Massive Gastrointestinal Bleeding Research Articles

Gastrointestinal: A rare intra-abdominal hydatid cyst manifesting as an acute massive upper gastrointestinal bleeding.

Gastrointestinal: A rare intra-abdominal hydatid cyst manifesting as an acute massive upper gastrointestinal bleeding.

Unusual Cause of Hemobilia

AbstractHemobilia is one of the rare causes of upper gastrointestinal (GI) bleeding. Causes of hemobilia vary from benign lesions, malignant tumors, to vascular causes. Rupture of a hepatic artery aneurysm into common bile duct is rarely encountered in clinical practice, and sometimes can be very tricky to diagnose if the clinician is not aware of this cause of GI bleeding. We diagnosed a young female who has had a recent gallbladder surgery and presented with a massive upper GI bleeding. She was managed with coil embolization of the right hepatic artery.

Modern diagnostic methods for early assessment of the abdominal involvement in Schönlein-Henoch disease.

Schönlein-Henoch disease is a small vessel vasculitis resulting from IgA-mediated inflammation. It is the most common acute systemic vasculitis in childhood, mainly affecting the skin, gastrointestinal tract, joints, and kidneys. Although the prognosis of Schönlein-Henoch is generally good, gastrointestinal tract involvement is a potential complication, presenting as massive gastrointestinal bleeding, bowel infarction, perforation, as well as intussusception and peritonitis.

Analysis of risk factors for acute pancreatitis complicated with pancreatic sinistral portal hypertension and construction of predictive model.

Objective: Pancreatic sinistral portal hypertension (PSPH) is a common complication of acute pancreatitis (AP) and can cause massive gastrointestinal bleeding, which is one of the causes of AP-related mortality. However, there is currently no predictive model for AP concurrent with PSPH. This study aimed to identify the risk factors for AP concurrent with PSPH and use these factors to build a related predictive model. Materials and methods: We collected clinical data from 282 patients with AP. 192 patients were used as a training group and 90 patients as a validation group. Univariate and multivariate analyses were used to identify independent risk factors for AP complicated with PSPH, and then a nomogram was established. The models are cross verification and Internal verification. The predictive ability and accuracy of the model were evaluated based on the working curve of the subjects and the calibration curve, respectively. The clinical value of the model was evaluated using decision curve analysis (DCA). Results: The univariate analysis revealed significant differences in the occurrence of PSPH with respect to sex, recurrent AP, history of hypertension, smoking history, patency of the splenic vein, pancreatic necrosis or pancreatic pseudocyst formation, the most significant site of pancreatic swelling, presence of a Dmure D polymer, MCTSI, and involvement of lipase and amylase. The logistic multivariate regression analysis showed that male sex, splenic-vein stenosis or occlusion and swelling were located in the body-tail, and MCTSI was an independent risk factor for PSPH. The nomogram and ROC curve were constructed. The area under the working curve of the subjects was 0.91, and the sensitivity and specificity were 82.5% and 89.1%, respectively. In the validation group, the C-index is 0.826. The nomogram was internally validated using 1,000 bootstrap samples, and the c-index was 0.898. The calibration curve demonstrated that the predicted probability was concordant with the observed probability, and the DCA confirmed that the model had robust clinical utility. Conclusion: Male sex, splenic-vein stenosis or occlusion, recurrent AP, and swelling are located in the body-tail, and MCTSI is an independent risk factor for the occurrence of PSPH. The predictive model developed for AP complicated with PSPH may serve toward developing preventive and therapeutic approaches for PSPH.

Primary plasma cell leukemia discovered during a case of acute anemia following gastrointestinal bleeding

Plasma cell leukemia can occur in undiagnosed patients with myeloma. The existence of anemic syndrome with intolerance symptoms following massive gastrointestinal bleeding can mislead the diagnosis. Careful reading of blood smears is essential, especially in regions of the world with a weak technical platform. In this case, abnormal plasma cells were found on the blood smear. The myelogram revealed a bone marrow infiltration by dysmorphic plasma cells. An immunophenotypic analysis discovered circulating plasma cells, which helped to establish the diagnosis. A methodical identification of the etiology of anemia is needed to discover causes of anemia more easily.

