Cause Of Acute Gastrointestinal Bleeding Research Articles

A rare cause of recurrent lower gastrointestinal hemorrhage due to a rectosigmoid Dieulafoy’s lesion

BackgroundColonic Dieulafoy’s lesions (DLs) are an extremely rare cause of acute gastrointestinal bleeding. However, it could be presented from self-limiting, mild bleeding episodes up to recurrent, massive life-threatening hemorrhage.Case presentationWe present a case of 9-year-old female with recurrent attacks of hematochezia. The colonoscopy showed actively bleeding Dieulafoy’s lesions at the rectosigmoid colon that was successfully managed endoscopically by the application of two hemoclips.ConclusionA prompt and accurate diagnosis in patients with a Dieulafoy’s lesion carries paramount importance. A meticulous examination and proper resuscitation are a must because massive, uncontrolled bleeding from this lesion may culminate in the death of the patient fairly quickly.

S692 Trends and Disparities in Outcomes of Hospitalizations With Dieulafoy Lesions: A Decade-Long Analysis of the Nationwide Inpatient Sample

Introduction: Dieulafoy lesion (DL) is a rare yet potentially life-threatening cause of acute gastrointestinal bleeding. There is a paucity of research on the impact of sociodemographic indices on DL hospitalization outcomes. This study aimed to describe the epidemiologic trends and effects of sociodemographic disparities on outcomes among DL hospitalizations over a decade. Methods: We queried Nationwide Inpatient Sample (NIS) databases from 2010 to 2019, identified hospitalizations with DL, and excluded those of patients less than 18 years. We obtained the incidence and admission rate of DL per 1,000,000 adult hospitalizations for each year. We analyzed trends in mortality rate, mean length of hospital stay (LOS), and mean total hospital charge (THC). We highlighted disparities in outcomes stratified by sex, race, and mean household income (MHOI) quartile. We used multivariable regression analysis to obtain trends in incidence and admission rates, mortality, LOS, and THC adjusted for age categories, sex, and race. We used Joinpoint regression analysis to obtain trends in adjusted rates. Threshold for statistical significance was set at 0.05. Results: Of the 305 million hospitalizations included in our study, 59,862 were complicated by DL, with 40,356 principal admissions for DL. On Joinpoint analysis, there was no trend in adjusted incidence rate (p = 0.1) or adjusted admission rate (p = 0.05) over the study period. There was also no trend in adjusted mortality rate among all hospitalizations with DL (p trend = 0.855), admissions with principal diagnosis of DL (p trend = 0.754) or adjusted LOS (p trend = 0.879) but there was a US$4,011 increase in adjusted THC (p trend < 0.001).Middle-aged adults had increased odds of mortality (adjusted odds ratio, aOR = 1.48) compared to young adults (p = 0.046). Females had 16% lower odds of adjusted mortality (p trend = 0.046), 0.67 days reduction in adjusted LOS (p trend = 0.001), and US$16,905 reduction in adjusted THC (p trend < 0.001) compared to males. Blacks had 2.6 days increase in adjusted LOS and US$33,685 increase in adjusted THC (both p trends < 0.001) compared to Whites. Hispanics had increased odds of mortality (aOR = 1.76), 1.5 days increase in adjusted LOS, and US$50,476 increase in adjusted THC compared to Whites ((p trends = 0.018, 0.003 and < 0.001 respectively) (Figure). Conclusion: Outcomes of DL hospitalizations were worse in middle-aged adults, males, and ethnic minorities. Further studies may be needed to elucidate the reasons behind these findings.Figure 1.: Trends in mortality rates among hospitalizations with DL and admissions with principal admitting diagnosis of DL.

Acquired Hemophilia A with Gastrointestinal Bleeding

Peptic ulcer disease is the most common cause of acute gastrointestinal bleeding, followed by variceal bleeding, Mallory–Weiss syndrome, and malignancy. On the contrary, acquired hemophilia A is a very rare hemorrhagic disease, which usually manifests with musculocutaneous bleeding, caused by autoantibodies against coagulation factor VIII.A 78-year-old man presented to the Emergency Department with melena. Dieulafoy’s lesions were observed on, and endoscopic cauterization was performed. However, the patient complained of back pain and symptoms indicative of upper gastrointestinal bleeding. Abdominopelvic computed tomography was performed, and hematoma in the psoas muscle was detected. Antibodies against coagulation factor VIII were confirmed with a blood test, and the diagnosis of acquired hemophilia A was made. Here, we report a case of acquired hemophilia A presenting with upper gastrointestinal bleeding symptoms and present a brief review of literature.

