Intestinal Blood Loss Research Articles

Evaluation of the Effect of an Intraperitoneal Cytostatic-Loaded Supramolecular Hydrogel on Intestinal Anastomotic Healing in an Animal Model.

The prognosis of colorectal cancer patients with peritoneal metastases is very poor. Intraperitoneal drug delivery systems, like supramolecular hydrogels, are being developed to improve local delivery and intraperitoneal residence time of a cytostatic such as mitomycin C (MMC). In this study, we evaluate the effect of intraperitoneal hydrogel administration on anastomotic healing. Forty-two healthy Wistar rats received a colonic end-to-end anastomosis, after which 6 animals received an intraperitoneal injection with saline, 18 with unloaded hydrogel and 18 with MMC-loaded hydrogel. After 7 days, animals were euthanized, and the anastomotic adhesion and leakage score were measured as primary outcome. Secondary outcomes were bursting pressure, histological anastomosis evaluation and body weight changes. Twenty-two rats completed the follow-up period (saline: n = 6, unloaded hydrogel: n = 10, MMC-loaded hydrogel: n = 6) and were included in the analysis. A trend towards significance was found for anastomotic leakage score between the rats receiving saline and unloaded hydrogel after multiple-comparison correction (p = 0.020, α = 0.0167). No significant differences were found for all other outcomes. The main reason for drop-out in this study was intestinal blood loss. Although the preliminary results suggest that MMC-loaded or unloaded hydrogel does not influence anastomotic healing, the intestinal blood loss observed in a considerable number of animals receiving unloaded and MMC-loaded hydrogel implies that the injection of the hydrogel under the studied conditions is not safe in the current rodent model and warrants further optimalisation of the hydrogel.

Cachexia, chorea, and pain in chronic nonbacterial osteitis and inflammatory bowel disease: a case report

BackgroundInflammatory bowel disease is an inflammatory disorder that primarily impacts the gastrointestinal tract, leading to malnutrition and chronic microscopic intestinal blood loss. Uncontrolled systemic inflammation can impact other parts of the body, known as extraintestinal manifestations. Up to 25% of patients with inflammatory bowel disease are reported to have these complications in their skin, joints, bones, eyes, liver, lung, and pancreas (Rogler et al. in Gastroenterology 161(4):1118–1132, 2021). Neurologic involvement as extraintestinal manifestations are less common, reported at 3–19%, including neuropathies, demyelination, and cerebrovascular events (Morís in World J Gastroenterol. 20(5):1228–1237, 2014).Case presentationA 13-year-old Caucasian boy presented with 1 month of progressive lower-extremity pain, weakness, and weight loss. His physical examination was notable for cachexia, lower-extremity weakness, and chorea. Labs revealed normocytic anemia and systemic inflammation. Imaging revealed symmetric abnormal marrow signal in the pelvis and upper femurs. Pathologic examination of the bone revealed chronic inflammation consistent with chronic nonbacterial osteitis. Endoscopy revealed colonic inflammation consistent with inflammatory bowel disease.ConclusionsChildren and adolescents with musculoskeletal pain lasting more than 2 weeks with systemic signs or symptoms like weight loss should prompt evaluation for systemic inflammatory disorders such as chronic nonbacterial osteitis, which can occur in isolation or associated with inflammatory bowel disease. This patient also had a nonspecific neurologic abnormality, chorea, which resolved with treatment of underlying inflammatory disorder. These extraintestinal manifestations may be concurrent with or precede intestinal inflammation, requiring a high index of suspicion when investigating nonspecific systemic inflammation.