Recurrent Massive Gastrointestinal Bleeding as a first presentation of AL Amyloidosis in a 76-Year-Old Patient

Background: Light chain or AL amyloidosis is a systemic disease that occasionally involves the gastrointestinal tract, but very rarely presents as gastrointestinal bleeding without evidence of systemic involvement. In such cases recognition of amyloidosis as the cause of bleeding is essential in order to rapidly initiate effective treatment to stop the bleeding. Case presentation: We describe a 76-year-old patient who presented with recurrent massive gastrointestinal bleeding as the initial manifestation of AL amyloidosis. One episode necessitated emergency right colectomy, and histopathological analysis of the resected bowel revealed diffuse amyloid infiltration. This finding prompted further investigations, which demonstrated elevated plasma lambda light chain levels, and 10% monoclonal plasma cells in the bone marrow. Treatment with bortezomib, dexamethasone, and daratumumab was initiated and no further gastrointestinal bleeding occurred. Conclusion: The diagnosis of amyloidosis involving the gastrointestinal tract should be considered in adult patients with unexplained recurrent gastrointestinal bleeding.

Dieulafoy's lesion, the endovascular approach as a therapeutic option when endoscopic treatment has failed: A case report and brief review

AbstractDieulafoy's lesion is defined as a dilated submucosal artery that can cause spontaneous rupture and massive gastrointestinal bleeding. It is usually an incidental finding and is identified as a prominent linear or serpentine artery.We report the case of a 47-year-old patient who presented with a Dieulafoy's lesion located in the gastric fundus, which was repeatedly treated with clipping and endoscopic sclerosis, without resolving. She presented to the interventional radiology service for endovascular treatment, which after performing angiography confirmed active bleeding at the level of the left gastric artery and proceeded to embolize with 2 coils. This is a case where endovascular treatment proves to be an effective and decisive option for the treatment of bleeding in this type of injury.

Bleeding Duodenal Diverticula Managed With Surgical Resection: A Case Report

The duodenum is the most common extra-colonic site of diverticulum. If present, it rarely manifests with symptoms or complications. A case is discussed involving a 78-year-old female who presented with massive upper gastrointestinal bleeding from duodenal diverticula. Due to hemodynamic instability, she eventually underwent duodenal resection, with a side-to-side duodenojejunostomy as a means of restoring intestinal continuity. The postoperative course was unremarkable. The patient was able to feed enterally and had no recurrence of bleeding. Conclusion/Learning Points: Duodenal diverticula are rarely symptomatic but remain to be a valid differential diagnosis for cases of massive upper gastrointestinal bleeding. It must be recognized in order to provide the most appropriate management. Surgical resection is indicated for patients who present with hemodynamic instability, or failure to improve by conservative or endoscopic means Key words: upper gastrointestinal bleeding, duodenal diverticulum

A Rare Autopsy Case of Aggressive Combined Hepatocellular-Cholangiocarcinoma with Stem Cell Features in A 59-Year-Old Female

Abstract Introduction/Objective Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare liver tumor with histologic and phenotypic features of both hepatocellular carcinoma and intrahepatic cholangiocarcinoma. It is believed to arise from hepatic progenitor cells. It consists of intermingled malignant biliary and hepatic tissue and thus is a distinct entity, rather than two separate coexisting malignancies. Methods/Case Report A 59-year-old female with a history of hepatitis C and cirrhosis presented with abdominal pain, shortness of breath, and altered mental status. She developed hematemesis and went into cardiac arrest. Massive transfusion and cardiopulmonary resuscitation were initiated. She was intubated, and an esophageal/gastric balloon was placed. She then underwent a procedure to relieve portal hypertension and related gastrointestinal bleeding. Despite extensive interventions, her condition continued to deteriorate. She expired one day after her initial presentation. Results (if a Case Study enter NA) At autopsy, the liver was diffusely and markedly fibrotic with numerous nodules of varying size with invasion into adjacent vasculature. Microscopic examination of the nodules revealed cHCC-CC with stem cell features and lymphovascular invasion. Further examination revealed tumor emboli scattered throughout the right lung. The patient’s history of chronic hepatitis C may have contributed to the development of her cHCC-CC. Although gross appearance resembled cirrhosis, upon microscopic inspection the nodules showed excessive tumor burden. Ultimately the patient had end stage liver disease due to the accumulation of damage and consequent fibrosis. This led to portal hypertension with subsequent massive gastrointestinal bleeding, hemorrhagic shock, and death. Conclusion cHCC-CC is a rare aggressive primary liver tumor with a poor prognosis. It can present with a cirrhotomemetic pattern with small nodules that can evade clinical and radiographic detection. Autopsy findings can provide valuable insights into the pathogenesis and clinical course of cHCC-CC, highlight the aggressive nature of the disease, and may inform future diagnostic and therapeutic strategies. Accurate diagnosis of this tumor is important for patient management and prognostication.

