Evidence Of Upper Gastrointestinal Bleeding Research Articles

Hemobilia in the setting of cystic artery pseudoaneurysm secondary to type I Mirizzi syndrome

Hemobilia is an uncommon diagnosis and is often not suspected in the absence of recent hepatobiliary intervention or trauma. Hemobilia in the setting of cystic artery pseudoaneurysm secondary to type I Mirizzi syndrome is a rare occurrence. We report the case of a 61-year-old male who presented with epigastric pain and vomiting. Blood tests demonstrated hyperbilirubinemia with elevated inflammatory markers. Magnetic resonance cholangiopancreatography revealed type I Mirizzi syndrome in the presence of a 21 mm cystic duct stone. During endoscopic retrograde cholangiopancreatography, hemobilia was identified. Subsequent triple phase computed tomography imaging identified a 12 mm cystic artery pseudoaneurysm. Angiography with successful coiling of the cystic artery was accomplished. Cholecystectomy was performed, confirming type I Mirizzi syndrome. This case demonstrates the importance of considering ruptured pseudoaneurysm in patients presenting with evidence of upper gastrointestinal bleeding in the setting of biliary stone disease. Transarterial embolization, followed by surgical management, is effective in both the diagnosis and management of ruptured cystic artery pseudoaneurysm with associated hemobilia.

S2355 Although Rare, a Hardware Fracture and Migration of Anterior Cervical Spine Plating Can Present With Upper Gastrointestinal Bleeding and Associated With High Mortality

Introduction: Anterior cervical spine plating (ACSP) is a common surgical intervention indicated for many cervical osteopathologies. Esophageal perforation is a rare complication of ACSP that can occur shortly following surgery, due to over prominent screws or friction between the esophagus and the plate. Screw fracture and migration following the surgery is very rare but is a potentially life-threatening complication that can result in perforation of the adjacent organs like the esophagus and mediastinum, and increase the risk of infections in this area. (1-4) Case Description/Methods: An 84-year-old man with cervical disc disease (C6-C7) status post ACSP (Anterior cervical spine plating ) with resultant need for a PEG tube placement secondary to newly developed severe oropharyngeal dysphagia after aforementioned spinal surgery with persistent aspiration, who presented with dark color liquid output coming out from the PEG tube.Esophagogastroduodenoscopy (EGD) showed a foreign metal hardware (looks like cervical plate) seen embedded in the wall of the hypopharynx and eroding out, but no ulceration or blood was seen around the PEG insertion site. CT cervical spine showed a fracture of the right C6 anterior fusion screw with evidence of anterior displacement of the fusion plate with 4 to 5 mm gap between the plate and the anterior margin of C6. Disc spacer material appears to extend beyond the anterior margin of the C6-7 disc space ( Figure). Discussion: Comprehensive surgical history is important for any patient presenting with evidence of upper gastrointestinal bleeding. Patients with a history of Anterior cervical spine plating (ACSP) need urgent cervical spine imaging to assess the status of the hardware, and if there are any radiologic features of infection. Cervical spine imaging will help to triage the urgency and type of intervention, whether conservative or urgent surgical intervention.Figure 1.: CT scan on the cervical spine showing the hardware and screw migration to the esophagus.

TC-325 hemostatic powder in the management of upper gastrointestinal malignant bleeding: a randomized controlled trial.

Background and study aims Upper gastrointestinal bleeding (UGIB) from malignancy is associated with high rebleeding and mortality rates. Recently, TC-325 powder has shown promising results in the treatment of UGIB, including malignant bleeding. The aim of this study was to compare the efficacy of TC-325 versus best clinical management. Patients and methods From August 2016 to February 2020, all patients with evidence of UGIB from malignancy were randomized to receive TC-325 therapy or control group, in which endoscopic treatment was not mandatory. Exclusion criteria were hemoglobin drop without overt bleeding and UGIB from non-tumor origin. The primary outcome was 30-day mortality. Secondary outcomes were 30-day rebleeding, blood transfusion and length of hospital stay. Results Sixty-two patients were randomized, three were excluded and 59 were included in the final analysis (TC-325 group = 28; control = 31). Groups were similar at baseline. Active bleeding was observed in 22 patients in the TC-325 group and 19 in the control group ( P = 0.15). Successful initial hemostasis with TC-325 was achieved in all cases. Additional therapy (radiotherapy, surgery or arterial embolization) was equally performed in both groups (42.9 % vs 58.1 %; P = 0.243). There were no differences in 30-day mortality (28.6 % vs. 19.4 %, P = 0.406) or 30-day rebleeding rates (32.1 % vs. 19.4 %, P = 0.26). Logistic regression identified no significant predictors of rebleeding. Age, Eastern Cooperative Oncology Group (ECOG) score 3 to 4 and AIMS65 score > 1 predicted greater mortality. Conclusions TC-325 was effective in achieving immediate hemostasis in malignant gastrointestinal bleeding but did not reduce 30-day mortality, 30-day rebleeding, blood transfusion or length of hospital stay. Age, ECOG 3–4, and AIMS65 > 1 were predictive factors of mortality.