A Review on the Clinical Symptoms and Treatment Methods of Human Hookworm Infections

Introduction: Hookworm infection has overwhelmed human beings for ages and there are explanations about helminths in the primary medicinal manuscripts from 1500 BC. Hookworm is one of the immense three Soil-Transmitted Helminths (STH) (Ascaris Lumbricoides, Trichuris Trichiura, and hookworm). The goal of this study is to review the prevailing studies on Hookworm infection, clinical symptoms, prevention and treatment to examine different findings in this dominion.
 Material and Methods: In the present investigation, the databases of PubMed, Google Scholar, IranDoc and SID were examined from 2000 to 2021 and related articles were reviewed.
 Results: Review of related investigations revealed that nearly, 2 billion individuals are affected with these helminths around the world and the infection encumbrance might approach malaria. Hookworm infection diagnosis relies on fecal trials, either microscopic or molecular. This infection causes intestinal blood loss, which lead to anemia. In this regard, school-aged children and pregnant women are individuals at the highest risk of infections.
 Conclusion: Several aspects such as warm and moist environment, polluted water supply, and poor hygiene affect transmission rate. Besides, some risk factors such as agricultural occupation, barefoot walking, exposure to infected soil, poor environmental sanitation, low socioeconomic background, poor personal hygiene, host age, genetics, and nutritional aspects affect both STH transmission and infection. Clinical symptoms of hookworm contagions are frequently non-specific and could be confusing. Thus, attention to the epidemiology, clinical factors, and laboratory results are significant for examination process. Now more than ever, new plans are needed to regulate hookworm and other STH infections

Case Report: Severe Anemia Associated With an Abomasal Fibrosarcoma in a Goat

A 10-year-old female goat was presented to the clinic with lethargy, emaciation, and pale mucous membranes. Laboratory diagnosis revealed severe anemia with regenerative character as well as melena. Blood transfusions were administered, but the animal's condition continued to deteriorate, so it was euthanized. The main finding in the necropsy was an abomasal neoplasia with two metastases in the mesenterium which was positive for vimentin, but negative for smooth muscle actin and c-kit using immunohistochemistry, indicating a fibrosarcoma that might have contributed to gastrointestinal blood loss. Further pathological findings consisted of changes in the liver cells as well as a cervical leiomyoma. These findings illustrate that intestinal blood loss due to neoplasia should also be considered in older goats with anemia.

Polygenic Infantile Juvenile Polyposis Syndrome Managed With Sirolimus and Endoscopic Polypectomy

In the following clinical case of infantile juvenile polyposis syndrome (JPS), administration of a pharmacologic agent sirolimus was associated with reduced disease burden without need for bowel resection. The positive impact included improvement in protein-losing enteropathy, decreased intestinal blood loss, and improved weight gain. In addition, the number of polyps resected per unit time and frequency of upper and lower endoscopic evaluation needed dropped after initiation of sirolimus. This case report describes a positive clinical outcome and discusses the use of sirolimus with aggressive polypectomy as a potential treatment for the rare disease entity of polygenic infantile JPS. Through this case, we aim to emphasize that while administration of this drug may mitigate many sequelae of infantile JPS, it does not appear to eliminate the need for aggressive polypectomy.

Effects of intestinal parasite infection on hematological profiles of pregnant women attending antenatal care at Debre Markos Referral Hospital, Northwest Ethiopia: Institution based prospective cohort study.