S826 Does Obesity Offer Protection in Massive Gastrointestinal Bleeding?

S826 Does Obesity Offer Protection in Massive Gastrointestinal Bleeding?

A case of hemorrhagic shock due to massive upper gastrointestinal bleeding: from the differential diagnosis to the correct management

Upper Gastro-Intestinal Bleeding (UGIB) spans from minor bleeding to life-threatening events. Identification of early signs of shock, proper management of hemodynamically unstable patients, and correct risk stratification are essential for an appropriate diagnostic workup and therapy. This case reports a young man admitted to the emergency department with haematemesis. His medical history was unremarkable, without any risk factors for gastrointestinal bleeding. A few hours after admission, further episodes of haematemesis occurred, and the patient's condition rapidly deteriorated to irreversible shock. A contrast-enhanced computed tomography (CECT) revealed morphological features of chronic liver disease and oesophagal varices. The patient underwent upper gastrointestinal endoscopy, confirming oesophagal varices with massive bleeding. Although promptly applied, endoscopic hemostasis was ineffective, and the patient died twenty-four hours after admission. Based on this case, we reviewed the diagnostic and therapeutic approaches for patients with massive UGIB and provided a practical approach to this life-threatening emergency.

Roux-en-Y biliary reconstruction as a definitive treatment for serious complications of portal biliopathy. Case series.

Portal biliopathy (PB) is an abnormality of the biliary tree wall due to extrahepatic portal hypertension. Among the complications of portal biliopathy are digestive bleeding, jaundice, and cholangitis. Surgical treatment is an exception when medical management is not possible. This is a case series study of four patients with severe PB complications requiring surgical management in our center from 2005 to 2016. Two of them had previous surgical procedures related to portal hypertension. All presented with severe biliary stenosis and recurrent cholangitis, and two also had massive upper gastrointestinal bleeding. Because of endoscopic management failure, a Roux-en-Y hepaticojejunostomy was performed in all cases. Two patients presented morbidity Clavien-Dindo>IIIA, requiring reoperation. During follow-up, no one developed other complications related to PB. Surgical treatment for PB complications is a challenge and mainly implies a portosystemic shunt as a first step. When it fails, an alternative is perform a biliodigestive anastomoses, with high risk of bleeding given the prominent collaterals present in the hepatoduodenal pedicle secondary to portal cavernomatosis. Our patients after YRGB didn't present new complications due to PB. The surgery could be a definite solution for PB complications. It has only been made for selective cases because it implies high complexity and risk.

Severe gastrointestinal involvement in pediatric IgA vasculitis: a retrospective single-center cohort study in China.

The study aimed to describe the characteristics of gastrointestinal (GI) involvement in a cohort of hospitalized children with IgA vasculitis (IgAV) in China. We reviewed the records of hospitalized IgAV patients from January 2014 to December 2020 at one tertiary medical center. The patients were divided into the severe GI group and the non-severe GI group according to the presence of massive GI bleeding and complications. The clinical manifestations, laboratory factors, and treatment were analyzed between the two groups. A total of 1,179 patients were hospitalized due to IgAV. GI involvement was noted in 50% (589) of the patients, of whom 288 (48.9%) had severe GI involvement. GI complications were observed in 34 patients with IgAV with GI involvement. Rare onset age (<3 years or within 13-17 years), purpura above the waist, vomiting, high neutrophil-to-lymphocyte ratio, and decreased serum albumin were factors associated with severe GI involvement. Frequencies of renal involvement and biopsy-proven nephritis were higher in the severe GI group. The most commonly used medications were corticosteroids (100.0%) in the severe GI group. The maximum corticosteroid dose was higher (2.9 vs. 2.0 mg/kg), and more second-line therapies were needed (30.9% vs. 16.94%) in the severe GI group. Severe GI involvement in children is common in our center. Rare onset age, purpura above the waist, vomiting, high neutrophil-to-lymphocyte ratio, and decreased serum albumin are associated with severe GI involvement. Patients with severe GI involvement need higher doses of corticosteroids and second-line therapy.

