Massive Melena Research Articles

A CASE OF INTRAARTERIAL INFUSION OF VASOPRESSIN FOR MASSIVE BLEEDING FROM AN ARTERIOVENOUS MALFORMATION IN THE INTESTINE

Reports on gastrointestinal bleeding causing by an arteriovenous malformation (AVM) in the GI organs are increasing seen with a progression in its diagnostic technology. Surgical excision is commonly employed for this disease, but we often have difficulties to perform emergency operation at massive bleeding. Recently a case of massive melena from an AVM in the large intestine in a 46-year-old man is experienced. The diagnosis was made based on abdominal antiography. Since his general condition was poor, a catheter was continuously indwelled without choice. Sustained intraarterial vasopressin infusion successfully managed the bleeding. There has been no bleeding, as of about 2 years after the treatment. Evaluation of everlasting effect of this vasopressin regimen for a colorectal AVM would demand further long-term follow up and accumulation of such cases. This regimen can at least be the first choice on serious cases having high risks for operation, like this case.

THREE CASES OF BENIGN INTESTINAL LESION WITH MASSIVE MELENA

We have experienced 3 cases of benign intestinal lesion in an 18-year-old male with an ulcerating Meckel's diverticulum and associated massive melena, in a 65-year-old female with jejunal AVM, and in a 44-year-old female with jejunal hemangioma. All three cases were got well after operation and followed up.From these experiences the following facts could be drawn out: (1) In dealing with acute or chronic gastrointestinal bleeding of unknown etiology, vascular lesion on the small intestine should be considered as a possible case; (2) Immediate abdominal angiography may be useful for diagnostic and therapeutic aids in intestinal diseases associating with massive malena; (3) When the sourse of bleeding is difficult to identify macroscopically during operation, it is recommendable and even essential to perform intraoperative endoscopy while irrigating the international lumen; (4) In order to minimize the intestinal resection, operation should be most desirably performed while the lesion in bleeding if clinical conditions permit; (5) When the location of the lesion can not be found during surgery, a resection longer than angiographically estimated segment of the intestine is advisable to minimize the bleeding lesion left unresected.Diagnosis and treatment in the 3 cases are delineated with some comments about relevant literature.

A CASE OF REPORT OF COMPLICATING MASSIVE HEMORRHAGE RESULTING FROM TYPHOID INFECTION

A 56-year-old man was admitted with a 10 day history of persistent melena and a fever of two week's duration. On examination he was toxic; temperature 38°C, pulse rate 130/min, and BP 80/50 mmHg. Abdominal examination revealed tenderness in the right lower abdomen. Blood profile showed Hgb. 10.2 g/dl, total leucocyte count 3000/μl, GOT 120, and GPT 62 mU/ml. Blood and stool culture did not show any pathogenic bacteria. Fiberscopy and angiography did not detect any bleeding focus. He developed massive melena with peripheral circulatory failure resistant to blood transfusion. Emergency laparotomy was performed. Multiple ulcers in the terminal ileum with mesenteric lymphadenopathy were detected. Proximal 180 cm of ileum showed tell-tale sign on its serosal surface. Ileocecal resection was performed with the resection of the ulcer bearing area of the ileum. The culture from resected mesenteric lymph nodes was positive for Salmonella typhi organism. Histological examination of resected specimen showed massive intramural hemorrhage associated with infiltrated large lymphocytes and typhus cells. The patient made a rapid recovery with chloramphenicol therapy in the postoperative period.

Cardiogastric fistula occurring 9 years after resection of left ventricular aneurysm

An 83-year-old man, 9 years after repair of a postinfarction aneurysm of the left ventricle, developed fever, anemia, and congestive heart failure. Extensive evaluation of the gastrointestinal tract revealed no evidence of ulcer disease. While in the hospital, he developed massive hematemesis and melena and died 2 days later. At autopsy, a communication existed between a left ventricular pseudoaneurysm and the stomach to form a cardiogastric fistula. Infection of the left ventricular pseudoaneurysm may have precipitated the gastric perforation. This represents an extremely rare late complication of aneurysmectomy procedures and, to our knowledge, is the first case to be reported in the absence of primary gastrointestinal pathology.

