Cause Of Gastrointestinal Bleeding Research Articles

Angiodysplasia and its correlation to serum magnesium level in patients with chronic kidney disease stage 5D under maintenance hemodialysis

Background Angiodysplasias (ADs) are vascular ectasias not associated with any familial syndrome, cutaneous lesions, or systemic vascular disease. They are the most common vascular malformations of the gastrointestinal tract in the general population with a prevalence of 0.82%. Most AD occurring in the general population are detected in patients older than 60 years of age, although presentation in patients with chronic kidney disease (CKD) can be earlier. The aim was to correlate AD with serum magnesium level in patients with CKD stage 5D under maintenance hemodialysis. Patients and methods This study included 60 patients with CKD stage 5D on maintenance hemodialysis. Upper and lower gastrointestinal tract endoscopy was done for all patients in Kafr Elsheikh University Hospital in a cross-sectional ‘prospective study,’ and all laboratory investigations were done. Results The mean age of patients with CKD was 49.03±14.66 years. There was a statistically significant increase in Mg among patients with AD and those without AD. This study showed that there were statistically significant negative correlations between Mg and parathyroid hormone. Conclusion AD is one of the common causes of gastrointestinal bleeding in all population and is the most common cause of bleeding in patients with CKD. Hypermagnesemia is associated with AD in patients with CKD.

COMPLICATION ASSOCIATED WITH UPPER GASTROINTESTINAL BLEEDING AMONG MEXICAN PATIENTS WITH CIRRHOSIS

Upper gastrointestinal bleeding is a common complication among cirrhotic patients and holds high mortality and morbidity; the most common cause is variceal hemorrhage. Nonetheless, non-variceal hemorrhage is also frequent; this study aims to determine the prevalence of upper gastrointestinal bleeding complications among Mexican patients with cirrhosis. Retrospective, cross-sectional, an analytic study among patients with cirrhosis of all etiologies admitted to the Gastroenterology department of the Hospital General de Mexico “Dr. Eduardo Liceaga” with acute upper gastrointestinal bleeding of both etiologies (variceal and non-variceal hemorrhage) in the period comprised from January 2017 to May 2021. Complications associated with the bleeding events were evaluated. For statistical analysis, quantitative variables were described as mean and standard deviation for qualitative variables in frequencies and percentages. A total of 295 patients were included, 55.3% male, mean age was 54.6 ± 11.8 years, 16.27% patients were staged as Child A, 49.15% Child B y 34.57% Child C, with and an average MELD score of 16. Main cirrhosis etiology was alcohol-related liver disease in 39.7%, viral hepatitis 6.4%, NASH 5.8% and others 3.4%; however, in 44.7% of patients, we were not able to determine the etiology of liver disease. The main cause of gastrointestinal bleeding was variceal hemorrhage in 71.1% and 28.9% non-variceal. The shock was identified in 5.76% (17) of patients, 9 of them required vasopressors, hepatic encephalopathy was present in 42.71% (126), Ascites in 18.64% (55), jaundice in 16.94% (50), acute kidney injury in 31.52% (93), bacterial infections in 24.06% (71), four patients (1.35%) died. Complications related to gastrointestinal bleed according to disease severity are depicted in table 1. Complications associated with upper gastrointestinal bleeding among Mexican patients with cirrhosis are frequent. Encephalopathy is the most common (42.71%) followed by acute kidney injury (31.52%) preponderantly of high grade, patients with more advanced disease are more prone to present infections, mainly UTI and ascites. Therefore they must be monitored closely. The authors declare that there is no conflict of interest.

Laparoscopic treatment in gastrointestinal bleeding due to Dieulafoy's lesion.

Dieulafoy's lesion is a rare cause of gastrointestinal bleeding. Produced by the erosion of aberrant vessels in the submucosa, usually at the gastric level. The jejunal location is unusual. Its diagnosis is complicated by the intermittent characteristic of bleeding, initially recommending the endoscopic approach. It is an unusual entity that must be taken into account in the differential diagnosis of gastrointestinal bleeding. Massive bleeding can occur, compromising the life of the patient. Initial endoscopic/radiological management is recommended, reserving the surgical approach for refractory bleeding for less invasive treatments.

