Gastrointestinal Tract Bleeding Research Articles

A comprehensive review on phytochemicals as potential therapeutic agents for stress-induced gastric ulcer

AbstractGastric ulcers are the most common chronic gastrointestinal tract disorders, marked by an inflamed break of the mucus membrane covering the alimentary tract. According to recent research, stress-induced ulcers are widespread in our society. A stress ulcer is a mucosal defect that may become complicated due to upper gastrointestinal tract bleeding. The underlying cause of this condition is pH. Physiological stress leads to severe sickness by triggering the excessive secretion of peptic juices or gastric acid. There is a never-ending quest for safe and affordable medication for this disorder. Nature offers many medicinal plants that can be used to treat a wide range of human ailments. Due to their relatively harmless and comparatively free of harmful effects, health-promoting features, pharmacological practices, and affordability to common people to regulate various diseases, medicinal plants, and herbal preparations are gaining a lot of interest in scientific communities these days. Many studies have recently been performed to classify extracts and their constituents that may have a therapeutic effect on peptic ulcers. Therefore, this review aims to address the molecular mechanisms and pharmacological effects of various phytochemicals related to stress-induced gastric ulcers. Combining phytochemical constituents with modern drugs and treatment methods can lead to the development of therapeutic drugs for gastric ulcers. Gastric ulcers and other related diseases may be treated permanently with this approach.

Histopathology and molecular pathology confirmed a diagnosis of atypical Caroli’s syndrome: a case report

Caroli’s syndrome is a congenital disease characterized by dilation of intrahepatic bile ducts and congenital hepatic fibrosis. It is a rare condition in clinical work. Typically, the diagnosis of this disease is confirmed through medical imaging. Here, we report a case of atypical Caroli’s syndrome in a patient who presented with recurrent upper gastrointestinal tract bleeding. The patient underwent imaging examinations, liver biopsy and whole exome sequencing. The results of the imaging examination were non-specific. However, with the aid of pathological examination, the patient was diagnosed with Caroli’s syndrome. In conclusion, for cases where the imaging presentation of Caroli’s syndrome is inconclusive, an accurate diagnosis should rely on pathology. By discussing this specific case, our aim is to enhance readers' understanding of this disease, provide valuable information that can aid in the early detection and appropriate management of Caroli’s syndrome, ultimately improving patient outcomes.

MONITORING OF MEDICINE THERAPY IN DM (Diabetes Mellitus) PATIENTS, MELENA, ANEMIA, HIPOALBUMIN AND SEPSIS IN HOSPITAL “ X ”

Diabetes Mellitus (DM) is a group of chronic metabolic diseases with hyperglycemia characteristics, this disease can attack several organs of the body causing various complaints. Diabetes Mellitus (DM) is a disease characterized by blood sugar levels. Physical activity is any body movement produced by skeletal muscles that requires energy. Lack of physical activity is an independent risk factor for chronic disease. This study aims to determine the effect of physical activity on blood sugar levels in patients with diabetes mellitus. Sepsis is the invasion of pathogenic microorganisms or their toxins into the blood or other tissues, resulting in an exaggerated systemic response to infection, which causes a collection of clinical symptoms and ends in a life-threatening state of organ dysfunction. Anemia is indeed not a direct complication caused by Type 2 DM, but in patients with diabetes, diabetes can damage blood vessels in the body and can cause kidney problems in the long term if not controlled. Impaired kidney function can cause anemia. Melena is a condition when the stool becomes dark or black in color, which is caused by bleeding in the upper gastrointestinal tract. Hypoalbuminemia in critical illness is an important marker of mortality. The pathophysiology of hypoalbuminemia in critical illness including decrease of production, inflammation marker, vascular leakage, and malnutrition. Administration of intravenous human albumin is needed to be considered for treatment of hypoalbuminemia in critical illness.This report was conducted to find out drug related problems (DRP's) in the treatment management of DM (Diabetes Melius) Patients, Melena Anemia, Hipoalbumin and Sepsis at “ X “ Hospital. The patient on behalf of Mrs.R.M was treated in the inpatient room. Drug Therapy Monitoring to ensure rational use of drugs, so that unwanted events do not occur. 