LEIOMYOBLASTOMA OF THE JEJUNUM, A CASE REPORT

We report a case of leiomyoblastoma of the jejunum in a 43-year-old man, who complained of melena, light abdominal pain, and an abdominal mass. He had experienced massive melena 2 times, 6 and 10 years ago. The mass was 17×13cm in size and X-ray examination showed a filling defect existing at the jejunum 4cm distal from the Treitz's ligament. Endoscopy confirmed its location and angiography showed hepatic metastasis. An operation was successfully performed. The resected specimen showed a necrotic polypoid tumor measuring 15.0×12.5×11.0cm, and partial perforation to the omentum. Microscopic examination confirmed that the tumor was leiomyoblastoma. Leiomyoblastoma of the intestine is so rare compared to that of the stomach, as far as we could review, that only 27 oases including this case had been reported in Japan.

A CASE OF SPLENIC ARTERY ANEURYSM RUPTURED INTO THE PANCREATIC DUCT

We experienced a case of splenic artery aneurysm ruptured into the pancreatic duct which led to massive melena. The case is a 55-year-old man, who came to our hospital with the complaint of melena. General blood examination confirmed remarkable anemia (RBC 258×104/mm3, Hb 4.4g/dl, Hct 17.8%, but upper digestive 4.4g/dl, Hct 17.8%), but upper digestive endoscopy, small intestinography and enema obtained no findings suggestive of the source of hemorrhage. ERCP revealed a 28×20mm collection of the contrast medium at the pancreatic tail region and abdominal angiography revealed an 13×11mm aneurysm 3cm distally from the bifurcatio splenica, but not extravasation or deep stained tumor image. Under preoperative diagnosis as splenic aneurysm and pancreatocystic tumor, resection of the pancreatic tail portion associated with the spleen, including the splenic aneurysm was carried out. Resected specimen disclosed that cystic tumor was inexistent and splenic artery dilating cystically inside the pancreas with its lumen comprising thrombi and being partially very thin in communication with the pancreatic duct. The postoperative course was uneventful. Splenic artery aneurysm ruptured into the pancreatic duct is so rare that only 8 cases have so far been reported in Japan. Digestive hemorrhage of an unknown origin, if any, should be examined with suspicion of the present disease.

Rupture of a Dacron aortic prosthesis into the jejunum

A 55-year-old man was admitted to the hospital with massive melena and shock. He had a history of Dacron Y graft reconstruction for aortoiliac atheroscerotic occlusive disease 10 years before admission. At emergency laparotomy the jejunum was adherent to the graft. After separation a fistulous communication was detected between the two. A longitudinal tear in the stem of the graft was found. The graft was reconstructed with a Gore-Tex (Gore-Tex registered trademark of W.L. Gore & Associates, Inc., Elkton, Md.) patch. His postoperative course was uneventful.

A CASE OF JEJUNAL DIVERTICULOSIS WITH MASSIVE MELENA

A case of jejunal diverticulosis with massive melena, of which bleeding point was locally diagnosed by preoperative angiography, is reported. A 52-year-old male with the complaint of massive melena was admitted in pre-shock state. As anemia was not improved by conservative therapy and selective superior mesenteric angiogram revealed a bleeding lesion in the jejunum, emergency operation was performed. Two diverticula were recognized at the mesenteric border of the jejunum about 50cm and 130cm below the ligament of Treitz. Both of them were bilocular, and linear ulcers were found at their septums. A stump of artery was exposed in the ulcer of oral side diverticulum and the source of the bleeding was found macroscopically. Histopathologically a linear ulcer and ruptured artery at the bottom of the ulcer were shown and the additional discussion was made from a point of clinical surgery.

Angiodysplasia of the Small Intestine Associated with Aortic Stenosis

Angiodysplasia of the Small Intestine Associated with Aortic Stenosis

A CASE OF ANEURYSM OF THE RIGHT COMMON ILIAC ARTERY RUPTURED INTO APPENDIX

A case of aneurysm of the right common iliac artery with rupture into the appendix is reported.A 69-year-old man with massive melena received emergency surgery during shock. Upon laparotomy, a firmly adhering egg-sized sclerotic aneurysm of the right common iliac artery ruptured into the body of the appendix. With the procedure of appendectomy and partial aneurysmectomy, he recovered. However, six months later massive melena with shock occurred again, and he underwent reoperation. The residual aneurysm of the rifht common iliac artery regrew and ruptured into the sigmoid colon. Although removal of the entire aneurysm and femoro-femoral bypass was done, he died three days after reoperation with renal failure.Rupture of an abdominal aneurysm into the lower digestive tract is rare. This is considered the first case in Japan of a fistula between a common iliac aneurysm and the appendix. For the treatment of aneurysmo-lower intestinal fistula with massive melena, emergency operation consisting of the removal of the entire aneurysm and arterial reconstruction should be performed immediately to save the patient's life, rather than doing time-consuming diagnostic procedures.

