Management Of Massive Gastrointestinal Bleeding Research Articles

Disseminated talaromycosis complicated by recurrent gastrointestinal bleeding and hemorrhagic shock: a case report

BackgroundGastrointestinal involvement is not uncommon in patients with disseminated talaromycosis, but successful management of massive gastrointestinal bleeding and hemorrhagic shock secondary to talaromycosis is rarely reported. Clinical management strategies for these patients have not been well documented.Case presentationHere, we reported a case of disseminated talaromycosis with recurrent gastrointestinal bleeding and hemorrhagic shock who was successfully alleviated solely with medical treatment.ConclusionsEarly diagnosis and treatment for Talaromyces marneffei, intravenous fluid resuscitation, hemostatic therapy and blood transfusion are all essential for talaromycosis complicated with gastrointestinal bleeding and hemorrhagic shock. It is also necessary to warn about the possibility of bleeding induced or aggravated by endoscopic biopsy trauma.

Uncontrolled bleeding of the gastrointestinal tract.

Acute gastrointestinal bleeding is a frequent emergency situation, whose incidence will likely rise as a result of the increasing use of direct anticoagulants and of the medical progresses resulting in longer life expectancy with underlying comorbidities. Updated guidelines and improvements in the diagnostic and therapeutic tools are now available and will likely improve the management of massive gastrointestinal bleeding in the near future. The assessment of severity has been improved by validated scores useable upon admission. Massive blood transfusion protocols and specific care in case of bleeding of patients treated with direct anticoagulants, including concentrates of coagulation factors and monoclonal antibodies are now available. The endoscopic management has been facilitated by the use of hemostatic powders and by the use of self-expanding metal stents in case of variceal hemorrhage. New diagnostic tools include emergency video-capsule endoscopy, multiphasic computed tomography angiography and enterography. The implementation of multidisciplinary diagnostic and therapeutic algorithms for the management of massive bleeding requires a close collaboration between emergency physicians, intensivists, endoscopists, radiologists and surgeons. A sequential strategy involving each of these specialists is desirable for a successful management of acute and massive gastrointestinal bleeding.

Efficacy of selective splanchnic arteriography and vasopressin perfusion in diagnosis and treatment of gastrointestinal hemorrhage

Vasopressin infusion initially controlled 80 per cent of patients bleeding from portal hypertension, and 53 per cent did not rebleed after removal of the catheter. This figure is significantly greater than the 28 per cent of patients totally controlled by esophageal tamponade (p <0.075). Similar rates of success were achieved by vasopressin infusion for gastric, duodenal, and colonic bleeding sites. These results suggest that visceral arterial infusion of vasopressin is the method of choice for the short-term therapeutic management of massive gastrointestinal bleeding from portal hypertension. Vasopressin infusion also appears to be a valuable means of treating patients with massive gastrointestinal bleeding secondary to shallow gastric ulcers, gastritis, Mallory-Weiss tears, colonic bleeding and “poor risk” patients with deep gastric, marginal, or duodenal ulcers when conventional medical therapy has failed. The presence of a coagulation abnormality in patients with portal hypertension significantly reduced the complete control of bleeding to only 27 per cent (p <0.010) and survival rate to 14 per cent (p <0.050). Visceral arterial perfusion proved to be an effective means of arresting hemorrhage, but the overall improvement in hospital mortality in this group of poor risk patients remains unproved.

Transjugular approach to the liver, biliary system, and portal circulation.

More than 5 years of clinical and animal experience with the use of a transjugular approach to the liver, biliary system, and portal circulation is reviewed. It has been of clinical value in connection with hepatic manometry and venography, liver biopsy, and cholangiography. Satisfactory hepatic manometry and venography were achieved by the transjugular approach in all 47 cases where attempted; diagnostic liver specimens were obtained in 71 of 83 patients (86%); and cholangiography was successful in 48 of 52 patients with enlarged intrahepatic ducts (92%). No complications occurred with these studies. In animals, transjugular catheterization was used as a means for portal, mesenteric, and pancreatic venography. These procedures are ready for diagnostic clinical use. Therapeutic techniques explored in animals include intravascular tamponade of gastric coronary vein and the nonsurgical creation of intrahepatic portacaval shunts, both of promise in the future management of massive gastrointestinal bleeding from varices.