Acute respiratory failure prognosis in prolonged ICU stays

Objective: This study aimed to assess the outcome of patients with acute respiratory failure and need of mechanical ventilation who stayed for more than 21 days in the ICU. Methods: All acute respiratory failure patients in King Saud Medical City, Riyadh Saudi Arabia and adults ICU who required a lengthy intensive care unit stay of more than 21 days between January 2022 and August 2023 were identified in this retrospective study. Information was extracted from the hospital database by trained physicians. Results: Total 121 patients (mean age 61.2±15.8 years) were included. Of which, 24.1% patients were more than 70 years. Sepsis was the most common cause of prolonged ICU stay both in survivors and non-survivors with 77.8% and 76.1%, respectively. Compared to patients who survived, non-survivors had higher acute physiology and chronic health evaluation (APACHE 4) scores were considerably older. Moreover, non-survivors were more likely than survivors to have renal failure, arrhythmia, hepatic failure, or significant gastrointestinal tract bleeding as reasons for a lengthy ICU stay. Patients who were admitted to ICU because they needed further surgery were more likely to survive. Conclusion: When acute respiratory fever (ARF) patients needed a lengthy stay in the ICU, their prognosis was not good. A high risk of in-hospital death was linked to older ages, more than 28 days ICU stay, more than 25 APACHE 4 score, unstable hemodynamic condition, hepatic failure, renal failure, major gastrointestinal tract bleeding, and needing FiO2 ≥40%.

Hypovolemic Shock Due to Lower Gastrointestinal Tract Bleeding Secondary to Primary Rectal Syphilitic Ulcer. Case Report and Literature Review

Syphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum, it has a well-defined course with several stages throughout its natural history ranging from primary to tertiary. Rectal syphilis is a rare syphilis presentation and can occur in both primary and secondary syphilis, either in a syphilitic ulcer or proctitis. It's generally doesn't have symptoms, however it can cause rectal bleeding that in most cases tends to be self-limiting. The diagnosis is established when it's possible with direct observation studies; However, in cases of concomitant contamination by spirochetes of the usual rectal flora, the sensibility and specificity of direct observation tests decreases, so the diagnosis requires an adequate clinical, serological and, if necessary, histopathological correlation. The treatment and follow-up is the same as in other syphilis types and depends on the time of evolution and specific conditions of the patient in question. We present the case of a male patient with primary rectal syphilis that during his course triggered a state of hypovolemic shock secondary to massive rectal bleeding.

Role of Proton Pump Inhibitors in the Management of Peptic Ulcer

Proton pump inhibitors (PPIs) have been used to treat a variety of conditions affecting the upper gastrointestinal tract including gastroesophageal reflux disease (GERD), esophagitis, Zollinger-Ellison syndrome (ZES) and dyspepsia. PPIs are also useful in the treatment of Helicobacter pylori infection as well as the prevention of upper gastrointestinal tract ulcers and bleeding in patients who are taking non-steroidal anti-inflammatory drugs (NSAIDs). It is critical to get the best clinical response possible for people with an upper gastrointestinal peptic disorder. This is dependent on the PPI used. Although all members of this class suppress active parietal cell acid secretion in the same way, there are minor variations in pharmacokinetic characteristics, metabolism and FDA-approved therapeutic indications among PPIs. Regardless of this, each is successful in treating GERD and peptic ulcers. Despite their overall effectiveness, PPIs have certain drawbacks, including short plasma half-lives and the need for meal-associated dosing, which can cause breakthrough symptoms in some people, particularly at night. This article discusses the current indications for PPIs in the treatment of peptic ulcers, as well as their pharmacokinetics and pharmacodynamics.