The Need for a Coagulation Assay after Initiation of New Oral Anticoagulants in Patients with Renal Dysfunction: A Case Report.

BackgroundDabigatran etexilate, a new oral anticoagulant, was recently approved as an efficacious alternative to warfarin for the prevention of first and recurrent stroke in patients with nonvalvular atrial fibrillation. Limited data are available for dabigatran use in patients with a creatinine clearance rate (CrCL) of 15-30 mL/min. Furthermore, current guidelines do not recommend frequent blood monitoring after dabigatran use. We report herein a patient with severe renal dysfunction who exhibited profound coagulopathy after 2 days of dabigatran use.Case ReportAn 87-year-old woman was admitted for altered mental status and left-side weakness. She was diagnosed with right middle cerebral artery infarction. The baseline assessment revealed a serum creatinine concentration of 1.29 mg/dL and a CrCL of 27.2 mL/min. Dabigatran therapy was started 5 weeks after admission at a dosage of 110 mg twice daily. After 2 days of dabigatran use, the patient developed multiple bruises and evidence of upper-gastrointestinal bleeding. Laboratory tests demonstrated a severe coagulopathy, with a prothrombin time of 85.9 sec, an international normalized ratio of 11.36, an activated partial thromboplastin time of 119.2 sec, and a thrombin time of 230.8 sec. Serial assessment of the patient's renal function revealed substantial fluctuation of the CrCL (range, 17.9-26.5 mL/min).ConclusionsThe present case emphasizes the need for frequent checking of renal function and assessment using coagulation assays after commencing dabigatran therapy in patients with moderate-to-severe renal impairment.

OC-023 Specialist Care of in-Patients with Non-Variceal upper Gastrointestinal Bleeding is Associated with a Dramatically Shorter Length of Stay: Abstract OC-023 Table

<h3>Introduction</h3> Acute upper gastrointestinal bleeding (UGIB) is a common medical emergency that has a 10% mortality rate [1], requiring specialist input and management [2]. It is not known if the care, outcome and length of stay of UGIB is influenced by whether patients are primarily cared for by Gastroenterologists or General physicians. We conducted a retrospective study to assess these aspects of care for in-patients with UGIB. <h3>Methods</h3> A retrospective review of case-notes (Electronic patient record-EPR) was conducted for all patients admitted to Kings College hospital with suspected UGIB between February and September 2012. Patients were divided as to whether they came immediately under the care of Gastroenterologists (GI) or general physicians (non-GI) after initial evaluation in the Acute Admission Unit. Patients were assigned on the basis of bed availability in a ward-based system. Statistical comparisons were made as appropriate with t-test or Fisher’s exact test. <h3>Results</h3> 109 patient episodes were reviewed. 14 had no evidence of UGIB and were excluded from further analysis. 59 (76.6%) of patients had an initial risk assessment (including documented score) completed on admission. After excluding patients with major non-medical (‘social’) issues, 53 (69%) GI and 24 non-GI patients were compared. The two groups were broadly similar in their baseline characteristics. Mean length of stay (days) was significantly shorter in the GI group: 5.5 ± 5.7 vs 15.7 ± 20.8 (p = 0.02). Other comparators are shown in the table. <h3>Conclusion</h3> The length of stay of patients with UGIB is dramatically shorter when receiving specialist care. This was statistically significant even after adjusting for social issues. Further data regarding the specific management of each case will be forthcoming. In line with previous reports [3], we found that the incidence of UGIB was higher in males. There was a trend toward better risk assessment, shorter time to endoscopy, reduced need for surgery and mortality in the GI group. Mortality rates in both groups compared favourably to the national average. <h3>Disclosure of Interest</h3> None Declared <h3>References</h3> CG141 Scope for improvement: A toolkit for a safer Upper Gastrointestinal Bleeding (UGIB) service. www.bsg.org.uk Lanas A, García-Rodríguez LA, Polo-Tomás M etal; Am J Gastroenterol 2009; 104:1633–41.

