Cause Of Gastrointestinal Bleeding Research Articles

Management of bulb varices: A rare case of upper gastrointestinal bleeding

This article reports a rare case of upper gastrointestinal bleeding caused by an ulcerated varice in the duodenal bulb, associated with portal hypertension secondary to sarcoidosis. A 54-year-old patient was successfully treated with glue therapy without complications. Ectopic varices, such as those in the duodenal bulb, are rare but serious causes of gastrointestinal bleeding. Their management is complex due to their atypical location and the lack of standardized protocols. This case underscores the value of endoscopic techniques, such as glue therapy, combined with a multidisciplinary approach to optimize treatment and prevent recurrence.

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.

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.

Unlikely Death From Esophageal Variceal Hemorrhage in a Post-Orthotopic Liver Transplant Patient.

Gastrointestinal bleeding is one of the complications seen after a liver transplant with a poor prognosis and low survival. The most common cause of gastrointestinal bleeding after a liver transplant is ulcers followed by hemorrhagic enteritis and portal hypertensive lesions. We present a case of a middle-aged male, with improving liver function labs and imaging, who passed away from large-volume hematemesis approximately 2 months after a liver transplant. On autopsy, the cause of death was concluded to be from acute upper gastrointestinal hemorrhage due to esophageal variceal bleeding.

Pancreatic Arteriovenous Malformation Presenting with Upper Gastrointestinal Bleeding: Treatment with Transarterial Embolization—A Case Report

AbstractPancreatic arteriovenous malformations (AVMs) are a rare entity among visceral AVMs and less common cause of gastrointestinal bleeding. We report a case of pancreatic AVM in a 45-year-old man who presented with upper gastrointestinal bleeding and duodenal ulcers, and was hemodynamically unstable. Ultrasound and computed tomography (CT) of the abdomen showed multiple dilated arterial channels in the head region of the pancreas, arising from the gastroduodenal artery, with early filling of the portal vein, suggestive of an AVM. Transarterial embolization was performed by selectively embolizing the arterial feeders using poly-vinyl alcohol (PVA) particles. Postembolization, obliteration of the AVM was seen. On follow-up 2 months later, the patient was clinically stable.

Comparison of gastrointestinal bleeding in patients with and without liver cirrhosis

Objectives Upper gastrointestinal bleeding (GIB) in patients has been well-characterized in liver cirrhosis but studies on lower GIB are limited. The clinical characteristics, management and outcomes in patients with and without liver cirrhosis was compared to determine the overall features of GIB in patients with liver cirrhosis compared with non-cirrhotics. Methods A retrospective study on cirrhotics hospitalized for GIB 2010–2021, matched with control group of non-cirrhotics (1:4) for upper vs. lower GIB. Patients with overt bleeding leading to hospitalization were included. Results Overall, 396 patients had cirrhosis, 267 (67%) men, median age 62, alcoholic etiology 177/396 (45%), median MELD 12 (range 6–32). Overall 102 cirrhotics had GIB, matched with 391 non-cirrhotics. Overall 87 (85%) cirrhotic patients had upper and 15% lower GIB. Compared to non-cirrhotics, the cause of GIB was more commonly acute variceal bleeding (AVB) (42% vs. 1%), hemorrhoids 40% vs. 6% (p = 0.002), less commonly gastric ulcer 13% vs. 31% (p < 0.001), duodenal ulcer 9% vs. 29% (p < 0.001), 5% of cirrhotics used NSAIDs vs. 26% of controls (p < 0.001). Rebleeding occurred in 14% of cirrhotics vs. 3% in controls (p < 0.001). Only one cirrhotic patient (1%) died from GIB vs. 0.8% of controls within 45 days. Overall mortality 45 days after hospitalization was 10% in cirrhotics vs. 5% in controls (p < 0.001) Conclusions Bleeding from gastric and duodenal ulcers were less common in cirrhotics than in controls. Bleeding from hemorrhoids was more common in cirrhotics. Mortality due to GIB was low in both groups but overall mortality was significantly higher in cirrhotics.

