Cause Of Gastrointestinal Bleeding Research Articles

Treatment options for gastrointestinal bleeding blue rubber bleb nevus syndrome: Systematic review.

Blue rubber bleb nevus syndrome (BRBNS) is a rare challenging cause of gastrointestinal bleeding. We performed a systematic review of case reports and case series on BRBNS to gather information on the treatment options currently available. All studies reporting a case of BRBNS in humans were evaluated. Papers were ruled out if CARE criteria and explanations on patient's selection, ascertainment, causality, and reporting were not respected or identified. PROSPERO 2021 CRD 42021286982. Blue rubber bleb nevus syndrome was treated in 106 cases from 76 reports. 57.5% of the population was under 18 years old, and up to 50% of the cases reported a previous treatment. Clinical success was achieved in 98 patients (92.4%). Three main types of interventions were identified: systemic drug therapy, endoscopy, and surgery. After BRBNS recurrence or previous therapy failure, systemic drug therapy emerged as a preferred second-line treatment over endoscopy (P = 0.01), but with a higher rate of reported adverse events when compared with surgery and endoscopy (P < 0.001). Endoscopic treatment was associated with a higher number of required sessions to achieve complete eradication when compared with surgery (P < 0.001). No differences between the three main areas were found in the overall follow-up time (P = 0.19) or in the recurrence rate (P = 0.45). Endoscopy, surgery, and systemic drug therapy are feasible treatment options for BRBNS. Systemic drug therapy was the favorite second-line treatment after endoscopic failure or recurrence of BRBNS, but adverse events were more frequently reported.

Acquired Gastric Dieulafoy-Like Lesion due to Aberrant Blood Supply Diverted From the Left Phrenic Artery to an Enlarged Splenule

Dieulafoy lesion is an aberrant submucosal vessel that can erode into the overlying tissue leading to hemorrhage. It is a rare but important cause of gastrointestinal bleeding. We present a case of a patient who developed an acquired Dieulafoy lesion 39 years after splenectomy. Abdominal computed tomography showed an aberrant vessel from a branch of the left phrenic artery, coursing through the gastric fundus to supply a splenule. Angiography with embolization of the aberrant vessel resulted in no further bleeding.

Successful laparoscopic cholecystectomy for gallbladder hemorrhage from a Dieulafoy lesion in a patient on hemodialysis: a case report

BackgroundPatients on long-term dialysis are prone to hemorrhagic complications, particularly uremic bleeding, but gallbladder hemorrhage is rare, even in patients on dialysis. There have been occasional reports of a Dieulafoy lesion being a cause of gastrointestinal hemorrhage, but its occurrence within the gallbladder is quite rare. This report describes a case of gallbladder hemorrhage from a Dieulafoy lesion in a patient on hemodialysis that was diagnosed early and successfully treated by laparoscopic cholecystectomy.Case presentationThe patient was a 68-year-old woman on long-term hemodialysis with end-stage renal failure who presented with epigastralgia and back pain. There was no history of trauma or oral administration of antiplatelet or anticoagulant agents. There were no signs of an inflammatory reaction or hyperbilirubinemia. Contrast-enhanced computed tomography revealed a slightly hyperdense area in the distended gallbladder and extravasation within the gallbladder lumen but no gallstones. A severe atherosclerotic lesion was also found. She was diagnosed to have gallbladder hemorrhage and emergency laparoscopic cholecystectomy was performed. Although the postoperative course was complicated by drug fever, she was discharged on postoperative day 10 in a satisfactory condition. Histology revealed hemorrhagic ulceration with an exposed blood vessel accompanied by abnormal arteries in the submucosa. Arteriosclerosis with eccentric intimal hyperplasia in a small-sized artery was also seen. The diagnosis was gallbladder hemorrhage from a Dieulafoy lesion.ConclusionsA Dieulafoy lesion should be kept in mind as a cause of gallbladder hemorrhage in a patient with severe arteriosclerosis and a bleeding diathesis, particularly if on dialysis, and treated as early as possible.