Haemoperitoneum with hereditary haemorrhagic telangiectasia

In August, 2011, an 83-year-old woman presented to our emergency department with several days of diff use persistent abdominal pain. She also reported an episode of lower gastrointestinal bleeding with symptoms of orthostasis. She had a history of cardiac failure, pulmonary hypertension, and epistaxis of un known cause. On initial physical examination she was haemodynamically stable without signs of acute ab dom inal disease. She had oral mucocutaneous telangiectases. Gastric lavage was done, and no evidence of upper gastrointestinal bleeding was seen. Blood tests showed a haematocrit concentration reduction from 25% to 20%, and a haemoglobin of 69 g/L. She was admitted for blood transfusion and assessment. After 5 days, she developed acute abdominal pain, tachycardia (135 beats per min), and hypotension (80/40 mm Hg). Sonography of the abdomen showed a large amount of free abdominal fl uid. Multi-detector computed tomography (MDCT) of the abdomen and pelvis confi rmed intra-abdominal fl uid and also showed liver arteriovenous malformations. CT-guided paracentesis confi rmed a diagnosis of haemo peritoneum. An emergency surgical exploration of the abdominal cavity was done because of her poor clinical condition. Explor ation showed haemo peritoneum and a portal vein branch with active bleeding due to the vascular malformations (fi gure). Haemostatic suturing was done to stop bleeding, and the abdominal cavity was drained. She had an uneventful postoperative course and was discharged at postoperative day 10. At last follow-up in Lancet 2013; 381: 962

Acute Hemobilia and Hemocholecyst in 2 Dogs with Gallbladder Carcinoid

Acute Hemobilia and Hemocholecyst in 2 Dogs with Gallbladder Carcinoid

Pharmacologic Treatment of Upper Gastrointestinal Bleeding.

The first goal of therapy is to assess hemodynamic stability in a patient presenting with evidence of upper gastrointestinal bleeding and, second, to maintain hemodynamic stability using crystalloids or packed red blood cells. The diagnosis of the cause of upper gastrointestinal bleeding should be performed using endoscopic techniques, which should be performed early. Therapy directed at treating the cause of upper gastrointestinal bleeding should be initiated at the time of endoscopy. Pharmacologic management should be based on the prevention of ulcer rebleeding and should be initiated at the time of endoscopic diagnosis. Surgery should be considered only in cases when endoscopic and pharmacologic treatments are deemed a failure.

Colonic mucosal changes in patients with liver cirrhosis

Background: Portal colopathy has been reported in patients with cirrhosis of the liver. The aim of this study is to evaluate colonic mucosal changes and their clinical significance. Method: Seventy-five cirrhotic patients with anemia and hemoccult-positive stool and 75 control subjects underwent endoscopic examinations of lower gastrointestinal tract. Result: Colonic ectasiae were found to be significantly more common in the 75 cirrhotic patients (80% with hepatitis B or C infection) than control subjects (84% vs 0, p < 0.0001). The lesions in 63 cirrhotic patients were found throughout the entire colon. They included colonic telangiectasiae or angiodysplastic-like lesions in 56 (89%) patients, red spots in 14 (22%), features suggesting mild chronic colitis in 8 (13%), and midrectal colorectal varices in 10 (16%). Pathologic findings in patients with telangiectasiae or angiodysplastic-like lesions showed dilation of vessels (7 of 9 patients) and edema of mucosa (6 of 9 patients). There was no correlation between the severity of cirrhosis, grade of esophageal varices, and the presence of colonic ectasiae. Conclusions: Our observations demonstrate that colonic mucosal changes commonly occur in cirrhotic patients with viral hepatitis. The risk of intermittent hemorrhage from colonic ectasiae should be considered in cirrhotic patients with anemia but without evidence of upper gastrointestinal bleeding. These characteristic lesions may represent a spectrum of portal hypertensive intestinal vasculopathy. (Gastrointest Endosc 1995;42:408-12.)

Prevalence of, and risk factors for, upper gastrointestinal tract bleeding in critically ill pediatric patients