A Rare Case of Massive Gastrointestinal Bleeding as a Cause of Death in a Young Adult with Catastrophic Granulomatosis Polyangiitis

A Rare Case of Massive Gastrointestinal Bleeding as a Cause of Death in a Young Adult with Catastrophic Granulomatosis Polyangiitis

Convoluted tumorous lesions at second portion of duodenum in a cirrhotic patient with massive upper gastrointestinal bleeding and shock

Convoluted tumorous lesions at second portion of duodenum in a cirrhotic patient with massive upper gastrointestinal bleeding and shock

Solid Pseudopapillary Tumor of Pancreas in a 14-year-old Adolescent Presenting With Melena: A Case Report

Background: The incidence of pancreatic neoplasms in infants and children is 1.8 cases per 1000000. Three of children’s most common primary pancreatic neoplasms are pancreatoblastoma, solid pseudopapillary neoplasm of the pancreas, and pancreatic endocrine neoplasms. Solid pseudopapillary neoplasm of the pancreas is a low-grade malignant tumor. Solid pseudopapillary neoplasm in children is presented with a palpable mass (60%), followed by abdominal pain (33.3%). Although duodenal invasion frequently occurs in patients with pancreatic cancer, massive gastrointestinal bleeding is seldom encountered. The most helpful imaging technique is the CT scan. Surgical resection is the treatment of choice for solid pseudopapillary neoplasms. Case Presentations: A 14 years old male adolescent was presented to our pediatric emergency department with fatigue, dizziness, fever, vomiting, and tachycardia. He had melena 5 days before admission. Crystalloids, pantoprazole, and packed red blood cells were administered to stabilize the patient. As the initial resuscitation measures stabilized the patient, endoscopic gastroduodenoscopy was performed, and a vascular lesion measuring 60×70 mm was noted in the second part of the duodenum. CT scan of the abdomen with intravenous and oral contrast showed a mass with solid and cystic components measuring 75×52 mm between the head of the pancreas and gallbladder origination from the head of the pancreas. The patient underwent Whipple surgery. The diagnosis of the pathologic evaluation was a solid pseudopapillary tumor of the pancreas. Conclusions: Most pediatric pseudopapillary tumors of the pancreas present with a palpable mass and abdominal pain, and gastrointestinal bleeding is a rare presentation not mentioned in previous case reports.

Massive Ulcerative Upper Gastrointestinal Bleeding: Surgical Treatment, Techniques and Results (Experience of a Moroccan Surgical Emergencies Department)

Introduction: Upper digestive haemorrhages represent a medico-surgical emergency that can be life threatening. Material and Method: this was a retrospective study that was carried out over a period of five years (2015- 2019) in the Department of Surgical Emergencies of the Ibn Sina University Hospital of Rabat, involving six patients aged between 36 and 82 years. Result: the clinical symptoms was marked by hematemesis and melena in five patients, rectal bleeding in one patient, epigastralgia preceding the gastrointestinal bleeding in 3 patients. All of our patients presented with heavy bleeding. One of our patients had a history of bulbar ulcer complicated by peritonitis, four patients are chronic smokers. Medication intake was noted in two patients. The oesogastro-duodenal fibroscopy made the diagnosis and showed a gastro-duodenal ulcer in all the patients. All patients underwent surgical treatment: three ulcer sutures and three antrectomies. Haemostasis was ensured in five patients, surgical revision was necessary in one patient with postoperative hemodynamic instability. Discussion: In light of these results and a review of the literature, surgery remains the essential recourse in the event of severe bleeding from peptic ulcer. Conclusion: haemorrhagic ulcer is the most common cause of upper ulcerative digestive haemorrhages, its diagnosis is clinical and endoscopic, emergency surgery is immediately indicated in the case of massive bleeding.

(112) An Experimental Animal Study of the Histopathological Effect of Collagen Fleece (TachoSil) Patch of Tunica Albuginea Defects Associated with Penile Surgery