Intestinal parasitosis is a common disease that causes misery and disability in poor populations. The number of individuals affected is staggering. From two billion peoples who harbor parasites worldwide, 300 million suffer severe morbidity and more than 25% of pregnant women are infected with hookworm, which causes intestinal bleeding and blood loss, and has been most commonly associated with anemia. Intestinal parasite infection during pregnancy has been associated with iron deficiency, maternal anemia, and impaired nutritional status, as well as decreased infant birth weight. This study aimed to assess the effects of intestinal parasite infection on hematological profiles of pregnant women attending antenatal care in Debre Markos Referral Hospital from December 2017 to February 2019. A prospective cohort study design was conducted among 94 intestinal parasite-infected pregnant women as an exposed group and 187 pregnant women free from intestinal parasite were used as a control group. The effect of intestinal parasites on hematological profiles of pregnant women was assessed at Debre Markos Referral Hospital antenatal care ward. Socio-demographic data and nutrition status were assessed by using structured questionnaires and mid-upper arm circumference (MUAC), respectively. Two ml of venous blood and 2 gm of stool samples were collected to analyze the hematological profiles and detect intestinal parasites, respectively. Wet mount and formol-ether concentration (FEC) techniques were used to detect intestinal parasites. Hematological profile was analyzed using Mind ray BC-3000 plus instrument. Data were double entered into EpiData version 3.1 software and exported to SPSS version 24 software for analysis. Results were presented using tables and graphs. Associations of hemoglobin levels with intestinal parasitic infections were determined using binary logistic regression models. P≤0.05 was considered statistically significant. The mean hematological profile difference between parasite-infected and parasite-free pregnant women was computed using independent t-test. In the present study, the predominant parasites identified were Entamoeba histolytica, hookworm, Giardia lamblia, Schistosoma mansoni, and Ascaris lumbricoides. About 8.2% of intestinal parasite-infected pregnant women had mild anemia while 4% had moderate anemia. Only 1.2% of intestinal parasite-free pregnant women developed moderate anemia. The mean HGB, HCT, MCV, MCH, and MCHC values of intestinal parasite-infected pregnant women were 12.8g/dl, 38.2%, 94.7fl, 33.1pg and 34.7g/dl, respectively. But the mean HGB, HCT, MCV, MCH and MCHC values of pregnant women who were free from intestinal parasites were 14.4 g/dl, 39.8%, 94.9fl, 33.9pg and 35.5g/dl, respectively. Anemia was strongly associated with hookworm (AOR = 21.29, 95%CI: 8.28-54.75, P<0.001), S.mansoni (AOR = 63.73, 95% CI: 19.15-212, P<0.001) and A.lumbricoide (AOR = 14.12, 95% CI 3.28-60.65, P<0.001). Intestinal parasitic infection in pregnant women caused adverse impact on hematological profiles and was an independent predictor of anemia. Intestinal parasitic infection significantly decreased pregnant the level of HGB, HCT, MCV, MCH, and MCHC values. To minimize maternal anemia deworming could be good before pregnancy.

Iron-Enriched Nutritional Supplements for the 2030 Pharmacy Shelves.

Iron deficiency (ID) affects people of all ages in many countries. Due to intestinal blood loss and reduced iron absorption, ID is a threat to IBD patients, women, and children the most. Current therapies can efficiently recover normal serum transferrin saturation and hemoglobin concentration but may cause several side effects, including intestinal inflammation. ID patients may benefit from innovative nutritional supplements that may satisfy iron needs without side effects. There is a growing interest in new iron-rich superfoods, like algae and mushrooms, which combine antioxidant and anti-inflammatory properties with iron richness.

Curcumin induces mild anemia in a DSS-induced colitis mouse model maintained on an iron-sufficient diet.

Anemia is frequently encountered in patients with inflammatory bowel disease (IBD), decreasing the quality of life and significantly worsening the prognosis of the disease. The pathogenesis of anemia in IBD is multifactorial and results mainly from intestinal blood loss in inflamed mucosa and impaired dietary iron absorption. Multiple studies have proposed the use of the polyphenolic compound curcumin to counteract IBD pathogenesis since it has significant preventive and therapeutic properties as an anti-inflammatory agent and very low toxicity, even at high dosages. However, curcumin has been shown to possess properties consistent with those of an iron-chelator, such as the ability to modulate proteins of iron metabolism and decrease spleen and liver iron content. Thus, this property may further contribute to the development and severity of anemia of inflammation and iron deficiency in IBD. Herein, we evaluate the effects of curcumin on systemic iron balance in the dextran sodium sulfate (DSS) model of colitis in C57Bl/6 and BALB/c mouse strains that were fed an iron-sufficient diet. In these conditions, curcumin supplementation caused mild anemia, lowered iron stores, worsened colitis and significantly decreased overall survival, independent of the mouse strain. These findings suggest that curcumin usage as an anti-inflammatory supplement should be accompanied by monitoring of erythroid parameters to avoid exacerbation of iron deficiency anemia in IBD.