Haemosuccus pancreatitis: A rare cause of GI bleed, diagnosis on CT Angiography – Case series & review of literature

Haemosuccus pancreatitis also known as Pseudohaemobilia or haemoductal pancreatitis, is defined as upper gastrointestinal hemorrhage originating from the pancreatic duct into the duodenum via the Ampulla of Vater, or major pancreatic papilla. A triad of epigastric pain, intermittent gastro intestinal bleeding and hyperamylasemia [1,2]. We present three cases of chronic pancreatitis presenting as upper GI bleed and with epigastric pain and sudden drop in Hematocrit. One had bleed from pseudo aneurysm arising from hepatic artery leaking into pseudo cyst, second had erosion of wall of splenic vein leaking into pancreatic duct through small pseudocyst and the third patient was post cystojejunostomy with who bled into cyst, probably from a vessel in wall of cyst, well demonstrated on venous phase of CT angiography and later responded to conservative management. Hemorrhage from the pancreatic duct, i.e. Haemosuccus Pancreaticus (HP), is a rare cause of gastrointestinal bleeding. Pancreatic Homosuccus is usually due to the rupture of an aneurysm of a visceral artery, most likely the splenic artery, in chronic pancreatitis. Other causes of HP are rare. Keywords: haemosuccus pancreaticus; pseudo aneurysm; pancreatitic pseudocyst; upper gastrointestinal bleeding; embolization.

Case Report: Portal cavernoma related to multiple liver hydatidosis: A rare case of fatal cataclysmic haemorrhage.

Clinical presentation of liver hydatidosis can vary from asymptomatic forms to lethal complications. We report herein a rare case of a 27-year-old male from a rural Tunisian region who presented with large-abundance haematemesis, haemodynamic instability, and marked biological data of hypersplenism. Endoscopy showed bleeding esophageal varicose veins that were ligated. Abdominal ultrasound concluded the presence of three type CE2 hydatic liver cysts causing portal cavernoma with signs of portal hypertension. Despite resuscitation, the patient died of massive rebleeding leading to haemorrhagic shock. Hepatic hydatid cyst should be considered as an indirect cause of gastrointestinal bleeding in endemic countries. Early abdominal ultrasound in varicose haemorrhage is essential in orienting the diagnosis.

Characteristics of Patients with Nonvariceal Upper Gastrointestinal Bleeding - Are We Underestimating Gastroprotection during NSAIDs Therapy?

The aim of our study was to determine the etiological factors, treatment and outcome of patients with non-variceal bleeding from upper gastrointestinal tract. This study enrolled 200 patients admitted to Sarajevo University Clinical Center with signs and symptoms of upper gastrointestinal bleeding, from January 2019 to July 2020. All patients had undergone gastroscopy, confirming the cause of gastrointestinal bleeding. Clinical and laboratory data were collected retrospectively, including previous non-steroid antiinflammatory drugs (NSAIDs) and anticoagulant therapy, comorbidities, risk factors, as well as endoscopic findings, laboratory findings, treatment and clinical follow-up. The majority of patients were men (59%) with an average age of 53±6 years. Duodenal and gastric ulcers were the most common cause, followed by other etiologies. In our study, previous NSAIDs therapy had been registered in 29.5% of patients, anticoagulants in 8%, and proton pump inhibitors (PPI) in 2.9% of patients. Endoscopic intervention was required in 34% of patients. The need for transfusion occurred in 44.5% of cases. Rebleeding during hospitalization was observed in 7.5% of patients, mortality in 1.5% and surgery in 3% of patients. The patients admitted to our hospital with symptoms of acute nonvariceal upper gastrointestinal bleeding were elderly, predominantly males, with significant comorbidities and a higher incidence of NSAID use. Gastroprotection is underutilized during NSAID treatment in patients with other coexisting risk factors, with a low rate of concomitant use of PPI during NSAIDs therapy. Endoscopic therapy, together with PPI, significantly reduces rebleeding rates, mortality and the number of emergency surgical interventions.