Finding the Dieulafoy’s Lesion: A Case of Recurrent Rectal Bleeding in an Immunosuppressed Patient

A Dieulafoy's lesion (DL) is rare cause of acute gastrointestinal bleeding defined as a vascular abnormality of the submucosa. With a high prevalence for the stomach and upper gastrointestinal tract, it is rarely observed in the lower gastrointestinal tract. Its prevalence is rare accounting for less than 2% of all cases of acute gastrointestinal bleeding. The etiology of DL is unknown. Common comorbidities include cardiovascular disease, kidney disease, diabetes, alcohol abuse, liver disease, and chronic NSAID use. Few cases involving chronic steroid use and immunosuppressive treatment have been reported. The most common diagnostic and treatment modality is endoscopy with refractory cases treated with arterial embolization by angiography. We present a case involving a patient with significant comorbidities on chronic immunosuppression with a life-threatening, massive lower gastrointestinal bleed from a DL in the rectum.

An unusual Presentation of Dieulafoy’s Lesion as a Cause of Recurrent Lower Gastrointestinal/Rectal Bleeding: A Case Report

Background: Dieulafoy lesion is a rare cause of acute gastrointestinal bleeding. It can present with sudden and massive bleeding without any prior symptoms. It causes massive hemorrhage leading to hemodynamic instability and this complicated nature of disease puts emphasis on its immediate diagnosis and treatment. Most commonly it presents with upper GIT bleeding but it can present with lower gastrointestinal bleeding. Case Presentation: We report a case of recurrent lower gastrointestinal bleeding that was miss diagnosed initially as internal hemorrhoids. A 91-year-old male was discharged 2 weeks ago, who presented again with rectal bleeding and low hemoglobin found on lab reports. He was admitted and transfused two packs of PRBC. After not finding any visible bleeding on upper endoscopy, he had colonoscopy and a bleeding vessel was found in rectum. Clipping was performed to stop bleeding and he was discharged home. Lower gastrointestinal bleeding is a very rare presentation of dieulafoy lesion. Conclusion: Dieulafoy lesion can present with upper or lower gastrointestinal bleeding. Diagnostic improvements and research for the detection of DL needs to be conducted to reduce hospital stay and improve survival. Endoscopic measures, mechanical banding, hemoclipping and electrocoagulation are some of the frequently used treatment options.

Spectrum of upper gastrointestinal bleed in patients with cirrhosis of liver

Background &amp; Objectives:Acute upper gastrointestinal (UGI) bleeding is a serious medical problem in patients with cirrhosis of liver associated with high mortality. Gastro-oesophageal variceal bleed is the most common complication of portal hypertension in patient with liver cirrhosis. This study was undertaken to establish the causes of UGI bleed in cirrhosis, their relative incidences, clinical presentation , endoscopic findings, outcomes during hospitalization including rebleeding and mortality were studied.Materials &amp; Methods:One hundred and twenty patients with clinical features, sonological and endoscopic evidence of portal hypertension and cirrhosis of liver who presented with upper gastrointestinal bleed were included in the study. After haemodynamic stability, each patient underwent UGI endoscopy usually within 12 hours and the aetiology with diagnostic findings were documented. Results:Ruptured oesophageal varices was the most common cause of UGI bleed in cirrhotic patients. Non variceal causes of UGI bleed accounted for 33.3 % of cases. The majority of non variceal bleed was peptic ulcer disease and accounted for 19.2 % of total UGI bleed in liver cirrhosis. This was followed by portal hypertension gastropathy, erosive gastropathy, mallory-weiss tear and others.Conclusion:The most frequent causes of acute gastrointestinal bleeding in cirrhosis was oesophageal varices. Peptic ulcer disesase is also a common aetiology of UGI bleed in cirrhosis. Cirrhotic patients with variceal etiology have more chances of rebleeding and have higher mortality than those with non variceal aetiologies.

Gastrointestinal bleeding following removal of a feeding jejunostomy tube in a gastrectomised patient: an uncommon cause of acute upper GI bleeding

Haematemesis and haematochezia following removal of a feeding jejunostomy tube in a gastrectomised patient is an uncommon cause of acute gastrointestinal bleeding. Journal of the Postgraduate Institute of Medicine 2015;2:E15;1-3

Gastrointestinal bleeding from Dieulafoy's lesion: Clinical presentation, endoscopic findings, and endoscopic therapy.