Digestive Haemorrhage Revealing a Pseudoaneurysm of the Right Hepatic Artery: A Case Report

Introduction: Hepatic artery aneurysms (HAA) are rare and account for 20% of all visceral artery aneurysms. Hepatic artery aneurysms are often discovered at autopsy, but their rupture and bleeding cause significant morbidity and may manifest as haemobilia. Here we report a case of idiopathic right hepatic artery pseudoaneurysm revealed by upper GI bleeding. Presentation: A 72 year old Moroccan woman presented to the emergency department with an upper GI bleed with haematemesis and melaena without any evidence of jaundice. She was admitted with pre-shock haemorrhage and the initial management required early resuscitation measures he turned out to have a pseudoaneurysm of one of the branches of the right subhepatic artery. The aetiology of the pseudoaneurysm was atherosclerosis. The patient underwent radioembolization, the aftermath of which was uncomplicated. Clinical Discussion: Hepatic artery aneurysms (HAA) is a rare cause of gastrointestinal haemorrhage, the management of which requires resuscitative measures Atherosclerosis is the main cause of formation, but it may be associated with connective tissue disorders and arteritis. Most Hepatic artery aneurysms (AAA) are asymptomatic. Aneurysms can be managed by surgical or endovascular interventions. Conclusion: Digestive haemorrhage may reveal a pseudoaneurysm of the right hepatic artery by rupture or fissure in the biliary system. Knowledge on this subject is important for emergency doctors, resuscitators, gastroenterologists, vascular surgeons and hepatobiliary surgeons for the diagnosis and early intervention of this rare entity.

Impact of left atrial appendage closure in patients on anticoagulation for atrial fibrillation and recurrent or chronic gastrointestinal bleeding

BackgroundOral anticoagulation in non-valvular atrial fibrillation is associated with an increased risk of bleeding, particularly gastrointestinal bleeding, leading to treatment withdrawal in up to 50% of patients and putting them at risk of embolic events. Left atrial appendage closure (LAAC) can be an alternative to chronic anticoagulation. We aim to describe the impact of LAAC in patients with gastrointestinal bleeding (GIB) or chronic iron deficiency anaemia (CIDA) on healthcare resources consumption. MethodsObservational retrospective study of patients who underwent LAAC for GIB or CIDA at a single centre. ResultsNineteen patients with a median age of 74 years and a median Charlson score of six points were included in the study. Angiodysplasias were the most frequent cause of GIB or CIDA. The procedural success rate of LAAC was 100% with a median anticoagulant and antiplatelet treatment duration of 92 days. One year after the LAAC, we found a significant improvement in the lowest haemoglobin concentration and a reduction in the number of red blood cells transfusion, hospital admissions due to GIB and CIDA and the number of endoscopic examinations. One patient died due to a pulmonary thromboembolism. No deaths related to GIB were observed. ConclusionsLAAC seems to be a safe and effective alternative to anticoagulation in patients with GIB or CIDA.

Unusual cause of gastrointestinal bleeding in a patient with chronic pancreatitis

Unusual cause of gastrointestinal bleeding in a patient with chronic pancreatitis

Proven Cytomegalovirus Colitis Associated with Dasatinib Administration in Two Pediatric Allogeneic Hematopoietic Stem Cell Transplantation Recipients.

Gastrointestinal (GI) bleeding is a rare adverse event of dasatinib, which is known to be caused by dasatinib-induced colitis, severe thrombocytopenia, and platelet dysfunction. We present two cases of pediatric patients who developed hematochezia during treatment with dasatinib after hematopoietic stem cell transplantation (HSCT). A colonic tissue biopsy was performed to differentiate the cause of GI bleeding. Both patients were diagnosed with proven cytomegalovirus (CMV) colitis, but only one was treated with ganciclovir. The patient who did not receive antiviral therapy experienced recurrent GI bleeding during dasatinib administration, leading to multiple treatment interruptions. During dasatinib therapy after HSCT, patients with GI bleeding and confirmed CMV colitis may benefit from antiviral therapy to reduce interruptions in dasatinib therapy.

