Severe Gastrointestinal Bleeding Research Articles

Clinical case: severe upper gastrointestinal bleeding and covid-19

La hemorragia digestiva alta en pacientes con COVID-19 es inusual y puede llegar a ser mortal. Se describe en hasta un 13 % de los pacientes hospitalizados con coronavirus. El tratamiento endoscópico es un desafío para el paciente debido al riesgo de insuficiencia respiratoria, como para el personal de salud debido al riesgo de transmisión aérea. Presentamos un caso clínico atípico de hemorragia digestiva alta grave por COVID-19.

Haematological changes in canine parvovirus infection

Canine parvovirus (CPV) infection is a highly contagious disease caused by canine parvovirus type 2 and commonly produce acute gastrointestinal illness. All dogs are susceptible to CPV, although some dogs are at greater risk than others, as puppies (between 6 weeks of age and 6 months), unvaccinated or incompletely vaccinated dogs. Due to the virus multiplication and effect on the bone marrow, severe haematological changes are reported, resulted also from the combination of severe inflammation, gastrointestinal bleeding and depletion of hematopoietic cell lines. In the present study, haematological changes in dogs diagnosed with CPV infection were analysed.

Duodenal dieulafoy injury: case report

Dieulafoy's lesion is a rare but important cause of upper or lower gastrointestinal bleeding, resulting from bleeding from a large arterial vessel. Its extragastric location is rare and the diagnosis is usually endoscopic, allowing simultaneous treatment either with injection of sclerosing substances or by mechanical means. We present the case of a 72-year-old woman with severe gastrointestinal bleeding with Dieulafoy's lesion in the duodenal bulb, successfully diagnosed and treated endoscopically.

Massive Gastro Intestinal Bleeding Revealing an Ileal GIST: A Case Report and Literature Review

Gastrointestinal stromal tumors (GISTs) are the most common malignant subepithelial lesions of the gastro-intestinal tract, they can be difficult to diagnose and have a varied clinical outcome. We report the case of a 70-year-old man who presented a recurrent and severe gastro intestinal bleeding revealing an ileal GIST. Upper GI endoscopy and colonoscopy showed no abnormalities, meanwhile abdominal CT scan revealed the tumor. The patient underwent surgery and the diagnosis of an ileal GIST was confirmed by histopathological evaluation.

S823 The Impact of a CT Angiography-Guided Protocol for Severe Lower Gastrointestinal Bleeding on Utilization and Outcomes

S823 The Impact of a CT Angiography-Guided Protocol for Severe Lower Gastrointestinal Bleeding on Utilization and Outcomes

S3104 Severe Gastrointestinal Bleed Due to Dieulafoy Lesion Treated With Endoscopic Ultrasound Guided Intervention

S3104 Severe Gastrointestinal Bleed Due to Dieulafoy Lesion Treated With Endoscopic Ultrasound Guided Intervention

Observation on the Clinical Effect of Emergency Interventional Therapy on Acute Severe Non- Variceal Upper Gastrointestinal Bleeding

Objective: To observe the clinical effect of emergency interventional therapy for patients with acute severe non-variceal upper gastrointestinal bleeding. Methods: 78 patients with acute severe non-variceal upper gastrointestinal bleeding who were treated in the General Hospital of the Eastern Theater Command from May 2020 to May 2023 were randomly divided into two groups according to different treatment plans. The study group underwent emergency upper gastrointestinal angiography and interventional embolization therapy, the control group was treated with esomeprazole; the clinical data related to the two groups were compared, including the total effective rate of treatment, blood pressure stabilization time, bleeding control time, etc. Results: The effective rate of clinical treatment in the study group was 97.44%, which was higher than that in the control group, which was 79.49% (P < 0.05). Both were significantly shorter (P < 0.05); the 7 d rebleeding rate and 30 d rebleeding rate of the study group were lower than those of the control group (P < 0.05); the 7 d and 30 d mortality rates of the two groups after treatment were compared, and the comparative study group was lower, but there was no significant difference (P > 0.05). Conclusion: Emergency interventional therapy can control bleeding more quickly, shorten bleeding control time and complete hemostasis time, shorten blood pressure stabilization time and abdominal pain relief time, and reduce rebleeding rate in patients with acute severe non-variceal upper gastrointestinal bleeding.

Membrane procoagulation and N‑terminomics/TAILS profiling in Montreal platelet syndrome kindred with VWF p.V1316M mutation