Smíšený adenoneuroendokrinní karcinom žaludku – kazuistika

Neuroendocrine tumours represent a heterogeneous group of neoplasia arising from different anatomical locations, with approximately 50% of gastrointestinal origin. Main parameters in the evaluation of each case include tumour morphology, mitotic cell count, and Ki-67 index. Mixed adeno-neuroendocrine carcinomas (MANECs) are rare aggressive neoplasms consisting of both adenocarcinomatous and neuroendocrine cells, each component constituting at least 30% of the lesion. Our case represents 77-year-old polymorbid patient who, due to signs of acute bleeding in the upper gastrointestinal tract with anaemic syndrome, underwent a gastroscopic examination for melena with the finding of an ulcer lesion on the front wall of the stomach at the junction of the body and the antrum. The control gastroscopic examinations with biopsies, at first only signs of chronic gastritis with Helicobacter pylori positivity were histologically proven, then fragments of high-grade tubular to tubulovillous adenoma and structures of moderately differentiated tubular adenocarcinoma were found. Histological analysis of the gastric resection showed mixed adeno-neuroendocrine carcinoma with lymphangioinvasion.

Gastrointestinal tract bleeding in children with chronic cholestasis: Prevalence and risk factors in a tertiary referral hospital in Indonesia

Background Cholestasis can lead to several complications, including portal hypertension and risk of gastrointestinal bleeding. However, there is a paucity of studies on the risk factors and prevalence of gastrointestinal tract bleeding in children with chronic cholestasis, particularly in Indonesia.
 Objective To determine the prevalence and risk factors for gastrointestinal bleeding in children with chronic cholestasis in Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
 Methods This was a retrospective cohort study in a national referral hospital in Indonesia. Medical records of children with chronic cholestasis who visited the gastroenterohepatology outpatient clinic were collected for five years. Data on clinical symptoms, etiologies, and complications were obtained.
 Results A total of 97 participants were recruited on this study. The median age of the group was 0.31 years old. The most common causes of chornic cholestasis were biliary atresia, toxoplasma, other infections, rubella, cytomegalovirus, and herpes simplex virus (TORCH) infection, and urinary tract infection. Gastrointestinal bleeding occurred in 27.8% of patients, with hematemesis-melena being the most prevalent symptom. We found that liver cirrhosis, splenomegaly, thrombocytopenia, portal hypertension, and esophageal varices were all highly related with gastrointestinal bleeding. Splenomegaly, thrombocytopenia, and esophageal varices were associated with an increased risk of gastrointestinal bleeding in children with chronic cholestasis (P=0.018, P=0.008, and P=0.039, respectively).
 Conclusions The prevalence of gastrointestinal tract bleeding in children with chronic cholestasis is 27.8%, with  splenomegaly, thrombocytopenia, and esophageal varices as significant risk factors.

S3159 Development of Diffuse Upper Gastrointestinal Tract Submucosal Petechiae and Haemorrhage in a Patient With Newly Diagnosed Primary Immune Thrombocytopenic Purpura

S3159 Development of Diffuse Upper Gastrointestinal Tract Submucosal Petechiae and Haemorrhage in a Patient With Newly Diagnosed Primary Immune Thrombocytopenic Purpura

Endoscopic Evaluation among Patients Presenting with Upper Gastrointestinal Tract Bleeding

Background: Bleeding from the upper gastrointestinal tract is a critical medical condition that requires prompt diagnosis and management. Endoscopic evaluation plays a pivotal role in identifying the source of bleeding, determining its severity, and guiding appropriate interventions. Objective: The objective of this study was to conduct a comprehensive endoscopic evaluation in patients who have presented with bleeding originating from the upper gastrointestinal tract. Study Design: Descriptive cross-sectional study. Settings: Department of Gastroenterology, Islamic International Medical College, Rawalpindi Pakistan. Duration: Study duration was 7 months from November 2021 to April 2022. Methods: Patients who were 18 years of age or older and presented with active or recent upper gastrointestinal bleeding, regardless of gender, and were scheduled for endoscopic examination, were incorporated into the study. Upper gastrointestinal endoscopies were performed. The procedure was involving the direct visualization of the esophagus, stomach, and duodenum using an endoscope. Any visible lesions or bleeding sources were documented. Data regarding the location and nature of bleeding sources and the endoscopic diagnosis were recorded in a standardized data collection form and analyzed by SPSS version 26. Results: The study included 59 patients with a mean age of 52.27 years. Esophageal endoscopic findings revealed "Grade I to III Esophageal varices (EV) being less common (3.4%, 11.9%, and 13.6% respectively). LAX LEs, esophagitis and Hiatus hernia were observed in 10.2%, 3.4%, and 6.8% of cases. Rarer findings, including Venules, Ecstatic vein, Candidiasis, and various combinations, each accounted for 1.7% of cases. Portal hypertension gastropathy was the most prevalent condition (20.3%), followed by Antral gastritis (45.8%), Erosive gastropathy (10.2%), and other less frequent conditions, such as fundal varices, GOVI varices, diffuse gastritis and Ulcer. Grade II and III EV, and PHTN gastropathy, were significantly more prevalent among males, while Antral gastritis was notably higher among females (p < 0.05). Although the endoscopic findings did not show any statistically significant differences based on gender (p > 0.05). Conclusion: PHTN gastropathy, antral gastritis, grade III EV and erosive gastropathy were the most common conditions among patients with Hematemesis, along with less frequent findings like grade I to III Esophageal varices, Venules, Ecstatic vein, Candidiasis, and combinations of these conditions.