Meso-ileal ectopic varicose vein with uterine systemic shunt as an uncommon cause of severe lower gastrointestinal bleeding in patient with mild portal hypertension.

Abstract Ectopic varicose veins of the small intestine are an uncommon cause of gastrointestinal bleeding in patients with portal hypertension. We present the case of a 52-year-old female patient with mild portal hypertension and repeat episodes of lower gastrointestinal bleeding because of meso-ileal ectopic varicose vein with systemic uterine shunt secondary to previous pelvic surgery, radiological findings and treatment performed.

Prevalence, Causes and Outcomes of Acute Gastrointestinal Bleeding in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis.

The present study aims to investigate the prevalence, causes and outcomes of acute gastrointestinal (GI) bleeding in Rheumatoid arthritis (RA). A systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to 14th November 2023. All statistical analyses were conducted in Review Manager 5.4.1. Studies meeting inclusion criteria were selected. A random-effect model was used when heterogeneity was seen to pool the studies, and the result was reported in prevalence and their corresponding 95% confidence interval (CI). Other outcomes were assessed using qualitative analysis. A total of eight studies (six observational studies and 2 trials were used to conduct this systematic review and meta-analysis. A total population of 138,041 patients was used. Pooled analysis showed a statistically significant risk of GI bleeding in RA patients receiving NSAIDs (prevalence = 2% (1%, 3%); P < 0.00001; I2 = 98%). Qualitatively, causes and outcomes were discussed. Our study showed that 2% RA patients were subjected to GI bleeding, when they used NSAIDs. Other causes of GI bleeding were age-related factors, cardiovascular events, history of GI complications, and peptic ulcers. Outcome varied by the use of specific NSAIDs and the presence of comorbidities. Recent guidelines for the management of RA may mention GI bleeding as a potential complication, but the level of emphasis placed on this issue varies. Some guidelines provide comprehensive recommendations for its prevention and management, while others offer limited guidance.

Application of small bowel capsule endoscopy in children with Meckel's diverticulum.

Meckel diverticulum (MD) is an important cause of gastrointestinal bleeding in children. Small bowel capsule endoscopy (SBCE) is a first-line examination method applied to patients with obscure gastrointestinal bleeding, but there are few studies on its application in children with MD. This article aims to provide evidence in favor of the auxiliary diagnosis of MD in children by analyzing its characteristics using SBCE. We retrospectively collected the clinical data of patients with suspected MD. A total of 58 children were included in this study. All 58 children presented overt gastrointestinal bleeding (bloody stool or melena). Capsule endoscopy identified protruding lesions in 2 cases, double-lumen changes in 30 cases (all considered as MD), vascular lesions in 7 cases, intestinal mucosal inflammatory lesions in 3 cases, ulcers or erosion in 3 cases, and no obvious abnormalities in SBCE in 12 cases. Both SBCE and technetium-99 scans were performed for 24 cases, 22 of which were diagnosed MD by their combined results, giving a diagnostic coincidence rate of 91.7%. Eight cases were highly suspected as MD but were negative for the technetium-99 scan and positive for SBCE. SBCE has high accuracy in the diagnosis of MD in children, especially when performed in combination with a technetium-99 scan, which can greatly improve the diagnostic rate of MD in children.

Secondary aortoenteric fistula: a narrative review of the view of the surgeon

Aortoenteric fistula (AEF) is defined as the abnormal communication between the aorta and the gastrointestinal tract. AEFs are divided into primary and secondary usually after abdominal aortic aneurysm (AAA) recovery and are a rare but quite dangerous cause of gastrointestinal bleeding that the general surgeon may face during his/her career. Secondary AEF was first described in 1953 to a 44-year-old woman 3 months after an AAA operation. This review presents the role of the surgeon in the management of secondary aortoenteric fistulas. AEFs are a rare but fatal gastrointestinal bleeding cause that the general surgeon may be asked to manage. Diagnosis requires the combination of strong clinical suspicion and the presence of a history of AAA surgery. Although a vascular surgery case, general surgeons play a role in choosing the technique of restoring the intestinal tract, which seems to be significantly related to subsequent morbidity and mortality.