Prevalence of Iron Deficiency Anemia in Anemic Patients: A Hospital Based Study

Introduction: In developing countries like Nepal, iron deficiency anemia (IDA) is one of the major concern. The high rate incidence has been related to insufficient iron intake, accompanied by chronic intestinal blood loss due to parasitic and malarial infections. Therefore, a study was conducted to evaluate the prevalence of IDA in anemic patients of Universal College of Medical Sciences-Teaching Hospital (UCMS-TH), South Western region, Nepal.&#x0D; Material and Method It was a hospital based cross sectional study comprised of 100 anemic patients. Their detailed medical history and lab investigations, focusing on hematological parameters were documented. Peripheral smear examination and serum ferritin estimation were done to observe red cell morphology and iron status respectively.&#x0D; Results: This study revealed that out of 100 anemic patients, 35% were that of IDA. The most affected age group was 21-40 years with frequency 42.55%. IDA was more common in females (42.85%) than in male (21.62%). Out of 100 anemic patients, microcytic hypochromic anemia was predominant in 47% followed by macrocytic anemia (31%) and then normocytic normochromic anemia (22%). Out of 47 microcytic hypochromic anemic patients, 12 had normal serum ferritin. There was a statistical significant difference in Hb (p=0.011), MCV (p=0.0001), MCH (p=0.0001), MCHC (p=0.0001) and serum ferritin (p=0.0001) among all types of anemia. There was a statistical significant positive correlation of ferritin with Hemoglobin (0.257, p= 0.01), MCV (0.772, p= 0.0001), MCH (0.741, p=0.0001) and MCHC (0.494, p=0.0001).&#x0D; Conclusion: The peripheral smear in conjunction with serum ferritin estimation needs to be included for susceptible individuals to screen the IDA and other types of anemia.

Gastrointestinal iron excretion and reversal of iron excess in a mouse model of inherited iron excess.

The current paradigm in the field of mammalian iron biology states that body iron levels are determined by dietary iron absorption, not by iron excretion. Iron absorption is a highly regulated process influenced by iron levels and other factors. Iron excretion is believed to occur at a basal rate irrespective of iron levels and is associated with processes such as turnover of intestinal epithelium, blood loss, and exfoliation of dead skin. Here we explore iron excretion in a mouse model of iron excess due to inherited transferrin deficiency. Iron excess in this model is attributed to impaired regulation of iron absorption leading to excessive dietary iron uptake. Pharmacological correction of transferrin deficiency not only normalized iron absorption rates and halted progression of iron excess but also reversed body iron excess. Transferrin treatment did not alter the half-life of 59Fe in mutant mice. 59Fe-based studies indicated that most iron was excreted via the gastrointestinal tract and suggested that iron-loaded mutant mice had increased rates of iron excretion. Direct measurement of urinary iron levels agreed with 59Fe-based predictions that urinary iron levels were increased in untreated mutant mice. Fecal ferritin levels were also increased in mutant mice relative to wild-type mice. Overall, these data suggest that mice have a significant capacity for iron excretion. We propose that further investigation into iron excretion is warranted in this and other models of perturbed iron homeostasis, as pharmacological targeting of iron excretion may represent a novel means of treatment for diseases of iron excess.

Usefulness of fecal immunochemical test and fecal calprotectin for detection of active ulcerative colitis.