Re-bleeding and all-cause mortality risk in non-variceal upper gastrointestinal bleeding: focusing on patients receiving oral anticoagulant therapy

Objective Non-variceal upper gastrointestinal bleeding (NVUGIB) in patients receiving oral anticoagulants (OACs) may be fatal; however, little is known about re-bleeding and all-cause mortality after successful hemostasis. We investigated the clinical characteristics and risk factors for re-bleeding and death after successful hemostasis. Methods Patients receiving OACs and diagnosed with NVUGIB between 2007 and 2021 were enrolled. All NVUGIB incidents were confirmed if definite bleeding in the upper gastrointestinal tract was detected via esophagogastroduodenoscopy. Results A total of 132 patients receiving OACs were diagnosed with NVUGIB. Males were the majority (72, 54.5%), and bleeding was detected mostly in the stomach (99, 75%) and was most often due to peptic ulcers (PU) (88, 66.7%). After successful hemostasis of index NVUGIB, 40 patients (30.3%) experienced re-bleeding. Among them, 15 (37.5%) died, and among those, 3 (2.3%) were related to re-bleeding. Multivariate analysis revealed that duodenal bleeding (odds ratio [OR]: 3.305; 95% confidence interval [CI]: 1.152-9.479, p = 0.026) and Charlson comorbidity index score (CCI) (OR: 1.22; 95% CI: 1.052–1.419, p = 0.009) were significant risk factors for re-bleeding. Index albumin levels (OR: 0.134; 95% CI: 0.035–0.506, p = 0.003), previous PU or upper gastrointestinal bleeding (UGIB) history (OR: 4.626; 95% CI: 1.375–15.567, p = 0.013), and CCI (OR: 1.293; 95% CI: 1.058–1.581, p = 0.012) were related all-cause mortality. Conclusion CCI and duodenal bleeding are risk factors for re-bleeding in patients with NVUGIB who were receiving OACs, while low index albumin levels and previous PU and UGIB history are associated with all-cause mortality.

Assessment of Risks for Gastrointestinal Bleeding in Patients with Brain Injury

The aim of the study was to develop a risk model for upper gastrointestinal tract (GIT) bleeding in patients with brain injury of various etiologies.Material and methods. Case histories of 33 patients were included into a retrospective descriptive study: 22 patients had severe brain injury of various etiologies, and 11 patients after elective surgery for cerebral aneurisms with uneventful postop period were taken for comparison. The patients were grouped in two arms: Group 1 included patients with obvious signs of GIT bleeding (N=11) and Group 2 had no obvious signs of bleeding (N=22). Complaints, life and medical history, comorbidities, specialists’ exams data, results of laboratory and instrumental examinations, therapeutic regimens were analyzed. Presence of disproportionate pathologic sympathetic overreaction to acute brain injury, i.e., paroxysmal sympathetic hyperactivity (PSH), was assessed on admission and on Days 1, 3 and 5 after brain injury. Results. A model for upper GIT bleeding risk assessment was designed using logistic regression. The resulting model gains high quality rating: χ²=33,78, 3; p<0,001; OR=315. The risk of upper GIT bleeding exceeded 95% in patients having combination of 4 symptoms in their medical history (presence of PSH on Day 1 after acute brain injury; Karnofsky performance scale index 75; lack of neurovegetative stabilization in the acute period of brain injury; gastric and/or duodenal ulcer).Conclusion. Determining the risk factors thresholds enables stratification of patients by the risk for upper GIT bleeding. Modification of the identified four risk factors (presence of PSH on Day 1after acute brain injury; Karnofsky performance scale index 75; lack of neurovegetative stabilization in the acute period of brain injury; gastric and/or duodenal ulcer) will probably reduce the occurrence of upper GIT bleeding in patients with acute brane injury of various etiology.