A CASE OF ISCHEMIC COLITIS FOLLOWING A RUPTURED ABDOMINAL AORTIC ANEURYSM

A case of ischemic colitis following abdominal aortic aneurysmectomy in a 74-year-old male is reported. The patient was admitted to the hospital with a complaint of severe abdominal pain. A ruptured abdominal aortic aneurysm was suspected, and emergency laparotomy was performed. At the operation a massive hematoma was encountered in the retroperitoneal space caused by rupture of an abdominal aortic aneurysm. Aneurysmectomy was performed uneventfully. The left colon appeared to be viable at the end of the procedure. Three days after the operation he had diarrhea, and the symptoms of bowel ischemia progressed. Colonoscopy on the 7th day after the first operation revealed ischemic colitis. He was treated conservatively for 2 weeks without significant improvement. On the 19th postoperative day uncontrollable massive melena occurred. Emergency laparotomy was carried out again, and resection of the left colon and transverse colostomy were done. The postoperative course after the second operation was uneventful, and the patient is doing well now. Although clinically significant ischemic colitis following aortic reconstruction is rare, colonoscopy after the operation is useful for early recognition of ischemic changes before clinical manifestations.

Disseminated cytomegalic inclusion disease in an adult with cirrhosis of liver and review of literatures

We reported a 44 year old man with micronodular cirrhosis who eventually died from massive hematemesis and melena. At postmortem studies, there were disseminated cytomegalic inclusion bodies detected in various organs. In liver, intranuclear inclusion bodies were observed in cirrhotic liver. We discussed here possible pathogenesis of CMV (cytomegalovirus) infection in adults, in reviewing literatures.

Portal hypertension following exchange blood transfusion with complications of Listeria meningitis.

A male infant, 17 months, developed portal hypertension after two exchange blood transfusions and a prolonged umbilical vein catheterization during the neonatal period. Clinical course was characterized by an early onset of splenomegaly and after a latent period of time by a massive melena and hematemesis precipitated by Listeria meningitis. Treatment for portal hypertension consisted of splenectomy and proximal gastric devascularization. The importance of proper positioning of the catheter and avoidance of extended catheterization is recommended.

Diagnosis of Extrahepatic Portal Vein Obstruction

To the Editor.— In a recent article by Yale and Crummy entitled "Splenic Vein Thrombosis and Bleeding Esophageal Varices," the value of splenoportography and transarterial portography was emphasized in the preoperative evaluation of patients with bleeding gastroesophageal varices to allow identification of extrahepatic or segmental portal hypertension. 1 The authors correctly pointed out that the proper treatment of patients with extrahepatic portal obstruction should include splenectomy. In their excellent article, however, the authors did not mention another angiographic study, umbilical vein portography. The following case report is abstracted from previous papers. 2,3 Report of a Case.— A 58-year-old man was admitted because of massive hematemesis and melena. Marked splenomegaly was present, but the liver was not enlarged. Aside from leukocytosis, laboratory values, including liver-function tests, were within normal limits. An x-ray film series of the upper-gastrointestinal tract disclosed large esophageal, gastric, and duodenal bulb varices. A duodenal ulcer was suspected.

Colectomy in children with ulcerative and granulomatous colitis.

Seventy-five children, 15 of whom had granulomatous and 60 ulcerative colitis, were treated by a multidisciplinary team at the University of Michigan Medical Center between 1961 and 1970. The overall mortality was 9%. Fifty-three of these children underwent colectomy. Forty-one had ulcerative and 12 granulomatous colitis. Indications for operation included toxic dilatation of the colon, massive melena, and impaired growth. Impaired growth, as measured by height and weight, were responsible for colectomy in 17 children with ulcerative and six children with granulomatous colitis. Postoperatively, the height and weight distribution of the 37 surviving children with ulcerative colitis returned almost to normal. Three of 12 children with granulomatous colitis failed to develop an improved pattern of growth after operation.

