Recurrent Intestinal Bleeding Research Articles

A case of massive recurrent small intestinal bleeding

The article presents a clinical case of massive recurrent bleeding from angioectasias of the jejunum in a 66-year-old patient. Within 13 months in the conditions of the GBUZ KKB No. 2, Krasnodar, the patient underwent: 1 video capsule examination of the small intestine, 3 esophagogastroduodenoscopy, 3 colonoscopy, 3 balloon-assisted enteroscopy. At the place of residence, the patient repeatedly underwent blood transfusions, as well as endoscopic examinations of the upper and lower parts of the digestive tract. In our facility, the patient underwent diagnostic laparoscopy, and twice-resection of the jejunum area that carries vascular malformation.

Успешное хирургическое лечение пациента с профузным кровотечением из дивертикула Меккеля на фоне декомпенсированного цирроза печени

Meckel’s diverticulum is an important issue of modern surgery due to challenges in the diagnosis of its complications. Among them, intestinal bleeding is estimated at 5%. A man with gastrointestinal bleeding of unknown cause was urgently admitted to the surgical department of the Samara State Medical University. Previously, the patient was diagnosed with chronic hepatitis C and decompensated hepatic cirrhosis. Blood tests revealed reduced hemoglobin and RBC, increased WBC, ALAT, and ASAT, and abnormal coagulation. Abdominal ultrasound revealed enlarged liver and intraperitoneal fluid. Esophagogastroduodenoscopy and colonoscopy failed to identify any source of bleeding. Medical therapy was ineffective. Considering recurrent intestinal bleeding, the patient underwent laparotomy. After the dissection of the ileum, a vein of the submucosal layer of Meckel’s diverticulum with fresh blood coming from a defect was detected. Resection of the ileum with diverticulum was performed, intestinal anastomosis was constructed. The postoperative outcome was good. The patient was discharged with relevant recommendations. This observation is rather uncommon. Published papers describe only single cases of intestinal bleedings in patients with decompensated hepatic cirrhosis. KEYWORDS: Meckel’s diverticulum, hepatic cirrhosis, profuse intestinal bleeding, resection of the ileum. FOR CITATION: Katorkin S.E., Bystrov S.A., Andreev P.S. et al. Successful surgery for profuse bleeding from Meckel’s diverticulum in a patient decompensated hepatic cirrhosis. Russian Medical Inquiry. 2021;5(3):162–164. DOI: 10.32364/2587-6821-2021-5-3-162-164.

Difficulties the Conservative Treatment of Crohn’s Disease Complicated by Autoimmune Hemophilia A

Aim . To present a clinical case describing the management of a patient with Crohn’s disease complicated by recurrent intestinal bleeding and autoimmune hemophilia A. General provisions: A 21-year-old patient was admitted to St. Petersburg City Hospital No. 26 and diagnosed with Crohn’s disease with the lesions of the ileum, sigmoid and rectum in inflammatory form and continuously recurrent course. Upon admission, the patient demonstrated an elongated activated partial thromboplastin time (aPTT). In this connection, the levels of VIII (FVIII) and IX (FIX) coagulation factors and the content of von Willebrand factor antigen were determined. A study was conducted to the antibodies to these factors connecting von Willebrand factor capabilities with type I and III collagen. A 7 % decrease in the FVIII level and the presence of FVIII antibodies were detected. The patient was diagnosed with autoimmune hemophilia A. On August 14 in 2019, pulse therapy with methylprednisolone of 1000 mg per day by intravenous drip was started. After the first infusion, the aPTT index returned to normal and comprised 30 seconds, while the FVIII activity increased to 255 %. Conclusion. The presented clinical case demonstrates the importance of timely diagnosis and treatment of acquired coagulopathy. Acquired hemophilia A can be a life-threatening condition. When acquired coagulopathy develops in a patient with bleeding against the background of an inflammatory bowel disease, it aggravates the course of the disease and worsens the prognosis.