Causes of gastrointestinal bleeding in oral anticoagulant users compared to non-users in a population-based study

Background/aims Causes of gastrointestinal bleeding (GIB) in patients on oral anticoagulants (OACs) are not well established. The aims of the study were to compare the causes of GIB in patients on OACs and those not on OAC therapy. Methods A nationwide study of all GIB events in patients on OACs in Iceland from 2014–2019 was conducted. Bleeding events were obtained through ICD-10 codes and review of endoscopy databases, confirmed by review of medical records. For comparison, patients not on OACs from previous Icelandic population-based studies were used. Results Among 752 GIB events in 12,005 patients on OACs, 273 (1.9%) had verified upper and 391 (2.7%) had verified lower GIB. For lower GIB, multivariate analysis showed that OAC users were more likely to have colonic polyps (OR 6.6, 95% CI: 2.4 − 17.8, p < .001) or colorectal cancer (OR 3.7, 95% CI: 2.0 − 7.0, p < .001) but less likely to have ischemic colitis (OR 0.11, 95% CI: 0.04 − 0.26, p < .001). For upper GIB, bleeding from mucosal erosions (OR 4.0 95% CI: 2.5 − 7.9, p < .001) and angiodysplasia (OR 3.6, 95%CI: 1.5 − 8.6, p = .003) were more common in OAC users. Conclusions A high proportion of GIB caused by colonic polyps and colorectal cancer among OAC patients indicates that OACs treatment may facilitate cancer diagnosis. The low proportion of ischemic colitis among those on OACs suggests that OACs provide a protective effect against ischemic colitis. OACs seem to increase the bleeding from angiodysplasia and mucosal erosive disease.

The influence of surface roughness on the damage of von Willebrand Factor under shear flow condition.

Despite technological advances in mechanical circulatory support devices to treat end-stage heart failure, blood damage induced by non-physiological shear stress in operation often triggered clinical hemocompatibility complications. The loss of high molecular weight von Willebrand Factor (HMW-VWF) has been considered as an essential cause of gastrointestinal bleeding. In addition to the mechanics factors, interface factors may also affect blood damage, especially the surface characteristics. In this study, the effect of surface roughness on VWF damage under flow condition was investigated. A roller pump circulation experimental platform with a roughness embedded sample chamber was constructed to provide blood shearing flow condition. VWF molecular weight analysis, VWF antigen (VWF-Ag) concentration assay, and VWF ristocetin cofactor activity (VWF-Rico) assay were performed on the sheared blood samples. These variables are the main functional indicators of VWF. It was found that the surface roughness induced VWF damage is mainly caused by the loss of HMW-VWF rather than reducing the total amount of VWF. The threshold value of surface roughness for a rapid increase in the degradation of HMW-VWF under low flow rate was obtained between Ra 0.4 and 0.6 μm, which was smaller than the threshold for hemolysis. Our findings indicated that VWF is more sensitive to the interface factor of surface roughness than red blood cells, thus has a higher requirement for blood pump design. It could provide reference for the material design and processing in developing mechanical circulatory support devices.

Chronic gastrointestinal bleeding caused by a Dieulafoy\u2019s lesion in the\xa0small intestine: a case report

IntroductionDieulafoy’s lesion, first found by Paul Georges Dieulafoy, is an infrequent but important cause of recurrent upper gastrointestinal bleeding. The bleeding is usually severe, but patients rarely present with chronic, occult gastrointestinal bleeding.Case presentationIn this article, we discuss the case of a 68-year-old caucasian man with a history of recurrent hematemesis and chronic anemia with evidence of extravasation of contrast in the lumen of the bowel loop on computed tomography angiography. The patient was taken to the operating room, and a laparotomy procedure was performed.ConclusionDue to the infrequency of Dieulafoy’s lesion compared with other causes of gastrointestinal bleeding, it is often missed in the process of differential diagnosis. In this article, we have demonstrated the importance of this disease and different approaches to the treatment of this lesion, considering the location of the lesion among other factors.

Coil-Localized Laparoscopic-Assisted Resection of Symptomatic Gastrointestinal Vascular Malformations in Children and Young Adults.

