Fatal Hematemesis Research Articles

Management of Retrograde Dissection Complicating Thoracic Endovascular Aortic Repair

Background: Retrograde type A aortic dissection is a challenging surgical emergency associated with high morbidity and mortality. Objective: The aim of this study was to describe our experience with retrograde type A aortic dissection (RAAD) following thoracic endovascular aortic repair (TEVAR) and its surgical management strategy. Patients and Methods:Our study was conducted between January 2011 and January 2021 at Cairo University Hospitals, and included 100 patients undergoing (TEVAR) to highlight the management of retrograde dissection complicating the procedure. The mean age was 55 ± 9 years and 76% of patients were males. All retrograde dissection patients underwent emergency surgical repair. Results: The in-hospital mortality was 10% of patients who had RAAD and occurred in one patient who suffered from fatal hematemesis postoperatively. The mean cross clamp time was 93±17 minutes and circulatory arrest time was 25±6 minutes. One patient also suffered from acute renal failure requiring hemodialysis during the postoperative hospital stay. Conclusions: Retrograde type A aortic dissection is an uncommon but potentially catastrophic complication of TEVAR. Surgical replacement of ascending aorta and a segment of aortic arch involving the entry tear offers an efficient strategy

Aorto-esophageal fistula - An autopsy series.

Fistulous tracts within the thorax are best exemplified aorto-esophageal fistulas (AEFs), which are rare exsanguinations of the upper gastrointestinal tract. Most of them are diagnosed at autopsy. This is an autopsy-based study of fatal cases of AEFs gathered over a period of 20 years. Cases of AEFs were retrieved from the autopsy records of the cardiovascular pathology sub-specialty at a tertiary care center and were studied with reference to demographic details, modes of clinical presentation, and pathological features. Ten cases of AEFs (10 males and 8 females, mean age of 46.9 years) were identified in a span of 20 years. A clinical diagnosis of AEF was made in only one patient, while the rest were identified at autopsy. All the patients had a bout of massive and fatal hematemesis. The fistulous connections, involving the middle-third of the esophagus, were caused by a fishbone, esophageal ulceration and aneurismal aortic diseases of varied etiology. AEFs are often missed or misdiagnosed. Early recognition of this rapidly fatal condition is essential as these fistulas require quick and aggressive management.

1744 Not an Ordinary Ulcer: A Case of an Aorto-Esophageal Fistula

INTRODUCTION: Hematemesis is a common manifestation of variceal and non-variceal upper gastrointestinal (GI) bleed with a broad differential. Aortoesophageal fistula (AEF) is a life-threatening and catastrophic cause of gastrointestinal bleeding, which is caused by the abnormal communication between the aorta and the esophagus. We are presenting a rare case aorto-esophageal fistula in a young patient who was found to have a benign appearing esophageal ulcer on endocscopy that subsequently was found to be an (AEF). CASE DESCRIPTION/METHODS: A 33-year-old Caucasian male presented to the hospital for fatigue, non-blood emesis and progressively worsening leg swelling. His history is significant for hypertension, seizure disorder, chronic kidney disease (due to pauci-immune glomerulonephritis), heart failure and a descending aortic transection due to an accident 12 years ago which was repair endovascularly. The patient reported usage of NSAIDs prior to admission for pain control but otherwise denied alcohol or other substance abuse. The patient was admitted for his progressive renal failure and was started on hemodialysis complicated with a DVT for which was started on warfarin. During his hospitalization, the patient had an episode of hematemesis with hemodynamic instability which prompted cessation of anticoagulation. An EGD revealed a 2-3 cm non-bleeding ulcer in the proximal esophagus. The patient had stabilized hematocrit and hemodynamics and was restarted on anticoagulation. A week later, the patient had another episode of massive hematemesis with hypotension. A chest x-ray showed widening of the aortic knob, suggested change in location of the thoracic stent. CT angiogram showed aortoesophageal fistula with a leaking pseudoaneurysm at the proximal aspect of the thoracic aortic endovascular stent. Surgery proceeded with endovascular aortic repair of thoracic pseudoaneurysm. Patient had multi-disciplinary management strategy for staged repair. DISCUSSION: AEF are classified as primary i.e. spontaneous erosion of the aortic wall into the esophagus or secondary caused by either esophageal malignancy, surgeries or foreign body. Exact incidence of the AEF is unknown. Early recognition is important to decrease mortality. Chiari et al described the triad of midthoracic pain, herald hemorrhage, and fatal hematemesis as usual presenting features. Endoscopy plays a significant role in the evaluation however it has a poor rate of detection for AEFs prompting the need of CT imaging with high clinical suspicion.