A Comparison of the Charlson and Elixhauser Methods for Predicting Nursing Indicators in Gastrectomy with Gastric Cancer Patients

Background: Comorbidity indices such as Charlson’s (CCI) and Elixhauser’s (ECI) are used to adjust the patient’s care, depending on the severity of their condition. However, no study has compared these indices’ ability to predict nursing-sensitive outcomes (NSOs). We compared the performance of CCI and ECI in predicting NSOs in gastric cancer patients’ gastrectomy. Methods: Gastric cancer patients with gastrectomy, aged 19 years or older and admitted between 2015 and 2016, were selected from the Korea Insurance Review and Assessment Service database. We examined the relationships between NSOs and CCI or ECI while adjusting patient and hospital characteristics with logistic regression. Results: The ECI item model was the best in view of the C-statistic and Akaike Information Criterion for total NSO, physiologic/metabolic derangement, and deep vein thrombosis, while the Charlson item model was the best for upper gastrointestinal tract bleeding. For the C-statistic, the ECI item model was the best for in-hospital mortality, CNS complications, shock/cardiac arrest, urinary tract infection, pulmonary failure, and wound infection, while the CCI item model was the best for hospital-acquired pneumonia and pressure ulcers. Conclusions: In predicting 8 of 11 NSOs, the ECI item model outperformed the others. For other NSOs, the best model varies between the ECI item and CCI item model.

Use of Antidepressants and the Risk of Upper Gastrointestinal Tract Bleeding: A Case-control Study

PurposeTo investigate the association between the use of antidepressants and the risk of upper gastrointestinal tract bleeding (UGIB). MethodsA Case-control study was conducted in a Brazilian hospital complex. Cases were defined as patients with a diagnosis of UGIB and controls as patients admitted for reasons unrelated to gastrointestinal bleeding, gastric concerns, or complications associated with low-dose aspirin (LDA) or nonsteroidal anti-inflammatory drugs (NSAIDs) use. Sociodemographic and clinical data, comorbidities, drug therapy in use (long-term use and self-medication), and lifestyle habits were recorded through face-to-face interviews. Two groups were defined: use of antidepressants in general and use of antidepressants according to their affinity for serotonin transporters. The presence of synergism between the concomitant use of antidepressants and LDA or NSAIDs on the risk of UGIB was also explored. FindingsA total of 906 participants were recruited (200 in the case group and 706 in the control group). The use of antidepressants was not associated with the risk of UGIB (odds ratio [OR] = 1.503; 95% CI, 0.78–2.88) or the use of antidepressants with high affinity for serotonin receptors (OR = 1.983; 95% CI, 0.81–4.85). An increased risk of UGIB was observed in concomitant users of antidepressants and LDA (OR = 5.489; 95% CI, 1.60–18.81) or NSAIDs (OR = 18.286; 95% CI, 3.18–105.29). Despite the lack of significance, the use of antidepressants appears to be a positive modifier of UGIB risk in LDA and NSAID users. ImplicationsThese findings indicate an increased risk of UGIB in concomitant users of antidepressants and LDA or NSAIDs, suggesting the need to monitor antidepressant users, especially those most likely to develop UGIB. In addition, further studies with larger sample sizes are needed to confirm these findings.

An unusual opportunistic infection causing lower gastrointestinal tract bleeding in a patient with severe alcoholic hepatitis, post-liver transplantation.

The authors declare no confilicts of interest. Data sharing is not applicable to this article as no new data were created or analyzed in this study.