BackgroundThe Montreal platelet syndrome kindred (MPS) with VWF p.V1316M mutation (2B-VWDMPS) is an extremely rare disorder. It has been associated with macrothrombocytopenia, spontaneous platelet clumping, mucocutaneous, and other bleeding, which can be largely prevented by von Willebrand factor (VWF) concentrate infusion. However, supplemental platelet transfusion has been required on occasion, particularly for severe gastrointestinal bleeds. This raised the question of whether a previously uncharacterized platelet dysfunction contributes to bleeding diathesis in 2B-VWDMPS patients. We have previously shown that membrane ballooning, a principal part of the platelet procoagulant membrane dynamics (PMD) after collagen stimulation, is driven by the influx of Na+ and Cl-, followed by the entry of water.MethodsWe study two members (mother and daughter) of the MPS kindred with severe bleeding phenotype and address this question by coupling quantitative platelet shotgun proteomics and validating biochemical assays, with the systematic analysis of platelet procoagulant membrane dynamics (PMD). Using N-terminomics/TAILS (terminal amine isotopic labeling of substrates), we compare changes in proteolysis between healthy and 2B-VWDMPS platelets.ResultsHere, we report in 2B-VWDMPS platelets, the loss of the transmembrane chloride channel-1 (CLIC1), and reduced chloride ion influx after collagen stimulation. This was associated with diminished membrane ballooning, phosphatidylserine externalization, and membrane thrombin formation, as well as a distinct phenotypic composition of platelets over fibrillar collagen. We also identify processing differences of VWF, fibronectin (FN1), and Crk-like protein (CRKL). 2B-VWDMPS platelets are shown to be basally activated, partially degranulated, and have marked loss of regulatory, cytoskeletal, and contractile proteins.ConclusionsThis may account for structural disorganization, giant platelet formation, and a weakened hemostatic response.

Retrospective evaluation of the incidence of gastrointestinal bleeding in dogs receiving ophthalmic nonsteroidal anti-inflammatory drugs.

To report the incidence of gastrointestinal (GI) bleeding and associated risk factors in a population of dogs receiving ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs). Medical records of dogs prescribed ophthalmic NSAIDs (cases), dogs receiving systemic NSAIDs alone and dogs receiving systemic prednisone alone (controls). Data were collected retrospectively from the medical records of 204 dogs prescribed ophthalmic NSAIDs (diclofenac, ketorolac, or flurbiprofen), which were subdivided based on if they received any concurrent systemic NSAIDs or glucocorticoids, 136 dogs receiving a systemic NSAID (carprofen or meloxicam) alone, and 151 dogs receiving a systemic glucocorticoid (prednisone) alone at a referral hospital from 2015 to 2019. Gastrointestinal bleeds developed in 8/79 (10.1%) of topical NSAID-only cases, 10/136 (7.4%) of systemic NSAID controls, and 14/151 (9.3%) of systemic glucocorticoid controls, with no significant difference between the three groups (p = .6103). There were no significant differences in GI bleed rates between cases treated with ketorolac, diclofenac, or flurbiprofen (p = .160), although severe GI bleeding was only seen in ketorolac-treated dogs. Presence of a known concurrent risk factor for GI bleeding was significantly associated with the development of GI bleed in dogs on ophthalmic NSAIDs (p = .032). Dogs treated with ophthalmic NSAIDs developed GI bleeding at a frequency comparable to dogs receiving systemic NSAIDs or systemic glucocorticoids alone, suggesting that dogs receiving ophthalmic NSAIDs may be at increased risk of GI bleeding.

Dieulafoy’s lesion in the caecum as a cause of severe gastrointestinal bleeding during ulcerative colitis flare: a case report

Dieulafoy’s lesion in the caecum as a cause of severe gastrointestinal bleeding during ulcerative colitis flare: a case report

Use of specific antidotes in DOAC-associated severe gastrointestinal bleeding - an expert consensus - Antagonozation of direct oral anticoagulants in gastrointestinal hemorrhages

Gastrointestinal (GI) bleeding is one of the most common complications associated with the use of direct oral anticoagulants (DOAC). Clear algorithms exist for the emergency measures in (suspected) GI bleeding, including assessing the medication history regarding anti-platelet drugs and anticoagulants as well as simple coagulation tests during pre-endoscopic management. Platelet transfusions, fresh frozen plasma (FFP), or prothrombin complex concentrate (4F-PCC) are commonly used for optimizing the coagulation status. For severe bleeding under the thrombin inhibitor dabigatran, idarucizumab is available, and for bleeding under the factor Xa inhibitors rivaroxaban or apixaban, andexanet alfa is available as specific antidotes for DOAC antagonization. These antidotes represent emergency drugs that are typically used only after performing guideline-compliant multimodal measures including emergency endoscopy. Antagonization of oral anticoagulants should be considered for severe gastrointestinal bleeding in the following situations: (1) refractory hemorrhagic shock, (2) endoscopically unstoppable bleeding, or (3) nonavoidable delays until emergency endoscopy for life-threatening bleeding. After successful (endoscopic) hemostasis, anticoagulation (DOACs, vitamin K antagonist, heparin) should be resumed timely (i.e. usually within a week), taking into account individual bleeding and thromboembolic risk.

Severe Lower Gastrointestinal Bleeding Due to Choriocarcinoma with AVM to the Ileum: A Case Report

Background: Choriocarcinoma and other placental tumors are rare, and metastasis to the gastrointestinal, especially the small bowel, is extremely rare. Furthermore, about 5% of all metastasis belongs to the GI tract. Case Presentation: We reported an 18 -year-old patient with severe GI bleeding. Serum BHCG level was 57322 mIU/mL. CT angiography and Pelvic MRI suggested a metastatic arteriovenous malformation to the small bowel. In surgery, we detected the AVM from the right side of the uterus to the ileum, and pathological findings confirmed the choriocarcinoma with metastatic AVM to the ileum. Conclusion: Chemotherapy started after surgery, and the patient was asymptomatic on follow-up after 14 months. The results showed that GTN was a differential diagnosis when patients are referred with these signs and symptoms. ConclusioN: Findings from this study suggest a high prevalence of paradoxical VL suppression but not immune CD4 gain in the studied subjects following cART. Larger studies are needed to corroborate these findings.