Massive hemorrhage from jejunal diverticulosis

A case of unusual gastrointestinal hemorrhage from jejunal diverticulosis is reported. The literature is reviewed and all reported cases of hemorrhage are tabulated. Hemorrhage from jejunal diverticulosis is a disease of elderly persons and usually occurs as massive melena with clinical shock. This must be treated vigorously with both blood replacement and resection of the involved bowel.

A Type of Hepatic Bleeding

This is a report on three cases with massive bleeding into the digestive tract. In all cases, blood was found coming from the biliary tract via the biliary canaliculi. The hemorrhage was due to inflammatory bleeding in the Glisson's capsule caused by acute interstitial hepatitis. All patients were complicated with gallstone-like symptoms, urinary abnormal findings due to acute nephritis and impairment of the liver functions besides massive melena. They were all cured by administration of tetracycline. The author has found out that acute interstitial hepatitis could be one of the causes of massive melena.

Massive hemorrhage from diverticulitis of the colon.

Article1 June 1959MASSIVE HEMORRHAGE FROM DIVERTICULITIS OF THE COLONALEX W. ULIN, M.D., IRVIN H. SOKOLIC, M.D., C. THOMPSON, M.D., F.A.C.P.ALEX W. ULIN, M.D.Search for more papers by this author, IRVIN H. SOKOLIC, M.D.Search for more papers by this author, C. THOMPSON, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-50-6-1395 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptNothing can be more surgically urgent than massive hemorrhage. In hemorrhage of the gastrointestinal tract, unfortunately, the exact diagnosis and the easy surgical approach are too often missing. Consequently, the internist has assumed responsibility with the surgeon for managing these difficult emergencies. Despite the fact that it has been deëmphasized in the past, it has now come to be accepted that large bowel hemorrhage, sometimes of a severe nature, can and does arise from a colon with diverticulitis.1, 2, 7, 13, 14, 16Diverticulitis of the colon as a cause of massive hemorrhage is a serious problem and is not...Bibliography1. Fraenkel GJ: Rectal bleeding and diverticulitis, Brit. J. Surg. 41: 643, 1953-54. CrossrefGoogle Scholar2. Swinton NW: Surgical aspects of diverticulitis, Am. J. Surg. 82: 603, 1951. CrossrefMedlineGoogle Scholar3. Thompson W: Surgical significance of hematemesis and melena, Arch. Surg. 56: 623, 1943. Google Scholar4. WelchAllenDonaldson CEAWGA: Resection of the colon for diverticulitis of the sigmoid, Ann. Surg. 138: 332-343, 1953. CrossrefMedlineGoogle Scholar5. BrownMarday PWDM: Prognosis of diverticulitis and diverticulosis of the colon, J. A. M. A. 109: 1328, 1937. CrossrefGoogle Scholar6. Rosser C: Surgical management of diverticulitis, South. M. J. 32: 1203, 1939. CrossrefGoogle Scholar7. HoarBernhard GSWF: Colonic bleeding and diverticular disease of the colon, Surg., Gynec. and Obst. 99: 101-107 (July) 1954. MedlineGoogle Scholar8. WitteOvittConway DHDWJD: Surgical management of diverticulitis, J. Internat. Coll. Surgeons 19: 87-92 (Jan.) 1953. MedlineGoogle Scholar9. Linde SA: Diverticulosis and diverticulitis, J. Internat. Coll. Surgeons 19: 716-731 (June) 1953. MedlineGoogle Scholar10. Behrend M: Surgical treatment of diverticulitis of the colon, Pennsylvania M. J. 56: 553-558 (July) 1953. MedlineGoogle Scholar11. Cate WR: Colectomy in the treatment of massive melena secondary to diverticulitis, Ann. Surg. 137: 558-560 (Apr.) 1953. CrossrefMedlineGoogle Scholar12. FosterFisher RLRF: Colostomy as emergency treatment for massive melena secondary to diverticulitis, Am. Surgeon 20: 734-738 (July) 1954. MedlineGoogle Scholar13. QuinnOchsner WCA: Bleeding as a complication of diverticulitis of the colon, Am. Surgeon 19: 397, 1953. MedlineGoogle Scholar14. Turnbull GC: Massive hemorrhage from diverticula of the colon, Quart. Bull. Northwestern Univ. M. School 22: 292, 1948. MedlineGoogle Scholar15. Stone HB: Large melena of obscure origin, Ann. Surg. 120: 582, 1944. CrossrefMedlineGoogle Scholar16. Noer RJ: Hemorrhage as a complication of diverticulitis, Ann. Surg. 141: 674-685, 1955. CrossrefMedlineGoogle Scholar17. Stevens LP: Personal communication. Google Scholar18. Stanton A: Massive hemorrhage due to diverticula of the colon, Am. J. Gastroenterol. 24: 77-86 (July) 1955. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Philadelphia, Pennsylvania*Received for publication August 8, 1958.Read at the Regional Meeting of The American College of Physicians, Philadelphia, January, 1957.From the Albert Einstein Medical Center (Southern Division) and Hahnemann Hospital and Medical School, Philadelphia.Requests for reprints should be addressed to Irvin H. Sokolic, M.D., Department of Surgery, The Albert Einstein Medical Center, Southern Division, Fifth and Reed Streets, Philadelphia 47, Pennsylvania. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byDiverticular disease of the colonComplications of colonic diverticulitisReferencesAspects of the epidemiology of diverticular disease and ischemic heart diseaseCurrent knowledge of diverticular disease of the colonBleeding from diverticula of the colonDiverticular disease of the colon—A Disease of Western civilisationHemorrhage from diverticular disease of the colonDiverticular disease of the alimentary tractMassive hemorrhage from colonic diverticula caused by arterial erosion: A practical theory of its mechanism and causationSurgical management of colonic diverticulosis with massive hemorrhage by subtotal colectomyColitis: Management Based on Pathogenic MechanismsDiverticula, diverticulosis and diverticulitis of the colonTHE HIDDEN BLEEDING-POINT 1 June 1959Volume 50, Issue 6Page: 1395-1406KeywordsColonConstipationDiverticulitisGastrointestinal tractHemorrhageHypertensionSurgeons ePublished: 1 December 2008 Issue Published: 1 June 1959 PDF downloadLoading ...