Although relatively uncommon, Dieulafoy's lesion is an important cause of acute gastrointestinal bleeding due to the frequent difficulty in its diagnosis; its tendency to cause severe, life-threatening, recurrent gastrointestinal bleeding; and its amenability to life-saving endoscopic therapy. Unlike normal vessels of the gastrointestinal tract which become progressively smaller in caliber peripherally, Dieulafoy's lesions maintain a large caliber despite their peripheral, submucosal, location within gastrointestinal wall. Dieulafoy's lesions typically present with severe, active, gastrointestinal bleeding, without prior symptoms; often cause hemodynamic instability and often require transfusion of multiple units of packed erythrocytes. About 75% of lesions are located in the stomach, with a marked proclivity of lesions within 6 cm of the gastroesophageal junction along the gastric lesser curve, but lesions can also occur in the duodenum and esophagus. Lesions in the jejunoileum or colorectum have been increasingly reported. Endoscopy is the first diagnostic test, but has only a 70% diagnostic yield because the lesions are frequently small and inconspicuous. Lesions typically appear at endoscopy as pigmented protuberances from exposed vessel stumps, with minimal surrounding erosion and no ulceration (visible vessel sans ulcer). Endoscopic therapy, including clips, sclerotherapy, argon plasma coagulation, thermocoagulation, or electrocoagulation, is the recommended initial therapy, with primary hemostasis achieved in nearly 90% of cases. Dual endoscopic therapy of epinephrine injection followed by ablative or mechanical therapy appears to be effective. Although banding is reportedly highly successful, it entails a small risk of gastrointestinal perforation from banding deep mural tissue. Therapeutic alternatives after failed endoscopic therapy include repeat endoscopic therapy, angiography, or surgical wedge resection. The mortality has declined from about 30% during the 1970's to 9%-13% currently with the advent of aggressive endoscopic therapy.

Focal intestinal lymphangiectasia: An unusual cause of acute overt obscure gastrointestinal bleeding

AbstractDetection of bleeding lesion in a patient of acute overt obscure gastrointestinal bleeding is a real challenge. Recently, authors have showed superiority of urgent capsule endoscopy (CE) over angiography in patients with acute overt obscure gastrointestinal bleeding. Focal type of intestinal lymphangiectasia is a rare cause of acute gastrointestinal bleeding. Here, we describe a case of focal lymphangiectasia who presented to us with acute overt obscure gastrointestinal bleeding and diagnosed by urgent CE.

Role of interventional radiology in the management of acute gastrointestinal bleeding.

Acute gastrointestinal bleeding (GIB) can lead to significant morbidity and mortality without appropriate treatment. There are numerous causes of acute GIB including but not limited to infection, vascular anomalies, inflammatory diseases, trauma, and malignancy. The diagnostic and therapeutic approach of GIB depends on its location, severity, and etiology. The role of interventional radiology becomes vital in patients whose GIB remains resistant to medical and endoscopic treatment. Radiology offers diagnostic imaging studies and endovascular therapeutic interventions that can be performed promptly and effectively with successful outcomes. Computed tomography angiography and nuclear scintigraphy can localize the source of bleeding and provide essential information for the interventional radiologist to guide therapeutic management with endovascular angiography and transcatheter embolization. This review article provides insight into the essential role of Interventional Radiology in the management of acute GIB.

Sekundäre aortoenterale Fistel als Ursache akuter rezidivierender gastrointestinaler Blutungen, 20 Jahre nach Lebendnierenspende

Aorto-enteral fistulas (AEF) are a rare but life-threatening cause of acute gastrointestinal bleeding. Clinically, they can appear through massive haematochezia and haematemesis or as intermittent occult intestinal bleeding. The diagnostic procedure using endoscopy is often difficult but can contribute to making the correct diagnosis. We report on a patient who developed a secondary aorto-enteral fistula twenty years after a living kidney donation. The vascular surgery in combination with a chronic inflammatory reaction had resulted in the formation of a fistula between the renal artery stump and the duodenum. The inflammatory response was maintained by continuous treatment with methotrexate because of rheumatoid arthritis. Despite several total enteroscopies and diagnostic laparotomies, the fistula was seen on several occasions but was overlooked and misinterpreted in the absence of bleeding at first. The suspected fistula was finally marked with two endoclips and confirmed subsequently by radiological imaging by means of an abdominal CT scan.

Massive Bleeding From a Rectal Dieulafoy Lesion: Combined Multidetector-row CT Diagnosis and Endoscopic Therapy

Dieulafoy lesion is an uncommon cause of acute gastrointestinal bleeding. The diagnosis is usually carried out endoscopically. We report a 77-year-old woman with rectal Dieulafoy lesion. A recent endoscopic examination missed the lesion because it was small and the bleeding was intermittent. In our case, prompt colonoscopic therapy was allowed after locating the bleeder by multidetector-row computed tomography. On the basis of the success of this procedure, we suggest that an emergent multidetector-row computed tomography could have a role in the management of patients with massive lower gastrointestinal bleeding.