Black esophagus as an uncommon cause of gastrointestinal bleeding.

Black esophagus (BE) or Acute esophageal necrosis (AEN) is rare clinical entity with an estimated incidence of 0.01-0.2% of patiens undergoing esophagogastroduodenoscopy (EGD). BE is characterized by circumferential blackish coloration of the mucosa, with abrupt interruption at the esophagogastric junction level, secondary to hypoperfusion and ischemia. Upper gastrointestinal hemorrhage is the most common presentation (70-90%), being a rare cause of it. We present 3 cases that were admitted in our center for hematemesis.

Management of small bowel angioectasias diagnosed during video capsule endoscopy.

Small bowel angioectasias (SBA) are vascular malformations consisting of thin-walled, dilated capillaries located in the gastrointestinal mucosa. They are responsible for 10% of all causes of gastrointestinal bleeding and 60% of small bowel bleeding pathologies. The diagnosis and management of SBA depend upon bleeding acuity, patient stability and patient characteristics. Small bowel capsule endoscopy is a relatively noninvasive diagnostic approach ideal for non-obstructed and hemodynamically stable patients. It is superior to computed tomography scans in visualizing mucosal lesions, such as angioectasias, as it provides mucosal views. Management of these lesions will depend on the patient's clinical condition and associated comorbidities, and very often consists of medical and/or endoscopic treatment delivered through small bowel enteroscopy.

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.

P53 upregulated by HIF-1α promotes gastric mucosal epithelial cells apoptosis in portal hypertensive gastropathy.

Portal hypertensive gastropathy (PHG) is a serious complication of liver cirrhosis and a potential cause of gastrointestinal bleeding. Mucosal apoptosis is an essential pathological feature of PHG. However, whether HIF-1α and p53 are involved in mucosal apoptosis and whether HIF-1α induces PHG by mediating p53 remains unclear. Gastric mucosal injury and apoptosis were examined in PHG patients and animal models. The mechanisms of HIF-1α- and p53-mediated apoptosis were analyzed. The GES-1 cell line was used to elucidate the underlying mechanisms using siRNA knockdown of HIF-1α and p53 in a hypoxic environment in vitro. Epithelial apoptosis, HIF-1α, and p53 were markedly induced in the gastric mucosa of PHG. Apoptosis was attenuated in mice with HIF-1α- and p53-specific inhibitors. Apoptotic signaling factors were markedly induced in the gastric mucosa of PHG. Inhibition of p53 demonstrably attenuated the mucosal apoptosis; however, it did not affect HIF-1α expression. Conversely, targeted deletion of HIF-1α significantly inhibited p53 expression and attenuated the injury and p53-mediated apoptosis. Bax and Bcl-2 expression can be upregulated and downregulated by p53, respectively, to increasecleaved caspase-3 expression, which can be regulated by HIF-1α. These results indicate that HIF-1α regulates the p53-induced mucosal epithelial apoptotic signaling pathway and that HIF-1α and p53 are potential therapeutic targets for PHG.

Small bowel bleeding due to angiodysplasia causing fetal death in utero

Back ground: One of the known causes of GI bleeding is angiodysplasia, which usually causes bleeding over 70 years old patients. 30-40% of small bowel Angiodysplasia (AD) shows Gastrointestinal (GI) bleeding which occurs chronically and repeatedly. Case presentation: A 25-year-old patient in 27+6 weeks of pregnancy administered to our hospital with os bleeding. Fetal death in uterus was diagnosed with sonography and her initial lab showed hemoglobin 6.8 g/dl. On the second post operation day of cesarean section, the patient complained hematemesis and hematochezia, and her blood pressure was measured 80/50 mmHg with heart rate 128/min. Sigmoidoscopy and esophagogastroduodenoscopy were immediately done, and large amount of blood was shown at both stomach and sigmoid colon without any active bleeding site. Abdomen CT showed active small bowel bleeding with hematoma. Embolization was done and successfully blocked active bleeding. After two days, we examined capsule endoscopy and found angiodysplasia and ischemic change at jejunum. The patient was fully recovered and discharged after 8 days of delivery. Conclusions: Our report shows the rare case of young pregnant woman with angiodysplasia experiences massive GI bleeding which lead to FDIU. Our case highlights the need for close monitoring of pregnant women with bleeding diathesis such as diverticulitis and AV deformities during or before pregnancy.