Leukemic Infiltration of Colon

Leukemic infiltration of tissues of the body may occur late in the course of leukemia and result in bleeding from the gums or the gastrointestinal tract, or purpura. The bleeding is frequently a result of secondary thrombocytopenia. However, it is unusual for leukemic infiltration of the colon to produce massive melena. The purpose of this paper is to report a case in which massive melena resulted from leukemic infiltration of the colon. Leukemia as a cause of massive melena has been reported only rarely in the literature. Thompson and McGuffin 5 made a detailed study of a large series of patients with melena. Of the 293 cases studied, none had melena secondary to leukemia. Rives and Emmett 4 reviewed 129 cases of massive melena and found 1 case in which the cause was leukemia. Waterson 6 reviewed 170 cases of hematemesis and melena and found 1 case which was due

The surgical management of massive melena

When melena is associated with hematemesis its source is usually proximal to the ligament of Treitz. When melena occurs alone the bleeding may arise anywhere from the esophagus to the rectum. Operation is advised when the melena is obviously exsanguinating, persistent or repeatedly recurring. Many of the lesions causing melena can be diagnosed clinically. Their treatment will depend on the nature of the disease. In other patients a diagnosis cannot be made by the usual methods. In this group we advise diagnostic laparotomy while the bleeding is active, before the bleeding recurs too many times. In this manner bleeding Meckel's diverticula, extramural small bowel neoplasms, etc. may be discovered. If a lesion cannot be found, the highest level of intraluminal blood may serve as a guide to the bleeding point. Multiple enterotomies and colotomies are performed and the adjacent mucosa is intussuscepted into the opening in the bowel wall. If still no lesion is found, intestine containing obvious disease such as diverticulosis is resected. We believe, however, that in many elderly patients with sclerotic vessels the bleeding arises from rupture of an intestinal submucosal artery rather than from the coincidental diverticular disease. Illustrative case histories are included.