CAVERNOUS HEMANGIOMA OF THE JEJUNUM, AS A SOURCE OF RECURRENT INTESTINAL BLEEDING IN A 11-YEAR-OLD CHILD

Gastrointestinal hemangioma (GIH) is a benign vascular formation located in different parts of the intestinal tube. The clinical significance of hemangiomas of the gastrointestinal tract is usually associated with the development of complications such as gastrointestinal bleeding, invagination, intestinal obstruction or bowel perforation. Aim of the study. Demonstration of a rare clinical observation of jejunal cavernous hemangioma as a cause of recurrent intestinal bleeding. Material and methods. A boy, 11 years old, admitted to the Institute with complaints of chronic anemia and recurrent intestinal bleeding of unknown etiology. There was made a complex diagnostic search, including laboratory and instrumental methods, with a video capsular study of the gastrointestinal tract and angiography of the abdominal cavity. Results. At the base of the video capsular study of the gastrointestinal tract, the vascular formation of the jejunum, which is a possible source of intestinal bleeding, is suspected. The vascular structure of the formation is confirmed by angiography. During laparoscopy, a cavernous hemangioma with a diameter of about 1.5 cm was detected. Hemangioma was located in the wall of the jejunum and prolapsed both into the lumen of the intestine and from the side of the serous membrane. Under micro laparotomic access in the umbilical region, there was performed a resection of the jejunum area with the imposition of the anastomosis "end to end". A morphological diagnosis was confirmed. The postoperative period was uneventful. Conclusion. The cavernous hemangioma of the jejunum is rare and difficult to diagnose the cause of recurrent intestinal bleeding. The use of modern diagnostic and surgical technologies ensures timely and mini-invasive treatment, which leads to rapid recovery of the patient and ensures the cost-effectiveness of treatment.

You Can't Heyde Forever.

Heyde’s syndrome describes an association between aortic stenosis and a predisposition to bleeding from intestinal angiodysplasia resulting from acquired von Willebrand disease.We present the case of an 82-year-old woman with recurrent intestinal bleeding, severe anaemia and secondary myocardial infarction. Investigation identified ileal angiectasia as the source of haemorrhage. As echocardiography revealed severe aortic stenosis the patient underwent surgical valve replacement. At her 3-month follow-up, the patient reported no new bleeding episodes and her functional status had improved.This case highlights Heyde’s syndrome, an entity probably underdiagnosed despite the high prevalence of aortic stenosis and intestinal angiodysplasia in elderly patients.LEARNING POINTSIn a patient with bleeding intestinal angiectasia, Heyde’s syndrome should be considered in the differential diagnosis.Although supportive therapy is crucial for clinical stabilization, aortic valve replacement is the therapeutic gold standard.Appropriate management of these patients requires a multidisciplinary approach.

Octreotide for recurrent intestinal bleeding due to ventricular assist device

We report the case of a 64-year-old Jarvik 2000 recipient with a high risk of bleeding (anticoagulation treatment and acquired von Willebrand disease), who presented with intractable gastrointestinal hemorrhage due to severe gastric angiodysplasia. He was successfully treated with long-acting octreotide.

Small-Bowel Angiectasia as Detected by Capsule Endoscopy and Treated at Balloon Enteroscopy

In this article, the video demonstrated is an example of a 76-year-old male patient who presented with recurrent intestinal bleeding of unknown origin at the university hospital. Previously performed upper and lower gastrointestinal tract endoscopy did not reveal a bleeding lesion. Capsule endoscopy revealed small-bowel angiectasia that were treated by argon plasma coagulation at subsequent balloon enteroscopy. This article is part of an expert video encyclopedia.

Successful Medical Treatment for Recurrent Intestinal Bleeding Induced by Portal Hypertension in Biliary Atresia

Successful Medical Treatment for Recurrent Intestinal Bleeding Induced by Portal Hypertension in Biliary Atresia

THE CASE OF SURGICAL TREATMENT OF A CHILD WITH A DOUBLING OF THE ILEUM

научный биометрический журнал, который знакомит читателя с клиническими рекомендациями и особенностями применения лекарственных и вакцинных средств у детей, предоставляет исчерпывающую информацию о воздействии лекарственных средств на плод, о проводимых в

A Case of Primary Colon Amyloidosis Presenting as Hematochezia

Amyloidosis is characterized by a deposition of insoluble fibrils in various organs and tissues. Amyloid deposition, in the gastrointestinal track, provokes a dysfunction of the organ, due to an accumulation of fibrils, and causes a variety of clinical symptoms and endoscopic findings. Primary amyloidosis in the gastrointestinal tract is rarely reported in Korea. We experienced a case of recurrent intestinal bleeding, in a 59-year-old female patient with primary amyloidosis. A colonoscopy revealed the presence of multiple large circular ulcers. In the entire colon, diffuse nodular lesions with edema and bleeding were found. A colonoscopic biopsy established the diagnosis of amyloidosis, to the exclusion of other disease components. We concluded that the patient had localized amyloidosis. Though a definitive therapeutic strategy has not been established for localized gastrointestinal amyloidosis, the patient has been successfully treated with a high-dose of steroids and azathioprine.

Ectopic varices in portal hypertension

Ectopic varices (EcV) accounting for 1-5% of all varices in portal hypertension are composed of dilated portosystemic collaterals located in unusual sites instead of the most known gastroesophageal region. The difficulty in localization of bleeding is a great burden on the management of these patients. Herein, we present patients with EcV as well as with portal hypertension and recurrent intestinal bleeding. The sites of EcV were identified with computed tomographic angiography, after a series of inconclusive endoscopies, and moreover a selective celiac arteriographic examination of one of the patients.