To describe a technique of intentional preoperative coil localization of symptomatic pediatric GI vascular malformations by pediatric interventional radiology to facilitate fluoroscopically assisted laparoscopic resection. We searched the electronic privacy information center and picture archive and communication system in our center and found 3 cases. The electronic privacy information center and picture archive and communication system databases were the sources for retrieval of demographic, medical, radiological, and procedural information in all 3 cases. After many nondiagnostic investigations in all 3 patients, a GI vascular malformation as a cause of GI bleeding was diagnosed with computed tomography angiography/magnetic resonance angiography and catheter angiography. A preoperative 0.018-inch Hilal coil was placed as close as possible to the vascular malformation during super selective angiography. Laparoscopic surgery was performed within 24 hours of coil placement. In all cases, histology confirmed the resected bowel lesions to be vascular malformations. Intentional endovascular coil localization has the potential to increase the precision of lesion localization and may reduce laparoscopic operative time, when guided by the coil position.

Carcinoid of small intestine - the cause of gastro-intestinal hemorrhage and acute ileus

Carcinoid of small intestine - the cause of gastro-intestinal hemorrhage and acute ileus

Gastrointestinal Bleeding at CT Angiography and CT Enterography: Imaging Atlas and Glossary of Terms.

Gastrointestinal (GI) bleeding is a common potentially life-threatening medical condition frequently requiring multidisciplinary collaboration to reach the proper diagnosis and guide management. GI bleeding can be overt (eg, visible hemorrhage such as hematemesis, hematochezia, or melena) or occult (eg, positive fecal occult blood test or iron deficiency anemia). Upper GI bleeding, which originates proximal to the ligament of Treitz, is more common than lower GI bleeding, which arises distal to the ligament of Treitz. Small bowel bleeding accounts for 5-10% of GI bleeding cases commonly manifesting as obscure GI bleeding, where the source remains unknown after complete GI tract endoscopic and imaging evaluation. CT can aid in identifying the location and cause of bleeding and is an important complementary tool to endoscopy, nuclear medicine, and angiography in evaluating patients with GI bleeding. For radiologists, interpreting CT scans in patients with GI bleeding can be challenging owing to the large number of images and the diverse potential causes of bleeding. The purpose of this pictorial review by the Society of Abdominal Radiology GI Bleeding Disease-Focused Panel is to provide a practical resource for radiologists interpreting GI bleeding CT studies that reviews the proper GI bleeding terminology, the most common causes of GI bleeding, key patient history and risk factors, the optimal CT imaging technique, and guidelines for case interpretation and illustrates many common causes of GI bleeding. A CT reporting template is included to help generate radiology reports that can add value to patient care. An invited commentary by Al Hawary is available online. Online supplemental material is available for this article. ©RSNA, 2021.

Gastrointestinal Bleeds.

Gastrointestinal Bleeds.

Cryptogenic Multifocal Ulcerous Stenosing Enteritis

Crytpogenic multifocal ulcerous setnosing enteritis is an unusual cause of gastrointestinal bleed. The objective of this report is to highlight small bowel ulcerations as a cause of anemia and the role of wireless capsule endoscopy in the diagnosis of CMUSE. We present here two young women who had been evaluated for anemia with normal gastroscopy, colonoscopy and contrast CT's and requiring multiple blood transfusions over the years. Both patients had wireless capsule endoscopy which showed multiple ulcerations with stenosis in the small intestine, resulting in capsule retention in the small intestine which was retrieved. Both patients improved with steroids and azathioprine. To summarize CMUSE could be cause of obscure GI bleed, when CMUSE is a consideration as the cause of GI bleed wireless capsule endoscopy should be used in caution.

S2369 Ileocecal Dieulafoy’s Lesion: A Rare Case of Lower Gastrointestinal Bleeding