To determine the occurrence of, and risk factors for, the development of upper gastrointestinal (GI) tract bleeding in critically ill pediatric patients. Prospective, descriptive, comparative study. ICU in a tertiary care pediatric hospital affiliated with a university. All patients < 19 yrs of age who were admitted to the ICU for a 4-month period (n = 429) were eligible for inclusion. A total of 221 patients were excluded for reasons listed below. Thus, 208 patients were studied. None. Patients were evaluated for overt upper GI bleeding as indicated by coffee ground material or bright red blood in gastric aspirates or black, tarry stools. Excluded were patients who were transferred out of the ICU within 24 hrs of admission, were receiving medications that would alter their risk for upper GI bleeding, or had a GI tract surgical procedure. Patients were categorized by diagnoses and analyzed for relative risk for upper GI bleeding. Of the 208 patients included, 25% had evidence of upper GI bleeding. There was no association between upper GI bleeding and age, weight, race, or sex. Diagnoses independently associated with an increased risk for upper GI bleeding were: circulatory shock, an operative procedure > or = 3 hrs in duration, and trauma. No clinically important sequelae were directly attributable to upper GI bleeding in this group of patients; however, intervention with antacids and histamine-2 receptor (H-2) antagonists likely decreased the progression of GI bleeding. Overt evidence of upper GI bleeding is not uncommon in critically ill pediatric patients. Certain diagnoses or risk factors may predispose these patients to develop upper GI bleeding.

Massive Hiatal Hernia with Incarceration: A Report of 53 Cases

Between 1960 and 1980, 53 patients with massive, incarcerated hiatal hernia were treated surgically. In 24 of the 53 patients, there was an associated organoaxial volvulus. The following symptoms and signs, which are almost peculiar to massive, incarcerated hernias, were observed: postprandial precordial distress in 43 patients, upper gastrointestinal bleeding (manifest or occult) in 24 patients, severe dyspnea in 13 patients, and complete obstruction associated with organoaxial volvulus in 4. In only 1 of the 53 patients was the hernia of the true paraesophageal type with the esophagogastric junction remaining in its normal, intraabdominal location. The remainder were all believed to be advanced stages of an ordinary sliding hiatal hernia. Operative treatment consisted of gastroplasty and partial fundoplication in 36 patients, standard Belsey repair in 14, and transabdominal Nissen repair in 3. Gastroplasty and partial fundoplication were used much more frequently during the 1970s, when it was realized that there is a significant incidence of chronic peptic esophagitis and shortening in these patients. Postoperative complications were few in spite of the advanced age of many of the patients. There was one operative death. Only 1 patient was lost to follow-up, and of the 51 patients remaining for analysis, follow-up has extended from 1 to 16 years, with a mean of 6.2 years. No patient has developed recurrent precordial pain, evidence of upper gastrointestinal bleeding, iron deficiency anemia, or severe dyspnea. Seven patients have residual dysphagia; this condition is minimal in 5, and is significant in 2 who require interval esophageal dilation. Nine patients have symptomatic reflux, which is minimal in 5 patients, moderate in 2 patients, and severe in 2 others who were subsequently reoperated on. Contrary to popular concept, our observations indicate that almost all of these patients represent advanced degrees of sliding hiatal hernia with intrathoracic displacement of the esophagogastric junction. This implies a need for an adequate antireflux reconstruction in all patients undergoing operation, as well as an awareness that unanticipated cicatricial changes may be present in the distal esophagus and may prejudice the success of some of the standard hiatal repairs.

Diagnostic Advances in the Study of Gastrointestinal Bleeding: Experience with a New Device (Diagnostotube) for the Localization of Upper GI Bleeding and the Application of Cinefibergastroscopy in the Study of Bleeding Lesions.

s1 February 1964Diagnostic Advances in the Study of Gastrointestinal Bleeding: Experience with a New Device (Diagnostotube) for the Localization of Upper GI Bleeding and the Application of Cinefibergastroscopy in the Study of Bleeding Lesions.Victor W. Groisser, M.D., John DiBianco, M.D., Gerald Nissenbaum, M.D., Albert Attia, M.D.Victor W. Groisser, M.D.Search for more papers by this author, John DiBianco, M.D.Search for more papers by this author, Gerald Nissenbaum, M.D.Search for more papers by this author, Albert Attia, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-60-2-324_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe localization of the precise site of massive upper gastrointestinal hemorrhage is of considerable value in guiding therapy. Newer methods of diagnosing and documenting gastrointestinal hemorrhage employed by the Division of Gastroenterology at Seton Hall College of Medicine in the past 2 years have included the Fluorescein-Diagnostotube test and fiberoscopy with cine recordings where feasible.The fluorescein "string" test has been modified by development of a new flexible, plastic tube (Diagnostotube) with 60 intraluminal radiopaque numbers 1 inch apart, and an outer absorbent sheath. Experience has been gained in 92 patients, 71 of whom had evidence of upper gastrointestinal bleeding.... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Jersey City, New Jersey PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByA New Device (Diagnostotube) for the Localization of Upper Gastrointestinal Bleeding 1 February 1964Volume 60, Issue 2_Part_1Page: 324-324KeywordsGastrointestinal hemorrhageHemorrhageLesions Issue Published: 1 February 1964 PDF DownloadLoading ...