DIEULAFOY LESION CAUSING LOWER GI BLEEDING: A CASE OF COVID-19 CRITICAL ILLNESS PROMPTING UNUSUAL PRESENTATION OF A MORE RARE CONDITION

DIEULAFOY LESION CAUSING LOWER GI BLEEDING: A CASE OF COVID-19 CRITICAL ILLNESS PROMPTING UNUSUAL PRESENTATION OF A MORE RARE CONDITION

S374 Endoscopic Coiling of Mesenteric Varices Causing Stomal Bleeding Caused by Extensive Portal Vein and Superior Mesenteric Thrombus

Introduction: Ectopic varices are collateral vessels located outside the gastro-esophageal area. Small bowel varices, while an uncommon result of portal hypertension can be a life-threatening cause of gastrointestinal bleeding. We present a case of refractory stomal bleeding secondary to mesenteric varices, treated with endoscopic ultrasound (EUS) guided coiling. Case Description/Methods: A 54-year-old male presented with history of ulcerative colitis status post proctocolectomy and ileostomy, primary sclerosing cholangitis (PSC), and auto-immune hepatitis (AIH) overlap syndrome treated with a deceased donor liver transplant in 2019. This was further complicated by portal hypertension secondary to portal vein and superior mesenteric vein thrombus. The patient presented with refractory stomal bleeding at this ileostomy site requiring multiple blood transfusions. On CT imaging, prominent mesenteric varices extending to the area of the stoma were noted. An interventional radiology (IR) approach from the portal system was not feasible given thrombosis in the portal vein and superior mesenteric vein. Percutaneous IR approach was also felt to be suboptimal given the depth of the peri-stomal varices. After a multidisciplinary discussion, the patient underwent ileoscopy with EUS guided coiling of the terminal/culprit branches of the mesenteric varices. The linear echoendoscope was introduced through the ileostomy and advanced approximately 5-10cm. Multiple tubal anechoic structures consistent with varices were noted with flow seen on doppler examination. This was confirmed on pulse wave doppler. A large feeding variceal vein towards the patient’s left side was punctured with a 22G needle. Saline was injected and it was visualized on EUS to confirm location. Next, embolization coils (8mm x 2, 10mm x1) were inserted for varix eradication. Reduced flow downstream of the coiling site was confirmed on doppler exam after embolization. Brief fluoroscopic images showed appropriate placement of coils in the patients right lower quadrant, without any migration. There was no significant flow toward the lumen on EUS after coiling. Since this procedure, the patient’s stomal bleeding resolved. (Figure) Discussion: Small bowel varices in the setting of significant portal hypertension are a rare but clinically significant cause of gastrointestinal bleeding. EUS-guided interventions such as coil embolization can be an effective treatment modality, especially in patients who are poor interventional radiology candidates. Watch the video at https://tinyurl.com/ACGAbstractS374Figure 1.: (1a) Prominent mesenteric varices extending into the ostomy (1b) EUS-guided coil embolization (1c) Status post successful endoscopic coil embolization