A Henoch-Schönlein Purpura Case with Clinical Manifestation of Gastrointestinal Bleeding: A Case Report

Background: Henoch-schӧnlein purpura (HSP) or also known as immunoglobulin A (IgA) vasculitis, is an autoimmune vasculitis of small blood vessels. The incidence of HSP in adults is only 5 in 100,000 adult patients. One of the causes of these low incidences is due to misdiagnosed or underdiagnosed. This is inevitable as in adults, and the disease usually presents with atypical signs and symptoms. One of the rare manifestations of this disease is gastrointestinal tract bleeding. This study aimed to describe a case of Henoch-schӧnlein purpura with gastrointestinal bleeding and the treatment.
 Case presentation: A rare case of a 20-year-old adult male diagnosed with HSP with the chief complaint of severe abdominal pain and gastrointestinal bleeding was presented. The patient also complained of arthralgia. Upon closer examination, the patient had palpable purpura on both the ankle and trunk. Urinalysis showed protein (+2) with erythrocyte 25-50 cells. Esophagogastroduodenoscopy showed erosive pangastritis, bile reflux, and duodenal submucosal bleeding with a normal duodenal bulb. The patient was diagnosed with HSP and was given methylprednisolone and azathioprine. On 1 month follow-up, the patient's complaints subside.
 Conclusion: Henoch-schӧnlein purpura should be considered in adult patients, especially in patients with skin lesions without thrombocytopenia accompanied by multiorgan involvement (gastrointestinal, renal, and joint).

A case of refractory bleeding from duodenal angioectasia with acquired hemophilia A.

Acquired hemophilia A (AHA) is a coagulation disorder related to the factor VIII inhibitors, which might cause intractable bleeding of gastrointestinal tracts. However, its scarcity makes it difficult to recognize AHA as a pitfall of endoscopic hemostasis failure. An 81-year-old female with a history of endoscopic treatment for colon polyps visited a local hospital with chief compliments of bloody stool and severe anemia. During several examinations for the bleeding origin, esophagogastroduodenoscopy depicted a 5mm-sized hemorrhagic angioectasia of the duodenum, followed by treatment with argon plasma coagulation. However, hemostasis was not achieved by multiple sessions of endoscopic hemostasis and transcatheter arterial embolization, so blood transfusion was repeatedly done and she was transferred to our hospital. Laboratory data showed severe anemia with coagulation disorder. Based on the results of von Willebrand factor activity, factor VIII activity and factor VIII inhibitor, we diagnosed AHA as a comorbidity. Endoscopic hemostasis was confirmed only after improvement of APTT level and negative for the factor VIII inhibitor by hemostatic bypass treatment with recombinant active factor VII and immunosuppressive therapy with prednisolone and cyclophosphamide. In case of refractory bleeding of gastrointestinal tract, we should suspect of a comorbidity of coagulation disorder like AHA.

Upper endoscopic findings in patients attending the endoscopy unit of al-azhar assiut university hospital: 2019–2020

Background and aim An endoscope is a visual instrument used to inspect the internal cavities of the human body. Upper endoscopy has effective diagnostic and therapeutic functions; it can be used in patients with signs or symptoms suggestive of upper gastrointestinal (GI) disease, surveillance for upper gastrointestinal tract (GIT) malignancy in high-risk population, and also stoppage of upper GIT bleeding. The work is aimed to document the demographic characteristics, indications, endoscopic findings, and interventions done among patients referred to Al-Azhar Assiut University Hospital in the last 2 years (2019–2020). Patients and methods The study was conducted at the endoscopy unit in from January 2019 to December 2020. Results Our study showed that the most prevalent age group was aged between 20 and 50 years (65.4%). There is a slight predominance of female patients (51%) versus 49% who were males and the most common indications, while peptic ulcer disease was the most common endoscopic finding. Conclusion The most common indications were epigastric pain and upper GIT bleeding, while the most common GI finding was peptic ulcer disease. Also, esophageal varices were common esophageal findings for which band ligation and injection sclerotherapy were done.