Background/AimsUlcerative colitis undergoes periods of exacerbation and remission. Fecal calprotectin levels increase with gut inflammation and correlate with endoscopic disease activity in ulcerative colitis. Intestinal blood loss and fecal immunochemical test levels also correlate with endoscopic disease activity. This study statistically evaluated the usefulness of fecal calprotectin, fecal immunochemical test, and C-reactive protein (CRP) as markers of disease activity.MethodsA total 106 ulcerative colitis patients who underwent endoscopy and fecal calprotectin, fecal immunochemical test, and CRP testing, from March 2015 to August 2016, were retrospectively reviewed. Disease activity was assessed using a partial Mayo score and Mayo endoscopic score. The ability of fecal and serologic tests to reflect endoscopic disease severity was statistically evaluated.ResultsAmong 106 patients, 68 underwent endoscopy and stool study within 2 weeks. In patients with mild to severe activity, fecal immunochemical test and fecal calprotectin were superior to CRP at Mayo endoscopic score detection rate. The area under the curves of fecal immunochemical test and fecal calprotectin for the detection of Mayo endoscopic score ≥1 were 0.956 and 0.942, respectively, and were superior to that of CRP (0.756). At Mayo endoscopic score, the effects of combination of fecal immunochemical test and CRP or fecal calprotectin and CRP were found to be higher than those of the independent fecal immunochemical test or fecal calprotectin.ConclusionsFecal immunochemical test and fecal calprotectin can effectively detect active ulcerative colitis better than remission. As these markers reflect the status of mucosal inflammation, they may reduce the requirement for invasive endoscopic examination.

Iron Chelators Dictate Immune Cells Inflammatory Ability: Potential Adjuvant Therapy for IBD.

The importance of hemoproteins for life lies largely in their iron-mediated chemical properties. In the human body, there are about 4 g of iron, a precious resource preserved by sophisticated recycling mechanisms. Iron is also important for pathogen growth, so it is not surprising that immune cells developed mechanisms to reduce iron availability in cases of inflammation. In healthy conditions, macrophages degrade hemoproteins and export iron, while if inflammation develops, they retain cytoplasmic iron to reduce extracellular iron concentrations. Iron-rich macrophages possess a stronger inflammatory ability, which explains the chronic inflammatory response observed in states of iron overload. Inflammatory bowel syndromes are often characterized by intestinal blood loss and consequent anemia, but iron-supplementation therapies may exacerbate the inflammatory response. In chronically transfused patients iron overload is frequently observed; the iron can become toxic and in excess, even fatal if not treated with iron-chelating drugs. In the present review, we discuss the importance of iron homeostasis in states of health and inflammation, focusing on iron and iron-chelation treatment for IBD patients. Oral administration of natural ironchelating chemicals may be an effective adjuvant therapy for IBD patients, acting on numerous aspects of chronic inflammatory syndromes.

Antral mucosal perfusion is not increased in GAVE

ABSTRACTObjectives: Although a common cause of intestinal blood loss, the pathophysiology of gastric antral vascular ectasia (GAVE) is not well understood. We aimed to evaluate gastric antral and body mucosal flow in GAVE patients compared to a control population using laser Doppler flowmetry.Methods: 27 patients with GAVE and 11 control patients without GAVE were evaluated using an endoscopic LDF probe. The probe was placed in the gastric antrum and body in order to calculate standardized mucosal flow rates recorded as perfusion units (PU).Results: Despite its hyperemic appearance and propensity to bleed, antral blood flow was not increased in GAVE: 115.5 PU (IQR: [94.4, 135.9 PU]) in GAVE versus 123.7 PU (IQR: [109.7, 186.5 PU]) in controls. There was a significant gradient between the gastric body and antral blood flow in GAVE (p < 0.001) that was not evident in controls.Conclusion: These results indicate that antral mucosal blood flow is not increased in GAVE despite its grossly hyperemic appearance. A mild but statistically significant gradient was noted between the gastric antrum and body in patients with GAVE compared to controls. The pathophysiological significance of this finding is uncertain.