S3723 A Rare Cause of Upper Gastrointestinal Bleeding: Gastric Synovial Sarcoma

Introduction: Synovial sarcoma is an uncommon type of malignant mesenchymal neoplasm commonly found within joints of the extremities and very rarely found in the GI tract. Genetic sequencing techniques used as an adjunct to histochemical markers have proven indispensable for diagnosis following biopsy. We present a rare subtype of soft tissue neoplasm called primary gastric synovial sarcoma as cause for gastrointestinal bleeding in a middle-aged Hispanic patient. Case Description/Methods: A 51-year-old male with a medical history of Hypertension, and Diabetes was brought to the ER due to a syncopal episode. Patient denied abdominal pain, weight loss, hematemesis, hematochezia, hematuria, or melena. Physical exam was remarkable only for pale conjunctiva. Laboratory results remarkable for a hemoglobin of 5 g/dL warranting multiple packed red blood cell transfusions. Colonoscopy was performed with normal findings. Following upper GI endoscopy, a mid gastric body 3 cm polypoid irregular mass with shallow ulcerations was found. The patient was referred for endoscopic ultrasound revealing a 25 by 21 mm heterogenous hypoechoic mass in the greater curvature confined to mucosal layer. The acquired specimen displayed characteristics of a high-grade tumor with multiple negative markers (table 1). Therefore, an SS18 FISH test (18q11.2 probe) was performed and the results show the presence of translocation t(X,18) (p11.2;q11.2), consistent with a poorly differentiated synovial sarcoma, a spindle cell monophasic subtype. Completeness of resection of the tumor could not be documented so the patient was referred to surgery for partial gastrectomy of the involved area. The remaining tumor measured 0.7 cm, invaded the submucosal layer but all margins and lymph nodes were uninvolved. A subsequent PET/CT scan did not reveal evidence or residual or metastatic disease. (Figure) Discussion: This is the first known case of a primary gastric synovial sarcoma, in a patient of Puerto Rican ethnicity, without family history of genetic disorders, radiation exposure or previous malignancy. Prognosis remains challenging due to the small number of reported cases with surgical resection as the mainstay of treatment. Therefore, it is crucial to continue to identify and diagnose this rare malignancy to better inform treatment and prognostic decisions going forward.Figure 1.: Figure A: Friable lobular mass at greater curvature of stomach. Figure B: Endoscopic ultrasound revealed 2.5 by 2.1 cm heterogeneous hyperechoic mass at greater curvature of stomach confined to mucosal layer. Figure C: Picture of specimen following endoscopic mucosal resection. Table 1. - histochemical stains / Fluorescence in situ Hybridization performed for identification of tumor Tumor Marker Result Lymphoma CD20, CD23 Negative Gastrointestinal stromal tumor CD117, CD34, DOG-1 Negative Angiosarcoma CD34 Negative Leiomyosarcoma caldesmon, MSA, SMA, Desmin Negative Sarcomatoid carcinoma AE1, AE3 Negative Spindle cell melanoma S100, SMB 45 Negative Synovial Sarcoma SS18 FISH test (18q11.2) t(X;18)(p11.2;q11.2)

S2558 An Unusual Cause of Upper Gastrointestinal Bleed: Temporary Epicardial Pacing Wire

Introduction: A temporary epicardial pacing wire (TEPW) is frequently placed during cardiac surgery to treat postoperative arrhythmias. Gastrointestinal (GI) complications from TEPW are rare, and only a few have been described. Here we describe a rare case of upper GI bleed from TEPW traversing the stomach. Case Description/Methods: A 76-year-old male with a past medical history of coronary artery disease (CAD) status posts two stents, myocardial infarction, chronic kidney disease, hypertension, and stroke presented to the emergency department with chest pain. The patient had a non-ST-elevation myocardial infarction (NSTEMI); coronary angiography showed multivessel CAD. He underwent coronary artery bypass grafting (CABG), following which the patient had 1200cc dark blood drained through the nasogastric tube. The patient underwent esophagogastroduodenoscopy (EGD), which showed a significant amount of fresh blood (Figure A) and a suspicious linear object entering and exiting the gastric body (Figure B). He underwent a celiac and left gastric artery angiogram with embolization of the injured branch of the left gastric artery. The foreign body removed from the stomach was identified as right ventricle TEPW. Repeat EGD showed no active bleeding. Discussion: Epi-myocardium of the atria and ventricle are common sites for TEPW placement during cardiac surgery. They are tunneled to the outside through the left subcoastal margin. Poor sensing or capture, dislodgement, or retention are the most common complications. Other complication include bleeding from the right ventricular laceration with tamponade, avulsion of a side branch from a saphenous vein coronary bypass graft, and perforation of the superior epigastric artery. GI complications from this procedure are rare. Few reports of bowel perforation presenting as acute abdomen have been described. A case of dyspepsia due to gastric wall injury caused by the migration of TEPW into the gastric cavity has been described. To our knowledge, no case of upper GI bleed secondary to pacemaker wire misplacement has been described. Post-cardiac surgery patients are usually in the ICU. Therefore, if signs of GI bleeding are present in the postoperative period, EGD should be performed for diagnostic purposes. However, rarely displaced pacemaker wire may be one of the causes of GI bleeding, which should be on the physician's radar.Figure 1.: (A) EGD showing pooled blood in stomach giving definitive evidence of upper GI bleed. (B) EGD showing pacemaker wire traversing the stomach.