Octreotide for recurrent intestinal variceal bleeding in patients without portal hypertension

We report on the efficacy of octreotide acetate in two patients with intestinal phlebectasia and no evidence of portal hypertension or mesenteric thrombosis. Patient 1 was a 46-year-old woman with primary pulmonary arterial hypertension. She required repeated transfusions for recurrent episodes of gastrointestinal bleeding (GIB). Intraoperative enteroscopy revealed wide-spread small bowel phlebectasia and intestinal resection was not performed. Blue rubber-bleb syndrome, portal hypertension and mesenteric thrombosis were ruled out. Octreotide acetate long-acting release was started. A transient interruption in treatment was followed by severe overt GIB. This was effectively controlled with continuous infusion of octreotide acetate. After this episode, octreotide acetate long-acting release was resumed and no further episodes of GIB have been reported until the most recent follow up (total duration of 74 months). Patient 2 was a 51-year-old woman with a history of recurrent GIB requiring multiple blood transfusions since young adulthood with negative endoscopic investigations. An enteroscopy showed numerous submucosal serpiginous varices in the colon and the terminal ileum. All putative causes including portal hypertension or mesenteric thrombosis were ruled out. Monthly intramuscular injections of long-acting octreotide acetate were initiated, and no GIB occurred since then (27 months of follow up). Somatostatin analogues are known to reduce splanchnic blood flow, to increase vascular resistance, to enhance platelet aggregation; and are thus efficacious in preventing GIB secondary to various vascular lesions (portal hypertension, intestinal angiodysplasia and blue rubber-bleb syndrome). These case reports suggest that they are also effective in preventing GIB in intestinal phlebactasia without portal hypertension.

Kapselendoskopie

Video capsule endoscopy provides a noninvasive diagnostic approach to the entire small intestine. The main indications are suspected chronic or recurrent obscure intestinal bleeding, which can-not be clarified by esophago-gastro-duodenoscopy and colonoscopy. Further indications are polyposis syndromes, suspected Crohn's disease and malignomas of the small bowels. Esophago-gastroduodenoscopy and colonoscopy are essential preceding diagnostic procedures before capsule endoscopy.

Extraction of Entrapped Capsules from the Small Bowel by Means of Push-and-Pull Enteroscopy with the Double-Balloon Technique

The new technique of push-and-pull enteroscopy using the double-balloon technique (double-balloon enteroscopy) makes it possible to remove swallowed foreign bodies causing intestinal obstruction deep in the small bowel without the need for surgical laparotomy. This report describes two cases of enteroscopic removal of entrapped capsules. In one patient with acute recurrent intestinal bleeding and recurrent abdominal pain, Crohn's disease had been suspected on capsule endoscopy. The second patient, with known Crohn's disease, was suffering from abdominal pain and underwent capsule endoscopy for investigation of the small bowel. Prior enteroclysis had not revealed stenoses in either patient. An oral approach was chosen and the capsules were identified approximately 140 cm and 310 cm from the pylorus, respectively, in front of stenoses. The capsule endoscopes were removed successfully in both patients by means of push-and-pull enteroscopy using a new enteroscope device.

Recurrent intestinal angiodysplastic bleeding in a patient on hemodialysis ceasing spontaneously with CAPD

Recurrent intestinal angiodysplastic bleeding in a patient on hemodialysis ceasing spontaneously with CAPD

Transjugular intrahepatic portosystemic shunt in an infant

A 15-month-old girl, who presented with biliary cirrhosis secondary to cystic fibrosis with refractory ascites and recurrent intestinal bleeding, underwent percutaneous transjugular intrahepatic portosystemic shunting. Immediately following the procedure the ascites disappeared and no further bleeding occurred. The stent shunt was patent on Doppler ultrasound until the 22nd day. The patient died on day 22 because of liver failure due to a low-flow syndrome with severe hepatic ischaemia, but with no recurrence of bleeding or ascites.

Recurrent Intestinal Bleeding from jejunojejunostomy Caused by Portal Hypertension Following Hepatoportojejunostomy in Extra Hepatic Biliary Atresia (EHBA) - Successful Treatment by Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Premier rapport sur l'application d'un shunt transjugulaire intra-hepatique portosystemique (TIPS) pour traiter une hemorragie intestinale recidivante venant de l'anastomose distale de l'hepatoportojejunostomie chez un enfant presentant une atresie biliaire extra-hepatique et une hypertension portale.

Angiomyoma and Vascular Ectasia of the Small Bowel as a Cause of Intestinal Bleeding

A case is reported of a 31-year-old woman complaining of recurrent intestinal bleeding caused by an angiomyoma of the wall of the duodenojejunal flexure with diverticular features, accompanied by vascular ectasia of the overlying submucosa.