Anemia of cGKI deficient mice is caused by intestinal bleeding

Results cGKI-/- and cGKI rescue mice have significant lower erythrocyte levels than their control littermates, lower hematocrit and hemoglobin concentrations and elevated reticulocyte numbers. The spleens of these mice are massively enlarged. cGKI mutant mice clearly suffer from iron deficiency due to decreased plasma iron levels and the lack of iron in the spleen and liver. To maximize intestinal iron absorption in cGKI -/- mice hepcidin mRNA levels are down regulated in the liver. The iron regulatory hormone hepcidin binds to the only known cellular iron exporter ferroportin which leads to its degradation and therefore inhibits the iron transport via ferroportin [3,4]. IL-6 which is able to modulate the expression of hepcidin was elevated in the serum of cGKI mutants compared to controls [5]. Feeding the proton pump inhibitor (PPI) esomeprazol (18 mg/kg chow) did stop the intestinal bleeding as shown by Haemoccult test and prolong the survival of cGKI-/- mice. Perls Prussian blue tissue staining for ferric iron showed that PPI treatment rescues the iron deficiency in the spleen of cGKI -/- mice and normalized serum iron levels. These results were confirmed by western blot analysis for the iron storage protein ferritin light chain. In the liver ferritin levels and hepcidin mRNA levels are increased. Treatment with PPI normalizes red blood cell counts, hematocrit and hemoglobin levels as well as reticulocyte numbers and prevents splenomegaly. Serum IL-6 concentration was not affected by PPI treatment of cGKI mutants. Conclusion These data indicate that anemia and splengomegaly in cGKI-/- and cGKI rescue mice is caused by iron deficiency anemia due to intestinal blood loss and can be rescued by treatment with esomeprazol.

Vascular Ectasias: A Rare Cause of GI Hemorrhage in the Patient With Cirrhosis and Cardiovascular Disease

Introduction: Gastric antral vascular ectasia, or GAVE, is an extremely uncommon cause of recurrent intestinal blood loss. Up to 30% of patients suffering from this type abnormal gastric vasculature also have concurrent cirrhosis. In this case, we describe a patient with past medical history of multiple hospitalizations for anemia secondary to significant GI bleeds, with findings of cryptogenic cirrhosis, severe gastric antral vascular ectasia, splenorenal varices, multiple AVMs of the small bowel, and cavernous hemangiomas. Methods: Our case discusses a 74-year-old female with significant cardiovascular disease (coronary artery disease status post CABG, systolic cardiomyopathy, diabetes, hypertension) and chronic anemia with recurrent GI bleeding, who was admitted to our facility with the chief complaint of increasing lethargy. The patient had been hospitalized on multiple occasions in the past for symptomatic anemia and had required numerous blood transfusions secondary to substantial gastrointestinal blood loss. During this admission, the patient’s hemoglobin was as low as 5.3, with multiple potential sources for a GI bleed. A capsule endoscopy performed 1.5 years prior to this admission revealed evidence of vascular ectasias in the small bowel. A gastroscopy performed 7 months prior and repeated 3 months afterward demonstrated multiple, hemorrhagic, gastric antral vascular ectasias. Colonoscopy performed 2 months prior to admission demonstrated multiple colonic polyps in the cecum and sigmoid colon with pathology revealing a cavernous hemangioma. Results: Upon further investigation of the etiology of her abnormal vasculature, she was found to have evidence of cirrhosis, splenorenal varices, and ascites on CT imaging. Interestingly, however, portal venogram demonstrated no evidence of portal hypertension, and venous duplex confirmed patent portal and splenic veins, ruling out thrombosis. After an exhaustive work-up to determine the source of bleeding, the patient underwent a spiral enteroscopy, which demonstrated actively pumping angio-ectasia within the ileum. She eventually developed a perforated viscus, which required exploratory laparotomy with small bowel resection. Conclusion: This case illustrates the significant GI bleeding caused by a rare case of vascular ectasias in the small bowel. The case also discusses our experience using argon plasma coagulation, electrocautery, and laparoscopic surgery that served as therapeutic options. The pathogenicity of vascular ectasias still remains unclear, and is associated with multiple conditions including cirrhosis, portal hypertension, and cardiovascular disease; however, no direct relationship or etiology has been identified.