S2498 Endoscopic Treatment of a Dieulafoy’s Lesion in the Appendiceal Orifice

Introduction: A Dieulafoy’s lesion, typically a large caliber submucosal artery that erodes gastrointestinal (GI) mucosa, is a less common cause of GI bleeding. While these vascular abnormalities may occur throughout the GI tract, appendiceal Dieulafoy’s lesions are exceedingly rare, with described cases often resulting in surgical intervention. We present a case of a Dieulafoy’s lesion in the appendiceal orifice leading to massive GI bleeding which was successfully diagnosed and treated endoscopically. Case Description/Methods: A 75-year-old female with end stage renal disease, hypertension, hyperlipidemia, and heart failure with preserved ejection fraction presented with abdominal pain and rectal bleeding for 2 weeks duration. At onset, she was admitted to an outside hospital where computed tomography (CT) angiography showed aortoiliac and mesenteric atherosclerosis without evidence of large vessel occlusion. Esophagogastroduodenoscopy did not reveal a bleeding source. She reported infraumbilical abdominal pain and continued rectal bleeding and was transferred to our medical center. Upon arrival, the patient was hemodynamically stable with active rectal bleeding on exam. Laboratory analysis revealed hemoglobin of 6.9 grams per deciliter, platelet count of 101 per milliliter, blood urea nitrogen of 6.6 milligrams/deciliter (mg/dl), and creatinine of 6 mg/dl. She was treated with 3 units of packed red blood cell and a proton pump inhibitor. Colonoscopy showed a Dieulafoy’s lesion at the appendiceal orifice. Hemostasis was achieved with placement of 2 hemoclips (Figure). She was discharged 6 days after colonoscopy without recurrence of bleeding. Discussion: Only 6 cases of appendiceal Dieulafoy’s lesions have been reported in the literature and all were treated with laparoscopic appendectomy (Table 1). To our knowledge, this is the first reported case of an appendiceal Dieulafoy’s lesion that was successfully treated with endoscopic placement of hemoclips. There is no data comparing the efficacy of endoscopic intervention versus laparoscopic appendectomy in treating appendiceal Dieulafoy’s lesions; however, this case highlights that therapeutic endoscopy may be both safe and effective. Further reports are needed to inform recognition and optimal approach to appendiceal Dieulafoy’s lesions. Furthermore, in cases where hemostasis is achieved endoscopically, longer term follow-up may inform if appendectomy can be safely avoided.Figure 1.: Successful hemostasis of a Dieulafoy’s lesion at the appendiceal orifice after placement of 2 hemoclips. Table 1. - Previously reported Appendiceal Dieulafoy’s Lesions% and Outcomes Case Report Patient Clinical presentation and course Endoscopic hemostasis attempted? Management? Xue et al, 2020 21 F Massive hematochezia with lower abdominal pain and LOC* N Laparoscopic appendectomy Choi et al, 2016 72 M Hematochezia with associated mild abdominal pain and bloating sensation, previous melena from duodenal ulcer N Laparoscopic appendectomy and cecum wedge resection Johnson et al, 2014 51 M RLQ# pain, Acute appendicitis with incidental finding of Dieulafoy’s lesion on mid-distal appendiceal wall N Laparoscopic appendectomy Reynolds et al, 2013 68 M Massive hematochezia with perfusion requirement N Laparoscopic appendectomy Lee et al, 2011 22 M Severe lower GI† bleed N Laparoscopic appendectomy So et al, 1995 42 M Melena and dizziness N Laparoscopic appendectomy %In all previously reported cases, a Dieulafoy’s lesion was diagnosed using colonoscopy to visualize blood emerging from the appendiceal orifice, then subsequent resection revealing an ulcerated appendiceal mucosal lesion and microscopy and histopathology demonstrating tortuous vasculature penetrating the circumferential and longitudinal muscular wall of the appendix. Abbreviations: *Loss of consciousness, #Right lower quadrant, †Gastrointestinal.