Introduction: A Dieulafoy’s lesion (DL) is one of the rare causes of gastrointestinal bleeding characterized by a submucosal arterial lesion that becomes exposed due to a mucosal defect. These lesions are most commonly located in the proximal stomach, but the involvement of the small intestine is extremely rare. A Dieulafoy’s lesions can be asymptomatic; however, lesions with profound bleeding require medical attention. Here we report a rare case of the lower GI bleed secondary to an ileocecal valve DL in an elderly female. Case Description/Methods: A 79-year-old female with a past medical history of hypertension, Type 2 diabetes, ESRD on hemodialysis, and Atrial Fibrillation on apixaban presented with generalized weakness and melena for 2 weeks. No abdominal pain, weight loss, or hematemesis were reported. There was no history of GI bleeding or the use of non-steroidal anti-inflammatory drugs. On admission, blood pressure was 100/67 mm Hg, and pulse was 104 beats/min. Abdomen was soft, non-tender, non-distended without hepatosplenomegaly, bowel sounds were normal, and no hemorrhoids, nor masses on rectal exam. Hb level was 6.7gm/dl, HCT 21.3%, MCV 103.4. The patient also had a normal platelet count and liver function tests. Apixaban was discontinued and four units of blood were transfused. Urgent endoscopy was unremarkable. Colonoscopy showed a Dieulafoy’s lesion at the ileocecal valve that was actively oozing. Injection of epinephrine solution failed to stop the hemorrhage, but the placement of three hemoclips resulted in immediate hemostasis. She remained stable and was subsequently discharged home on day 5. Discussion: Although Dieulafoy’s lesions are extremely rare, they should be considered in the differential diagnosis of lower GI bleeding. The endoscopic approach is the gold standard for the diagnosis and management of these lesions. Our patient, who presented with overt GI bleeding resulting from Dieulafoy’s lesion at the ileocecal valve was successfully treated with an application of three hemoclips after failed injection therapy.Figure 1.: (A) DL lesion at Ileocecal valve area. (B) Hemostasis after placing hemoclips.

S2177 Ibuprofen Impaction: No Pill Is Too Small

Introduction: Acute esophageal necrosis (AEN) is an emerging cause of gastrointestinal bleeding with an increasing incidence over the past two decades. It appears as a circumferential necrotic lesion encircling the distal esophagus with various proximal extensions. It is most commonly associated with exacerbations of medical co-morbidities such as diabetes, renal failure, coronary disease;however cases of AEN due to mechanical alteration in gut anatomy are exceedingly rare and its prognosis is less defined. We present a unique constellation of AEN, Cameron ulcers (CU), and gastric volvulus from a large paraesophageal hiatal hernia. Case Description/Methods: A 77-year-old female began experiencing abdominal pain and repeated emesis. She had a history of COPD, GERD, episodes of bleeding ulcers, hiatal hernia, malnutrition, and recently COVID-19. She was hemodynamically stable, ill-appearing with tenderness to abdominal palpation and a negative stool guaiac. BP 106/48 mm/Hg, HR 107, requiring oxygen. Investigations revealed WBC 18.5 k/uL, Hgb 9.8 g/dL, and acute renal failure. A CT abdomen revealed complete herniation of the stomach into the posterior mediastinum, dilated esophagus, organoaxial gastric volvulus, and gastric distension [Figure 1 - Pane A-C]. IV fluids, pantoprazole 80 mg, and ondansetron 4 mg were given. An EGD revealed a large hiatal hernia, Cameron ulcers (CU), and necrotic ulceration along the mid-to-lower third of the esophagus. The patient deferred surgical intervention and was discharged home on hospice. Discussion: These constellations represent a common underlying pathophysiologic mechanism that stems from large hiatal hernias and their effect on surrounding structures in our case, precipitated by a paraesophageal hiatal hernia that became too large causing acute gastric volvulus. In severe presentations, the stomach may herniate into the posterior mediastinum known as an upside-down stomach requiring surgery while CU represents trauma to the mucosa from the hernia sliding. In our patient, lower esophagus blood flow traversing through the lesser gastric curvature may have been compromised during gastric necrosis. Simultaneously, sudden gastric stunning from acute outlet obstruction can lead to prolonged acidic bathing of the esophageal mucosa. Often the esophagus can compensate for this by increasing blood flow, however, this is compromised in low-flow states. Limitations of our study include lack of follow-up. A systematic review of all cases of AEN and gastric volvulus are in Table 1.

Gastrointestinal stromal tumor as an unusual cause of gastrointestinal bleeding in pediatrics.

Gastrointestinal stromal tumor as an unusual cause of gastrointestinal bleeding in pediatrics.

Management of gastrointestinal bleeding during COVID-19: less is more!

Management of gastrointestinal bleeding during COVID-19: less is more!