PICA with microcytic hypochromic anaemia and hookworm infestation: A case report

Major clinical manifestations of hookworm infestation are consequences of chronic intestinal blood loss. Iron-deficiency anaemia may occur and patient may develop pica which is commonly seen in children.Laboratory findings of hookworm infestation with iron deficiency anaemia include hypochromic microcytic anaemia and eosinophilia.B.A is a 7 year old boy residing at a village in Zamfara, North western Nigeria. He presented with a one month history of ingestion of stones and sand. He had normal neuro-developmental milestones and does not have any neuro-psychiatric disorder. He had mild generalised abdominal tenderness with multiple cystic swellings. On rectal examination, multiple stones were felt and evacuated which range between 1 and 3 cm.Blood film showed moderate anisocytosis with few target cells, hypochromia and microcytosis. Stool microscopy showed trophozoite of Entamoeba histolytica and eggs of hook worm. Pus cells with numerous blood cells were seen. Abdominal x-ray showed multiple dense radio opacities of calcific densities in the lumen of large bowel from caecum to rectum.He had enema and a total of 180 stones were passed within three days of admission. He was treated with Fersolate, Albendazole and Metronidazole and discharged after 8 days on admission when pica had stopped. He was asked to continue iron supplement for 3 months. Our case report is unique as stones passed out in stool were kept and counted. Enema may be needed for evacuation of larger stones. Children with pica should be evaluated for hookworm infestation and iron deficiency anaemia.

Large, segmental, circular vascular malformation of the small intestine (in a female toddler with hematochezia): unusual presentation in a child

BackgroundFailure to thrive and hematochezia in children may be alarm signs warranting endoscopy. In contrast, vascular malformations of the small intestine are uncommon in this age group. We report on a female toddler in whom various imaging techniques revealed an unusually large segmental vascular malformation of the ileum as the cause of the child’s main clinical symptoms.Case presentationA 19 months old girl presented with severe anemia (Hb 3 mmol/l), failure to thrive and chronic diarrhea. Diagnostics for intestinal blood loss and pathogens were negative. The child had duodenoscopy, also for histological diagnosis of celiac disease, with negative results. A dietary protocol was suggestive for inadequate iron intake and she was supplemented. After symptomless four-months the child presented again, now with mild abdominal pain and, for the first time, hematochezia. An orienting abdominal ultrasound (US) study showed a suspicious tumorous bowel condition. A subsequent detailed abdominal US supplemented by a saline enema during investigation (i.e., “hydrocolon”, to improve outlining of the formation’s localization) revealed a large circumferential cystiform vascular mass of the ileum causing segmental ileal obstruction.Complementing preoperative abdominal hydro-MRI, planned based on the findings of the US study, confirmed the suspected vascular malformation of the ileum and exquisitely outlined the extent, location and anatomy.The patient was successfully operated laparoscopically, the affected ileum segment with the mass was completely removed as proven by histology, and the child recovered well.ConclusionsThe huge segmental vascular malformation of the distal ileum described here is an extreme rarity in young children. Although the reported child’s presenting symptoms malabsorption and malnutrition could have been responsible for its severe anemia, this was obviously caused by blood losses from the ileal vascular malformation. It was due to incipient abdominal pain rather than hematochezia that abdominal US was performed and proved crucial for correctly diagnosing this rare malformation. Even in this extensive case detailed imaging work-up including adapted MRI added all information necessary for minimal invasive laparoscopic en bloc resection.