Unusual Cause of Hemobilia

AbstractHemobilia is one of the rare causes of upper gastrointestinal (GI) bleeding. Causes of hemobilia vary from benign lesions, malignant tumors, to vascular causes. Rupture of a hepatic artery aneurysm into common bile duct is rarely encountered in clinical practice, and sometimes can be very tricky to diagnose if the clinician is not aware of this cause of GI bleeding. We diagnosed a young female who has had a recent gallbladder surgery and presented with a massive upper GI bleeding. She was managed with coil embolization of the right hepatic artery.

A Rare Cause of Gastrointestinal Bleeding in a Kidney-Pancreas Transplant Recipient – Case Report

Kidney-pancreas transplantation is the preferable therapeutic option for patients with type 1 diabetes mellitus and end-stage kidney disease. We describe the case of a 35-year-old pancreas-kidney transplant recipient with dual-graft failure that presents with massive hematochezia and hemodynamic instability, evolving into hemorrhagic shock. The diagnostic assessment revealed a fistula between a pseudoaneurysm of the right common iliac artery and the adjacent transplanted duodenum segment, a rare but life-threatening cause of gastrointestinal bleeding in these patients. An endoprosthesis was placed into the iliac artery, prophylactic antibiotics were instituted, and a pancreatic transplantectomy was performed in a second procedure. This case highlights that the diagnostic workup of gastrointestinal bleeding in pancreas-kidney transplant recipients must include the possibility of arterio-enteric fistulas, which is more frequent in the presence of pancreatic graft failure, as was the case of our patient. Endovascular exclusion is the advocated treatment. Pancreatic graft transplantectomy could also be a possible approach for patients with a failed pancreas but it is highly controversial due to potential risks.

Hyperplasia of Brunner's glands as a cause of gastrointestinal bleeding in a young patient: endoscopic approach.

Brunner's gland hyperplasia or Brunneroma is a rare benign proliferative lesion of the small intestine. It is often incidentally discovered during endoscopy or imaging studies. The endoscopic presentation can be nodular, polypoid, or a diffuse glandular proliferation with thickening of the duodenal wall, which can be mistaken for malignant neoplasia. It rarely causes gastrointestinal bleeding. Is presented a case of a 25-year-old man who presented with melena and anemia secondary to Brunner's gland hyperplasia.

Pseudoaneurysm rupture of the splenic artery: a rare cause of gastrointestinal bleeding.

Splenic artery pseudoaneurysm (SAP) is a rare and potentially life-threatening complication of pancreatitis, with a high risk of rupture and mortality rate. Early diagnosis and treatment are crucial, typically through endovascular approaches such as embolization. A 46-year-old woman with chronic pancreatitis experienced gastrointestinal bleeding from a ruptured SAP, which was successfully treated with embolization using hydrocoils, resulting in complete recovery.

Rapid formation of aortoesophageal fistula complicated by mycotic thoracic aortic aneurysm secondary to infective endocarditis.