Determine the Frequency of Different Causes CF Upper Gastrointestinal Bleed

Objective: To determine the frequency of various causes for upper gastrointestinal bleed. Study Design: Observational study. Place and Duration of Study: Department of Gastroenterology, Bolan Medical College Quetta from 1st July 2021 to 31st March 2022. Methodology: One hundred and thirty five patients in an age limit of &gt;30 years were registered. The inclusion criteria were based on clinical diagnosis of GB of upper tract, blood tests included H-pylori conformational test as well as CBC. The first endoscopy was performed within the 48 hours initiation of bleeding. Results: The mean was 41.2±4.5 years. There were 68.8% males and 31.1% females. The main cause of gastrointestinal bleeding in cases was observed as varices and gastric ulcers highest within 40-60 years group while erosive gastritis and duodenal ulcers were presented most in males. Conclusion: The frequency of varices was 65.9% followed by 10.37% gastric ulcers presented in gastrointestinal bleeding of upper tract. Keywords: Gastrointestinal bleeding, Varices, Melena

Intravascular papillary endothelial hyperplasia in the cecum: a case report

Background Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson's tumor, is a benign, non-neoplastic vascular lesion that is characterized by reactive proliferation of papillary endothelial cells associated with a thrombus. These lesions typically develop in the vascular regions of the head and neck, oral cavity, or extremities; however, other organ systems have been affected. IPEH in the gastrointestinal tract is rare, with only a few cases reported to date. Thus, the pathogenesis and clinical features of IPEH in the gastrointestinal tract are not entirely understood. Moreover, the local excision of certain subtypes of IPEH can be curative; this makes timely diagnosis essential. We present the case of a patient with IPEH in the cecum that was discovered while investigating the cause of severe anemia.Case presentationA 29-year-old woman visited a general practitioner (GP) with the complaint of abdominal pain. She was diagnosed with acute appendicitis and was prescribed antibiotics. After treatment, her abdominal pain disappeared. However, she was found to be severely anemic (hemoglobin level, 6.5 g/dl). To determine the cause of her anemia, the GP referred her to our hospital for further examination and treatment. Computed tomography scan revealed cecal wall thickening. Further, a lower gastrointestinal endoscopy revealed a 2-cm raised mass-like lesion in the cecum. This lesion was pathologically identified as an inflammatory granuloma. The cause of her anemia was determined to be bleeding from the lesion in the cecum. She underwent laparoscopic ileocecal resection.Histopathological examination of the surgical specimen revealed a spongy structure comprising many small papillary fibrous tissues lined by a typical monolayer endothelium. Further, immunohistochemical analysis showed that the cells of the endothelium monolayer expressed CD31, CD34. The Ki-67 labeling index was < 1%. Based on these findings, the lesion was identified as an IPEH in the cecum. The patient’s postoperative course was uneventful, and there was no evidence of recurrence during the 1.3 years of follow-up.Conclusions IPEH rarely arises within the abdominal cavity. Surgery remains the only treatment for IPEH and is associated with an excellent prognosis and a low recurrence rate. More aggressive lesions such as angiosarcoma should be excluded when considering the histologic diagnoses of IPEH, and expert pathologic review is vital. This is the first report of IPEH occurring in the cecum and represents a novel cause of gastrointestinal bleeding which the clinician should consider when evaluating a patient with atypical or difficult gastrointestinal bleeding sources.

Identification and Treatment of an Unusual Cause of Gastrointestinal Bleeding

Identification and Treatment of an Unusual Cause of Gastrointestinal Bleeding