Occult blood in stool in exclusively formula fed infants versus exclusively breast fed infants in the first six months of life

BackgroundSince most of infant’s formula are based on cow’s milk to which allergy can occur, and considering the neurodevelopmental consequences of iron deficiency during infancy; we aimed to verify the occurrence of occult intestinal blood loss during the first 6months of life in response to being fed cow’s milk based formula versus breast milk. We also studied the iron status in order to assess prevalence of iron deficiency anemia. MethodsHealthy full term infants from birth to 6months who were either exclusively breast fed (BF) (n=50) or formula fed (FF) (n=50) were considered for enrollment. Detailed questionnaire describing perinatal period was taken from the mothers. Complete blood count, serum iron, total iron binding capacity (TIBC), serum transferrin and occult blood in stool were requested for each infant. ResultsWe reported no significant differences in hemoglobin, hematocrit and MCV between both groups. FF infants had higher levels of TIBC. We found that 4/50 FF infants had positive occult blood in stool; while only 1/50 BF infants was positive. The prevalence of iron deficiency anemia was higher in the FF group (14%) rather than in the BF group (8%). ConclusionAlthough iron content in formula is higher than breast milk, BF infants attained better iron status than FF infants and the prevalence of anemia among the FF group was higher.

Factors Associated with Mortality in Patients with Intestinal Angioectasia (IA) and Blood Loss using a Population-based Inpatient Sample

Purpose: To assess the association between mortality and demographic, comorbidities, and inpatient intervention among patients with hemorrhagic intestinal angioectasia. Methods: Using the National Inpatient Sample data between 2000 and 2009, logistic regression (univariate and multivariate) analysis were conducted to assess the association of the following variables on mortality. Demographic covariates included age, race/ethnicity, income, and gender. Comorbidities included the presence of hypovolemia, congestive heart failure (CHF), aortic stenosis (AS), valvular insufficiencies (VI), acute renal failure (ARF), chronic kidney disease (CKD), COPD, and von Willebrand disease. The Charlson-Deyo Index (CDI) and interventions such as packed red cell transfusion (PCT), endoscopy, surgical resection, hemodialysis (HD), central venous catheterization (CVC), and mechanical ventilation (MV) were included in the analysis. Results: We identified 32,238 patients with a primary diagnosis of IA. Multiple logistic regression modeling showed that significant mortality is associated with age range 75-84 years (odds ratio [OR] 1.93) age >85 years (OR 2.96). CDI score range 3-4 (OR 1.64) and CDI score >5 (OR 2.88). Increased mortality is seen with ARF (OR 2.72), CHF (OR 1.33), AS (OR 2.85), VI (OR 3.74), hypovolemia (OR 1.85), and coagulopathies (OR 2.25). Interventions such as HD (OR 1.88), CVC (OR 2.64), MV (OR 19.1), and surgical resections (small bowel OR 1.34, colon OR 3.6, and combined OR 8.28) were associated with increased mortality. The patients who received endoscopy (small bowel, colonoscopy, or both) had lower mortality when compared with those who did not receive endoscopy (OR 0.68, OR 0.50, and OR 0.40, respectively). This trend was also realized among patients who received PCT (OR 0.71). Conclusion: This is the first study to show risk factors for mortality in hospitalized patients diagnosed with IA and blood loss. This study also showed that patients with AS and IA were at increased risk for mortality. Other factors for increased mortality in IA include advanced age, male gender, increased CDI score, ARF, CHF, coagulopathies, and hypovolemia. This trend was also noted in patients who had HD, CVC placement, mechanical ventilation, and surgical resection. Protective factors included PCT and inpatient endoscopy.Figure: Graph of univariate odds ratio of variables associated with mortality.

Small Bowel Capsule Endoscopy Visualizing Colonic Adenocarcinoma

Small bowel endoscopy is indicated for patients with an unidentified bleeding site in esophago-gastro-duodenoscopy and ileo-colonoscopy and symptoms of intestinal blood loss or unexplained anemia. In approximately two-thirds of these cases, capsule endoscopy (CE) detects a lesion within the small bowel that explains the patient's symptoms. In few cases, though, lesions outside of the small bowel might be revealed by CE. Therefore, attention to all intestines that are visualized by CE might be necessary not to overlook bleeding sites that had not been discovered by prior flexible endoscopy.The authors present the case of a 71-year-old male patient who presented to their outpatient clinic for unexplained anemia. Small bowel CE revealed minor bleeding from an adenocarcinoma in the cecum. This article is part of an expert video encyclopedia.