Abstract Introduction A penile tunica defect may arise during penile prosthesis surgery or reconstruction of the penis in patients with Peyronie’s disease. Collagen fleece (TachoSil) was recently reported in penile surgery to cover the tunica defect with reported clinical success. However, it is not known what the histological outcomes of these grafts are in the penis. Objective We study the novel application of TachoSil graft in an experimental animal model. We looked at the regeneration of tunica albuginea, development of inflammation and fibrosis, and histopathological effect on the underlying cavernous tissue. Methods Seven adult male Sprague Dawley rats were used. All procedures were carried out under general inhalation anesthesia. The penis was degloved through a circumferential subcoronal incision. A longitudinal 1x10 mm defect was created at the base of the lateral aspect of the penis. A TachoSil patch (Takeda, Japan) was applied to the defect in six rats and Surgicel (Ethicon) in one. The penile skin covering is then restored and fixed with interrupted 5-6 zero absorbable sutures. At two months, the rat penis was evaluated for excision. Euthanasia was carried out with an overdose of inhalation anesthesia and chest opening. The excised penis was examined by hematoxylin and eosin and trichrome stains. Results At the time of surgery, the rats’ weight was 390 gm (SD 33.8). All rats with TachoSil showed normal-looking penis at two months with complete healing, no scaring, tethering, or gross inflammatory features. The penis of three rats with a Tachosil patch was harvested at two months postoperatively. It showed histopathology of fibrosis, chronic inflammation, and foreign body giant cell reaction at the site of the patch. There was no generation of a new tunica albuginea, no new vascularity or distinct fibrous layer development. The underlying corpus cavernous tissue was not affected by any inflammatory or pathological reaction. One rat died on the 6th postoperative day. Postmortem showed massive gastrointestinal bleeding, intraperitoneal hemorrhage, and punctate hemorrhages of the parenchyma of both suprarenal glands, both kidneys, and the liver. A clinical diagnosis of DIC was made. Histopathology of the penis, however, did not show micro thrombosis. The fifth rat with a Surgicel patch showed immediate hematoma of the penis controlled by compression. After two months, during harvesting of the penis, large pockets of pus were seen spreading from the site of the patch to surrounding structures. Histopathology showed chronic inflammation and fibrosis extending into the corpus cavernosum. The sixth and seventh rats showed normal penis external appearance at two months and were left surviving for harvest at four months. Conclusions Tachosil patching of penile tunica albuginea defect forms a distinctive barrier against inflammation protecting the underlying corpus cavernosum. However, no regeneration of tunica defect is observed at two months. DIC is a potential complication of systemic absorption of TachoSil. Disclosure No

Paediatric gastrointestinal endoscopy in the Asian-Pacific region: Recent advances in diagnostic and therapeutic techniques.

There has been a rapid expansion in the knowledge of paediatric gastroenterology over the recent decade, with a fast-growing repertoire of diagnostic techniques and management strategies for a wide spectrum of childhood gastrointestinal (GI) diseases. Paediatric GI endoscopy is a core competency every paediatric gastroenterologist should possess, and represents one of the most common procedures performed in children for both diagnostic and therapeutic purposes. Yet there remains a dearth of literature on the utility and outcomes of paediatric GI endoscopy in the Asia-Pacific region. Data on the diagnostic value of paediatric GI endoscopy would be an important aspect of discussion, with the emergence of inflammatory bowel disease (IBD) and eosinophilic GI disease as increasingly common endoscopic diagnoses. Time-based trends in paediatric GI endoscopy do point towards more IBD and gastroesophageal reflux disease-related complications being diagnosed, with a declining incidence of GI bleeding. However, the real-world diagnostic value of endoscopy in Asia must be contextualised to the region-specific prevalence of paediatric GI diseases. Helicobacter pylori infection, particularly that of multidrug-resistant strains, remains a highly prevalent problem in specific regions. Paediatric functional GI disorders still account for the majority of childhood GI complaints in most centres, hence the diagnostic yield of endoscopy should be critically evaluated in the absence of alarm symptoms. GI therapeutic endoscopy is also occasionally required for children with ingested foreign bodies, intestinal polyposis or oesophageal strictures requiring dilation. Endoscopic haemostasis is a potentially life-saving skill in cases of massive GI bleeding typically from varices or peptic ulcers. Advanced endoscopic techniques such as capsule endoscopy and balloon-assisted enteroscopy have found traction, particularly in East Asian centres, as invaluable diagnostic and therapeutic tools in the management of IBD, obscure GI bleeding and intestinal polyposis. State of the art endoscopic diagnostics and therapeutics, including the use of artificial intelligence-aided endoscopy algorithms, real-time confocal laser endomicroscopy and peroral endoscopic myotomy, are expected to gain more utility in paediatrics. As paediatric gastroenterology matures as a subspecialty in Asia, it is essential current paediatric endoscopists and future trainees adhere to minimum practice standards, and keep abreast of the evolving trends in the diagnostic and therapeutic value of endoscopy. This review discusses the available published literature on the utility of paediatric GI endoscopy in Asia Pacific, with the relevant clinical outcomes.

Blue rubber bleb nevus syndrome with massive gastrointestinal hemorrhage and pulmonary embolism: A case report

Blue rubber bleb nevus syndrome with massive gastrointestinal hemorrhage and pulmonary embolism: A case report