Vascular ectasia of the whole intestine as a cause of recurrent gastrointestinal bleeding after high-dose chemotherapy

We present the first case in the literature of vascular ectasia of the whole intestine as a cause of recurrent and profuse gastrointestinal bleeding in a patient with relapsing Hodgkin's disease. The 17-year-old patient experienced early relapse of his Hodgkin's disease after first-line chemotherapy. Salvage chemotherapy was followed by high-dose chemotherapy and autologous stem cell transplantation. Complete remission was achieved after another relapse by means of a second transplant. The patient presented with profuse gastrointestinal bleeding 5 months later, however. Gastric antral vascular ectasia following hematopoietic stem cell transplantation was diagnosed by endoscopy, with histological confirmation. Similar lesions were found in the duodenum, the ileum, and throughout the entire colon. In conclusion, vascular ectasia of the whole intestine should be considered as cause of acute gastrointestinal bleeding after stem cell transplantation. Physicians should be aware of this complication because its onset is typically delayed. Importantly, this disease is not limited to patients who have undergone allogeneic transplantation, but can also occur after autologous transplantation.

Using non-geriatric clinical indicators in a department of rehabilitation and aged care.

We describe an audit using Gastroenterology Clinical Indicators (CIs) to measure quality of care for older patients with gastrointestinal haemorrhage. The gastroenterology CI for gastroscopy within 24 hours of admission was 60%, it was 70% for diagnosis of a cause of acute gastrointestinal bleeding after upper gastroscopy, and it was 30% for death after blood transfusion in a geriatric restorative unit. We discuss whether it is appropriate for a hospital department (Geriatric Medicine) to use the CIs for the specialty (Gastroenterology) providing the service to measure the quality of service being provided. This may be a useful approach given the trend towards cost recouping between different clinical departments.

Omeprazole: Therapy of choice in institutionalized intellectually-disabled children

We examined 157 patients aged from 1 day to 17 years (92 males and 65 females). Main indications were: caustic (73 pts) or foreign body (FB) ingestion (42 pts) and gastrointestinal bleeding (GIB) (40 pts). 2 patients were examined for severe and intractable hemesis. 73.8% of examinations were performed under general anaesthesia, 6.2 % with conscious sedation and 20 % with no sedation nor anaesthesia. 27.3% of patients had an endoscopic treatment. All caustic ingestions but four were accidental. 56.1% of these patients showed different degree lesions, evaluated on the basis of Niguarda '90 classification (Acta Endoscopica, 22 (4)~ 413-418, 1992). We retrieved as soon as possible any object lodged in the oesophagus. Those located in the stomach were removed in emergencY only if they could be dangerous because of their size, sharpness or possible toxicity; otherwise they were removed after 48-72 hours if they didn't cross the pylorus. Since we observed one case of mucosal lesion due to corrosive leakage from a disk-battery which Stayed in the stomach for almost 48 hours, we planned to retrieve them from the gastric cavity within 24 hours. 35 (87.5%) of all FB were successfully removed. In 5 patients (11.9%) FB had already reached the jejunum at the moment of endoscopy and couldn't be retrieved. In 2 patients FB couldn't be endoscopically localized because of the presence of food. Emergency gastrointestinal endoscopy led to a correct diagnosis of the source of bleeding in 33/40 patients (82.5%). Perinatal acute esophagitis (9 pts) and hemorrage from esophageal varices (8 pts), were, in our series, the most common cause of acute GIB. Other sources of bleeding were: acute hemorragic gastritis (5 pts), duodenal ulcer (6 pts) gastric ulcer (2 pts), esophageal ulcer (1 pt) and rectal polyps (2 pts). In 7 patients emergency endoscopy couldn't demonstrate any relevant lesion. Emergency sclerotherapy of esophageal varices as well as hemostasis of bleeding lesions were successful in all cases. We recorded 1 case (0.6%) of"ab ingestis" pneumonia. Our experience outlines that not only pediatrician or surgeon, but also endoscopist has a crucial role in the management of paediatric gastrointestinal emergencies, in fact 68.7% of our procedures showed some pathological feature, while only 31.2% were normal. Moreover in patients with gastrointestinal bleeding or foreign body ingestion, therapeutic endoscopy proved to be highly effective and safe.

Clinical features and endoscopic management of Dieulafoy's disease.

The experience of a specialized management team using urgent endoscopy in the management of acute gastrointestinal bleeding from Dieulafoy's disease is presented. Dieulafoy's disease was found in 19 of 1124 consecutive patients with upper gastrointestinal bleeding. Most patients with Dieulafoy's disease were elderly men with severe acute upper gastrointestinal hemorrhage. Endoscopic diagnosis was possible in all patients, but required multiple endoscopies in 37%. The lesions were in the proximal stomach (79%) and duodenal bulb (21%). Endoscopic therapy included epinephrine injection, then heater probe coagulation in 17 patients, bipolar electrocoagulation in 1, and Nd:YAG laser photocoagulation in 1. Endoscopic therapy was successful in 18 patients (95%); one patient had successful surgery after endoscopic therapy failed. There were no deaths due to bleeding and no endoscopic complications. Dieulafoy's disease is an unusual cause of acute gastrointestinal bleeding. Endoscopic diagnosis is sometimes difficult, but primary endoscopic therapy is safe, successful, and should be attempted.