Gastro-Duodenal Artery Aneurysm Rupture – Case Report

Background The definition of an aneurysm is a dilation of an artery more than 1.5 to 2 times its normal diameter. Visceral (or splanchnic) artery aneurysms include those concerning the celiac truncus, superior mesenteric artery, inferior mesenteric artery, and their branches. This classification does not include aortic and renal artery aneurysms. It is a rare, but clinically significant pathology because of the high mortality risk. Despite this rarity, cases have been accumulated and this pathology is better understood. Novel techniques for the management of aneurysms have been developed with the advent of interventional radiology. However, our case concerns the emergent surgical repair of a ruptured aneurysm, rather than the elective repair. Case presentation The 61-year-old female patient complains of diffuse, intermittent abdominal pain lasting for almost one week. On the last day the patient suffers from excruciating abdominal pain and is brought to the emergency department. Objective evaluation shows pallor, diaphoresis, low blood pressure, tachycardia and abdominal guarding in all quadrants. An abdominal ultrasound spots the presence of free fluid in all recesses. A diagnostic peritoneal needle aspiration shows pure blood. AB0 and Rhesus blood type is identified and the patient is prepared for the operating theatre. Following a laparotomy, peritoneal lavage, a rupture of gastro-duodenal aneurysm is identified and the artery is ligated in its origin. The patient tolerated the procedure well and was discharged in good health. Discussion Rare case reports in literature have reported Gastro-duodenal artery aneurysms. Because of this rarity in incidence there is no clear protocol on how to diagnose and manage it. Possible risk factors and associated conditions include: chronic pancreatitis, liver cirrhosis, vascular abnormalities as fibromuscular dysplasia and polyarteritis nodosa. Other events and diseases such as trauma, septic emboli, hypertension and atherosclerosis are also mentioned. The main symptoms of visceral artery aneurysms, with or without rupture are abdominal pain, hypotension, gastric emptying delay and other non-specific manifestations such as vomiting, diarrhoea, jaundice, upper gastro-intestinal tract haemorrhage (which occurs in about 50% of the cases with gastro-duodenal artery aneurysms) and retro and intra-peritoneal bleeding. Conclusion The rupture of gastro-duodenal artery is a serious fatal presentation of a rare condition. It requires high alertness and decisive action, as warning signs and symptoms may be dull or absent. Quick diagnosis before rupture can change the course of this disease and prevent lethal complications. As this disorder is so uncommon, there are no specific screening or follow-up recommendations. Treatment and diagnostic options should be decided on a case basis. Keywords: General Surgery, Visceral Artery Aneurysm, VAA, Splanchnic Aneurysm, Aneurysm Rupture. DOI: 10.7176/JEP/14-8-02 Publication date: March 31 st 2023

Gastrointestinal bleeding in children with familial dysautonomia: a case-control study.

Familial dysautonomia (FD) is a rare inherited autosomal recessive disorder with abnormal somatosensory, enteric, and afferent autonomic neurons. We aimed to define the incidence of gastrointestinal bleeding and its associated risk factors in patients with FD. In this retrospective case-control study, we identified all episodes of gastrointestinal bleeding in patients with FD, occurring over four decades (January 1980-December 2017), using the New York University FD registry. We identified 104 episodes of gastrointestinal bleeding occurring in 60 patients with FD. The estimated incidence rate of gastrointestinal bleeds in the FD population rate was 4.20 episodes per 1000 person-years. We compared the 60 cases with 94 age-matched controls. Bleeding in the upper gastrointestinal tract from gastric and duodenal ulcers occurred most frequently (64 bleeds, 75.6%). Patients were more likely to have a gastrostomy (G)-tube and a Nissen fundoplication [odds ratio (OR) 3.73, 95% confidence interval (CI) 1.303-13.565] than controls. The mean time from G-tube placement to first gastrointestinal bleed was 7.01years. The mean time from Nissen fundoplication to bleed was 7.01years. Cases and controls had similar frequency of intake of nonsteroidal antiinflammatory drugs (NSAID) and selective serotonin reuptake inhibitors (SSRI). The incidence of gastrointestinal bleeding in the pediatric FD population was estimated to be 4.20 per 1000 person-years, 21 times higher than in the general pediatric population (0.2 per 1000 person-years). Patients with FD with a G-tube and a Nissen fundoplication had a higher risk of a subsequent gastrointestinal bleeding.