A 73-year-old man was admitted with four weeks of intermittent fever. He had a history of total aortic arch replacement for aortic arch aneurysm four years prior. CT scans showed no abnormalities before admission. Repeated blood cultures yielded Streptococcus anginosus and Prevotella melaninogenica, suggesting infective endocarditis (IE). Transesophageal echocardiography revealed a vegetation on the aortic valve, confirming IE. He suddenly presented with massive hematemesis and hypotension. Endoscopy revealed an elevated lesion with a laceration but no active bleeding in the esophagus. CT scans showed a thoracic aneurysm involving the esophagus. A diagnosis of aortoesophageal fistula (AEF) complicated by mycotic thoracic aortic aneurysm (MTAA) was made, and he underwent stent graft interpolation followed by minimally invasive esophagectomy. MTAAs are more prone to rupture than arteriosclerotic aneurysms as they are usually not true but pseudoaneurysms. Antecedent infection, including endocarditis, sepsis, predisposes to MTAA. AEF is a rare but life-threatening cause of gastrointestinal bleeding characterized by Chiari's triad. There have been no reports of such rapid formation of AEF after the graft replacement, as shown here. A recent article reported a rapid formation (16 days) of AEF after thoracic endovascular aortic repair, emphasizing prosthetic infection as the most important risk factor. Our case underscores the importance of suspecting AEF and conducting repeated appropriate examinations even if initial examinations do not reveal any aneurysms.

A Feasibility Study Evaluating Von Willebrand Factor in Patients with Gastrointestinal Angiodysplasia

Background: Abnormalities of von Willebrand Factor (VWF), such as those found in von Willebrand Disease (VWD) are associated with the development of abnormal blood vessels known as angiodysplasia. Angiodysplasia occurs primarily in the gastrointestinal (GI) tract, particularly the small bowel. Among patients with VWD, angiodysplasia is significantly overrepresented as a cause of GI bleeding and occurs in all VWD subtypes although it is reported more frequently in those with loss of the high molecular weight multimer of VWF. Recent studies have demonstrated more than a third of patients with VWD and GI bleeding have angiodysplasia when systematically assessed with Video Capsule Endoscopy (VCE) to examine the small bowel. Given the relationship between angiodysplasia and VWD our objective was to assess the feasibility of evaluating patients with GI angiodysplasia for abnormalities of VWF. Methods: We undertook a prospective single center pilot study to assess patients over the age of 18 with GI angiodysplasia for underlying abnormalities of VWF. Patients were identified based on angiodysplasia being present on a VCE study. Patients who consented to enrollment completed a self-administered bleeding assessment tool (BAT) as well as baseline demographic data. VWF testing included VWF antigen (VWF:Ag), VWF functional assay (VWF:GPIbM), Factor VIII coagulant activity (FVIII:C), and VWF pro-peptide (VWFpp) levels. Results: After reviewing 190 consecutive VCE studies performed at our institution between April 2021 and April 2023, we identified 50 patients who had capsule endoscopies demonstrating angiodysplasia of the GI tract. Thirteen of these patients consented to enrollment in the study. The bleeding histories of included patients are detailed in Table 1 along with their baseline clinical, laboratory, and demographic data. Two patients endorsed lifelong bleeding symptoms and three reported a significant family history of bleeding - all in a female relative. ISTH-BAT scores ranged from 0 to 18 with a median score of 2. Since our population is older than other studies that report on bleeding scores, we considered an abnormal bleeding score to be &amp;gt;6 as recent evidence indicates normal BAT scores increase over time. Five patients (38.6%) in our study had an ISTH-BAT abnormal bleeding score. VWF levels were assessed (Table 1) and one patient aged 88 years old with a significant family and lifelong history of bleeding received a new diagnosis of Type 2A VWD. Severe iron deficiency anemia requiring ongoing IV iron was diagnosed in two patients. Conclusion: In our feasibility study, we demonstrated a feasible protocol for recruitment of patients with GI angiodysplasia for clinical and laboratory testing of VWF. A significant proportion of our patients (38.6%) had abnormal bleeding scores and one patient had an underlying Type 2A VWD diagnosis.

Lesión de Dieulafoy, ¿y eso qué es?