Lethal aorto-oesophageal fistula – Characteristic features and aetiology

Aorto-oesophageal fistula refers to a rarely encountered communication between the aorta and the oesophagus that results in massive and lethal haemorrhage into the upper gastrointestinal tract. Although the time between the initial haemorrhage and the terminal event may be days, a clinical diagnosis may not be established by the time of autopsy. A fistulous tract develops between the aorta and the oesophagus most commonly due to expansion of a thoracic aortic aneurysm or from an ingested foreign body. Less common causes include infiltrating neoplasms, oesophageal ulceration, vascular rings and iatrogenic lesions. Three cases are presented to illustrate the features of such cases due to aortic dissection, bronchial carcinoma and tuberculosis. Cases should be suspected if there has been a history of midthoracic pain or dysphagia, a ‘herald’ haemorrhage and then massive fatal haematemesis with bright red blood. Careful dissection at autopsy is required to demonstrate the site of the fistulous tract.

7044 Endoscopic stenting for malignant dysphagia: longterm experience.

Introduction . Insertion of expandable endoprosthesis is one of the methods of endoscopic palliation of inoperable malignant stenoses in the esophagus. We report our experience with expandable prosthesis and compare the current results with the results during the initial learning period. Methods . From 1/1996 till 10/1999, 48 patients with malignant dysphagia and unresectable disease were treated with an expandable coated prosthesis (Ultraflex, Boston Scientific). In 10 patients a broncho-esophageal fistula was present. The median age of the patients was 61 years (34-87). Therapeutic outcome was analysed (II) and compared with our previously reported results (I) (37 patients, treated from 1992 till 1996 (Gastrointest Endosc 1998 Oct; 48(4) 383-8)). Results . In the present series the procedure was succesfull in all patients and radiologic control showed good expansion of the prosthesis in all cases. The fistula were closed in all patients. There was one major complication (excessive bleeding) and 3 patients had minor complications (fever). During follow-up the endoprosthesis was patent in all patients until analysis or until death. In two patients tumor overgrowth was successfull palliated with laser therapy. One patient had fatal hematemesis 15 days after stent placement. The median survival of the patients was 64 days, six patients were still alive at the moment of analysis. Conclusions . The higher success rate and the low complication rate, compared with our previous results, are due to increasing experience of the physicians, to the better patient selection and to better stents. Although life expectancy is limited a well functioning prosthesis greatly improves quality of life.

Oesophago-vascular fistulae secondary to benign peptic ulcer disease: A rare cause of fatal haemorrhage

Oesophago-vascular fistulas are a very rare cause of massive upper gastrointestinal haemorrhage. The syndrome of sentinel haemorrhage, retrosternal pain and massive subsequent haemorrhage described by Chiari ~ is not always present and even though these fistulas are often associated with the presence of an aortic aneurysm or malignancy, this is not always the case. We present two cases of fatal haematemesis from an oesophago-vascular fistula secondary to benign peptic ulcer diseas4.

Fatal aortoesophageal fistula due to double aortic arch: An unusual complication of prolonged nasogastric intubation

Fatal hematemesis occurred in a 3-month-old boy due to erosion by a nasogastric tube into the right component of an unrecognized double aortic arch. This is the youngest of six reported patients with arterioesophageal fistula in the literature. Including this patient, five of six had nasogastric tubes in place. The tube may have led to fistula formation by compression of the esophageal wall against an anomalous vessel. When a vascular ring is suspected, indwelling esophageal tubes such as nasogastric tubes should not be used.

Caliber-persistent artery of the stomach (Dieulafoy's vascular malformation)

Caliber-persistent artery of the stomach (also known as cirsoid aneurysm, Dieulafoy's lesion, and submucosal arterial malformation) is clinically manifested as recurrent, massive, often fatal hematemesis. The lesion often is not seen endoscopically. Left gastric angiography in one patient with hematemesis showed a convoluted and ectatic artery in the gastric fundus, which proved to be caliber-persistent artery of the stomach on pathological examination. The tortuosity of the abnormal vessel in this condition has been attributed to artefactual contraction of the stomach following excision and formalin fixation. This is the first reported case in which a pathologically proven lesion has been clearly visualized by angiography. This demonstrates that the submucosal vessel is truly and not artifactually sinuous. It is proposed that angiographic demonstration of a nontapering, convoluted artery in the territory of the left gastric artery is highly suggestive of caliber-persistent artery of the stomach.