Gastrointestinal bleeding due to pseudoaneurysms in children.

Radiological embolization is the treatment of choice in adults with visceral artery pseudoaneurysm (PSA) and gastrointestinal bleeding, but pediatric data is scanty. We analyzed the etiology, clinical presentation, and outcome of radiological intervention in children with PSA of celiac (CA) or superior mesenteric artery (SMA) branches. Electronic records of children with PSA of CA or SMA branches were reviewed and data on clinical and laboratory profile, radiological intervention, and outcome was recorded. Eleven children with PSA (5 boys, 11 [7-17] years) were studied. Etiology was liver abscess (n 4), abdominal trauma (n 3), pancreatitis (n 3), and indeterminate in 1 case. Ten (91%) patients were symptomatic: abdominal pain (10, 91%), hematemesis/melena (9, 81%), and Quincke's triad (1, 9%). One child with pancreatic pseudocyst was diagnosed incidentally on imaging. Doppler ultrasound identified PSA only in 3 cases, while computed tomography angiography (CTA) picked all cases. Children with liver abscess, trauma, and unknown etiology had PSA from CA (right hepatic artery 7, left hepatic artery 1). Of the 3 pancreatitis cases, 2 had PSA from SMA (inferior pancreatico-duodenal artery and ileal branch) and 1 from CA (left gastric artery). Radiological embolization was done in 9 (81%) cases (coil 6, glue 2, both 1), without any complications or failure. One case resolved spontaneously and 1 died pre-intervention. Nine intervened cases were asymptomatic in follow-up [6 (1-24) months].Conclusion: Liver abscess, trauma, and pancreatitis are causes of PSA of CA and SMA branches in children. A majority present with gastrointestinal bleeding and are identified on CTA. Radiological embolization was safe with 100% success. What is Known: • Pseudoaneurysm of visceral artery is an uncommon cause of gastrointestinal bleeding. • Endoluminal intervention is an established and efficacious treatment modality in adults and preferred over surgery. What is New: • Liver abscess, abdominal trauma and pancreatitis are common causes of celiac artery and superior mesenteric artery branch pseudoaneurysm in children and computed tomography angiography has high sensitivity in identifying these pseudoaneurysms. •Minimally invasive radiological angio-embolization, in the hands of trained radiologists, is a safe and successful modality of treatment in children.

A case with massive hemobilia long-term after internal drainage surgery for congenital biliary dilation

BackgroundCurrently, there is an unwavering consensus that the standard surgery for congenital biliary dilation (CBD) is extrahepatic bile duct resection and choledochojejunostomy. However, decades prior, choledochocyst–gastrointestinal anastomosis without extrahepatic bile duct resection (internal drainage surgery, IDS) was preferred for CBD because of its simplicity. Currently, there is almost no chance of a surgeon encountering a patient who has undergone old-fashioned IDS, which has been completely obsolete due to the risk of carcinogenesis from the remaining bile duct. Moreover, the pathological condition long after IDS is unclear. Herein, we report a case of life-threatening bile duct bleeding as well as carcinoma of the bile duct 62 years after IDS in a patient with CBD.Case presentationAn 82-year-old Japanese woman with hemorrhagic shock due to gastrointestinal bleeding was transferred to our hospital. She had a medical history of unspecified surgery for CBD at the age of 20. Based on imaging findings and an understanding of the historical transition of the surgical procedure for CBD, the cause of gastrointestinal bleeding was determined to be rupture of the pseudoaneurysm of the dilated bile duct that remained after IDS. Hemostasis was successfully performed by transcatheter arterial embolization (TAE) in an emergency setting. Then, elective surgery for extrahepatic bile duct resection and choledochojejunostomy was performed to prevent rebleeding. Pathological examination revealed severely and chronically inflamed mucosa of the bile duct. Additionally, cholangiocarcinoma (Tis, N0, M0, pStage 0) was incidentally revealed.ConclusionIt has been indicated that not only carcinogenesis, but also a risk of life-threatening bleeding exists due to long-lasting chronic inflammation to the remnant bile duct after IDS for CBD. Additionally, both knowledge of which CBD operation was performed, and an accurate clinical history are important for the diagnosis of hemobilia.