Gastrointestinal bleeding is a common reason for consultation, both in hospital emergency services and in Primary Care. There are multiple etiologies that can motivate it. Dieulafoy's lesion is a rare but potentially serious cause of gastrointestinal bleeding. Its most common location is the stomach. Clinically it is expressed in the form of: melena, hematemesis or hematochezia. Various complementary exams can be used for its diagnosis, such as angiography, angio-CT or endoscopy. Recurrent bleeding treatment consists of embolization through interventional catheterization.

Gastric Antral Vascular Ectasia as a Reversible Cause of Upper Gastrointestinal Bleeding in the Oldest Old

Abstract Gastric antral vascular ectasia (GAVE) is a rare condition which accounts for 4% of the nonvariceal acute upper gastrointestinal (GI) bleeding. The mean age of diagnosis is 70 years. This condition is often misdiagnosed as hemorrhagic antral gastritis or portal hypertensive gastropathy. In this case report, we report the oldest person to date in the South Asian population with upper GI bleeding caused by GAVE. An 87-year-old, female, known case of chronic obstructive pulmonary disorder and systemic hypertension under medication for 2 years, current smoker, previous alcohol consumer presented to the emergency department with complaints of hematemesis, melena, and easy fatigability. On general physical examination, pallor was present. A provisional diagnosis of chronic anemia secondary to upper GI bleeding was made. Upper GI endoscopy revealed ectatic vessels radiating from the gastric antrum which was diagnosed as GAVE. Blood transfusion was done, and three sessions of argon plasma coagulation were done. In the oldest old, GAVE is an overlooked cause of GI bleeding and persistent severe anemia. It might also mimic the signs and symptoms of GI malignancy. However, the frail older adult and their caretakers must be counseled about its reversibility, good prognosis, and nonmalignant nature. Simple intervention can improve the quality of life in the frail oldest old.

Diagnostic imaging in determining the signs of possible bleeding from gastric varicose veins (literature review)

Annotation. Gastric varicose veins are one of the common causes of gastrointestinal bleeding in patients with portal hypertension. Bleeding of this localization has a greater percentage of death and difficulty in achieving hemostasis than bleeding from esophageal varices. This paper discusses the etiology and main aspects of the pathophysiology of portal hypertension, the mechanisms of bleeding, which play an important role in the prevention of complications prevention. The venous outflow from the stomach, variants of porto-systemic collateral anastomoses and types of varicose veins of the stomach itself are presented in sufficient detail. The advantages and disadvantages of diagnostic imaging in the assessment of gastric varicose veins and the possible prediction of the risk of bleeding are demonstrated.Aim: to analyze the data of foreign and domestic literature on varicose veins of the stomach, to identify criteria that determine the risks of bleeding according to the methods of diagnostic imaging.Results. Analysis of foreign and domestic literature showed that the problem of diagnosing gastric varicose veins is extremely relevant and requires special consideration of all its various aspects. There are many diagnostic methods with certain advantages and disadvantages. But, in our opinion, the possibilities of non-invasive methods, especially computed tomography, in the diagnosis of varicose veins of the stomach and the prognosis of bleeding from them are underestimated and require further study.

Gastric varices.

Gastric varices are a rare cause of gastrointestinal bleeding in patients with portal hypertension. There have been significantly advances within endoscopic ultrasound for treatment of gastric varices over the past 5 years in addition to the conventional endoscopic and endovascular therapies. In this review, we will review the latest literature on gastric varices with emphasis on changes to the conventional classification systems and comparisons among the different treatment options for gastric varices in terms of efficacy and safety. There have been new guidelines proposed by the American Gastrointestinal Association on a simpler classification system compared to the conventional Sarin classification. In addition, endoscopic ultrasound guided coil embolization, a novel treatment pioneered over the past 5 years for gastric varices, has shown increased efficacy and reduced adverse event profile compared to cyanoacrylate glue, the more traditional therapy for gastric variceal bleeding. Options for endovascular therapy overall have not significantly changed over the recent years. Based on our literature review, we recommend a step-up approach with initial medical and endoscopic management with consideration of endovascular therapies when initial therapies fail.