Fatal haematemesis in childhood associated with aorto-oesophageal fistula

A case of fatal haematemesis associated with a non-traumatic, non-tuberculous aorto-oesophageal fistula in a 9-year-old Nigerian boy is presented. Autopsy revealed two inflamed and ulcerated mild-oesophageal pulsion diverticula, one of which had eroded into the right pleura as a sinus track. The second diverticulum had perforated and caused mediastinitis and eventually aorto-oesophageal fistula which led to the fatal haematemesis. A mild chest injury is seen as a precipitating factor of the haematemesis and not the initiator of the pathology.

CANDIDA INFECTION COMPLICATING PEPTIC ESOPHAGEAL ULCER. INFECTION IN AN AORTIC-ESOPHAGEAL FISTULA.

Communication between the esophagus and the aorta occurs uncommonly. The usual cause is trauma1incurred by the ingestion of a foreign body, or less often by surgery or penetrating chest wound. Another prominent cause of aortic-esophageal fistulae is carcinoma of the esophagus.2Aortic-esophageal fistulae are usually located at the level of the aortic arch1where these two structures are approximated most closely. The present communication presents what seems to be a unique situation. A patient who was trained in esophageal speech after total laryngectomy developed a hiatus hernia with peptic ulceration at the esophageal-gastric junction. This ulcer penetrated posteriorly into the aorta and produced fatal massive hematemesis through the resultant aortic-esophageal fistula. At postmortem examination yeast-like organisms, morphologically characteristic ofCandida, were found in the wall of the aorta along the fistulous tract. Report of a Case A 62-year-old white man was admitted to the West Haven

Fatal haematemesis due to foreign body in stomach.

Fatal haematemesis due to foreign body in stomach.

Coarctation of the aorta with aneurysm and rupture into the esophagus: Report of a case and review of the literature

A case of coarctation of the aorta with aneurysm distal to the stenosis and rupture into the esophagus with fatal hematemesis is presented. The literature concerning coarctation, aneurysm formation distal to the stenosis, and rupture beyond the stenosis is briefly reviewed. A case of coarctation of the aorta with aneurysm distal to the stenosis and rupture into the esophagus with fatal hematemesis is presented. The literature concerning coarctation, aneurysm formation distal to the stenosis, and rupture beyond the stenosis is briefly reviewed.

Fatal haematemesis, from oesophageal varices, in presence of large portal-caval anastomosis.

<h3>ABSTRACT</h3> <h3>BACKGROUND</h3> SARS-CoV-2 causes COVID-19 through direct lysis of infected lung epithelial cells, which releases damage-associated molecular patterns (DAMPs) and induces a pro-inflammatory cytokine milieu causing systemic inflammation. Anti-viral and anti-inflammatory agents have shown limited therapeutic efficacy. Soluble CD24 (CD24Fc) can dampen the broad inflammatory response induced by DAMPs, and a recent randomized phase III trial evaluating impact of CD24Fc in patients with severe COVID-19 has shown encouraging clinical efficacy. <h3>METHODS</h3> We studied peripheral blood samples obtained from 22 patients enrolled in the SAC-COVID trial (NCT04317040), which were collected before and at multiple time points after treatment with CD24Fc or placebo. We performed high dimensional spectral flow cytometry analysis and measured cytokine levels to discern the immunological impact of CD24Fc treatment on patients with COVID-19. <h3>RESULTS</h3> Patient characteristics from the CD24Fc vs. placebo groups were clinically matched allowing us to compare results without apparent confounding factors. Using high-content spectral flow cytometry, we found systemic hyper-activation of multiple cellular compartments in the placebo group, including CD8⁺ T cells, CD4⁺ T cells, and CD56⁺ NK cells in patients with untreated COVID-19. By contrast, CD24Fc-treated patient samples demonstrated blunted systemic inflammation, with a return to homeostasis in both NK and T cells within days. A single dose of CD24Fc significantly attenuated systemic IL-10 and IL-15 cytokines, and diminished the coexpression and networking among inflammatory cytokines associated with COVID-19. <h3>CONCLUSIONS</h3> Our clinical and immunological data supports further development of CD24Fc as a novel therapeutic against severe COVID-19.

Fatal Hematemesis from Rupture of Aortic Aneurysm into Carcinoma of Esophagus

Fatal Hematemesis from Rupture of Aortic Aneurysm into Carcinoma of Esophagus

Esophageal varices in portal hypertension pathogenesis and diagnosis by roentgenography

1. The value of esophograms in the demonstration of esophageal varices, and therefore in the early diagnosis of portal hypertension, is emphasized. 2. Early diagnosis is essential if surgical intervention is to be successful. 3. A case of fatal hematemesis from ruptured esophageal varices secondary to portal cirrhosis is reported with operative and autopsy findings.

Fatal Haematemesis, from Cirrhosis of the Liver

Fatal Haematemesis, from Cirrhosis of the Liver