at the first year of life. The authors present a clinical case which demonstrates endoscopic diagnostics and resection of a jejunum polyp in a 12-month-old child weighing 6.3 kg. We did not find similar publications in literature. CLINICAL CASE DESCRIPTION: A 12-month-old boy was admitted to our clinic with long-lasting complaints of dark stool and iron deficiency anemia. For the first time, gastrointestinal bleeding symptoms appeared at the age of one month. The child was repeatedly examined, but gastrointestinal bleeding source was not found. The child was prescribed symptomatic therapy for iron deficiency anemia including red blood cell transfusion. At current hospitalization in our clinic an intestinal polyp and transient small intestinal intussusception were suspected at ultrasound examination. The child underwent esophagogastroduodenoscopy, video capsule endoscopy, colonoscopy, laparoscopy. But the source of the bleeding was not found. During the repeated enteroscopy at 40 cm distally to the pylorus a sporadic juvenile jejunum polyp 17×15 mm was found and resected. The postoperative period was uneventful. In 1 month, there were no complaints as for the catamnesis, the child's stool had the usual characteristics, the indicators of "red blood" corresponded to the age norm. CONCLUSION: A sporadic juvenile jejunal polyp may be a cause of obscure recurrent intestinal bleeding in children. Modern intraluminal endoscopy allows not only to put diagnosis, but also to perform a minimally invasive surgical intervention.

Image-enhanced endoscopy in upper gastrointestinal disease: focusing on texture and color enhancement imaging and red dichromatic imaging.

Endoscopic examination plays a crucial role in the diagnosis of upper gastrointestinal (UGI) tract diseases. Despite advancements in endoscopic imaging, the detection of subtle early cancers and premalignant lesions using white-light imaging alone remains challenging. This review discusses two novel image-enhanced endoscopy (IEE) techniques-texture and color enhancement imaging (TXI) and red dichromatic imaging (RDI)-and their potential applications in UGI diseases. TXI enhances texture, brightness, and color tone, which improves the visibility of mucosal irregularities and facilitates earlier detection of neoplastic lesions. Studies have suggested that TXI enhances the color differences between lesions and the surrounding mucosa and improves the visibility of the lesion. TXI aids in the diagnosis of various UGI diseases, including early gastric cancer, esophageal cancer, premalignant conditions such as atrophic gastritis and Barrett's esophagus, and duodenal tumors. RDI utilizes specific wavelengths to enhance the visualization of deep blood vessels or bleeding points, aiding in the rapid and accurate identification of bleeding sources during endoscopic procedures. Although promising, TXI and RDI require further large-scale studies across diverse populations to establish their clinical utility, diagnostic performance, and cost-effectiveness before integration into the guidelines. Standardized training is also required for effective utilization. Overall, these IEE techniques has the potential to improve the diagnosis and management of UGI.

Hemobilia: A Narrative Review of Current Diagnostic Techniques and Emerging Management Strategies.

Hemobiliais a relatively uncommon but important cause of gastrointestinal bleeding. It occurs dueto abnormal communications between the biliary system and surrounding vasculature, often caused by surgical interventions, trauma, infections, or malignancies. The rise of advanced hepato-pancreato-biliary techniques, includingradiofrequency ablation and transjugular intrahepatic portosystemic shunt(TIPS) placement, necessitates careful evaluation for the potential presence of hemobilia during the post-procedural period of these patients. Hemobilia can be difficult to diagnose, as common symptoms like jaundice, abdominal pain, and gastrointestinal bleeding are not always present together. Imaging techniques such as Doppler ultrasound, contrast-enhanced computed tomography (CT), and angiography are critical for identifying the source of bleeding. Treatment typically focuses on achieving hemostasis and ensuring proper bile flow, with options including endoscopic techniques, angiography with transcatheter arterial embolization, and, in severe cases, surgical intervention. This review highlights recent advances in diagnostic and therapeutic approaches, emphasizing the need for early recognition and tailored interventions to improve patient outcomes.