Isolation of Malassezia yeasts from dogs with gastrointestinal disease undergoing duodenal endoscopy.

To culture Malassezia and other fungi from the duodenum of dogs with gastrointestinal signs undergoing routine endoscopic examination. Quantitative microbial culture was performed on duodenal juice aspirated from dogs with suspected enteropathy during routine upper gastrointestinal endoscopy; samples were cultured on Sabouraud's dextrose agar (30, 32 and 37°C) and modified Dixon agar (32°C) for 14 days. Isolates were identified phenotypically and by matrix-assisted laser desorption ionisation-time of flight, and internal transcribed spacer sequencing. Yeast presence was also evaluated by cytological and histopathological examination of smears and biopsy specimens. Forty-five dogs were recruited with chronic inflammatory enteropathy (n=38), granulomatous colitis (n=2), gastric adenocarcinoma (n=2), duodenal small cell lymphoma (n=1) and idiopathic severe gastrointestinal haemorrhage (n=2). Fungi were cultured from 14 dogs: Malassezia pachydermatis was isolated from eight [chronic inflammatory enteropathy (n=7) (along with Candida albicans n=1); granulomatous colitis (n=1)] and Malassezia sympodialis from another (gastric adenocarcinoma). Five dogs with chronic inflammatory enteropathy yielded other yeasts (C. albicans, Candida glabrata, Kazachstania slooffiae, Kazachstania telluris, Pichia kudriavzevii [syn. C. krusei]). Yeasts were never observed in histopathological specimens. Fluorescent microscopical examination of cytological specimens showed yeast in only one case, from which K. slooffiae was subsequently isolated. Based on a literature search, this is the first report of isolation of M. pachydermatis, M. sympodialis, K. slooffiae and K. telluris from the canine duodenum. Further studies are needed to determine whether these are resident or transient fungi in the canine duodenum and whether their presence has a pathogenic effect on the host.

Small-bowel B-cell lymphoma presenting as autoimmune hemolytic anemia and severe obscure gastrointestinal bleeding.

Small-bowel B-cell lymphoma presenting as autoimmune hemolytic anemia and severe obscure gastrointestinal bleeding.

Did angiodysplasia associated with heyde’s syndrome disappear spontaneously?: a case report

BackgroundHeyde’s syndrome can be easily overlooked or misjudged in clinical practice because it shares common clinical manifestations with multiple diseases as well as limited accuracy of several corresponding examinations for diagnosing Heyde’s triad. Moreover, aortic valve replacement is often delayed in these patients due to the contradiction between anticoagulation and hemostasis. Herein, we present a rare case of atypical Heyde’s syndrome. The patient’s severe intermittent gastrointestinal bleeding was not completely cured even through a local enterectomy. In the absence of direct evidence of acquired von Willebrand syndrome (AVWS) or angiodysplasia, her long-standing gastrointestinal bleeding was finally stopped after receiving transcatheter aortic valve implantation (TAVI).Case presentationA 64-year-old female suffered from refractory gastrointestinal bleeding and exertional dyspnoea. A local enterectomy was performed owing to persistent hemorrhage and repeated transfusions; subsequently, histological examination revealed angiodysplasia. Heyde’s syndrome was not suspected until 3 years later, at which time the patient started bleeding again and was also found to have severe aortic valve stenosis upon echocardiography. TAVI was consequently performed when the patient was in a relatively stable condition even though the predisposition to bleed, but there was no evidence of angiodysplasia and AVWS during angiography at that time. The patient’s above symptoms were significantly relieved after TAVI and followed up for 2 years without any significant ischemic or bleeding events.ConclusionsThe visible characteristics of angiodysplasia or a shortage of HMWM-vWFs should not be indispensable for the clinical diagnosis of Heyde’s syndrome. Enterectomy could be a bridging therapy for aortic valve replacement in patients with severe hemorrhage, and TAVI may be beneficial for moderate to high surgical-risk patients even if they have a potential risk of bleeding.

Dual-Energy CT Evaluation of Gastrointestinal Bleeding

Gastrointestinal (GI) bleeding is a potentially life-threatening condition accounting for more than 300 000 annual hospitalizations. Multidetector abdominopelvic CT angiography is commonly used in the evaluation of patients with GI bleeding. Given that many patients with severe overt GI bleeding are unlikely to tolerate bowel preparation, and inpatient colonoscopy is frequently limited by suboptimal preparation obscuring mucosal visibility, CT angiography is recommended as a first-line diagnostic test in patients with severe hematochezia to localize a source of bleeding. Assessment of these patients with conventional single-energy CT systems typically requires the performance of a noncontrast series followed by imaging during multiple postcontrast phases. Dual-energy CT (DECT) offers several potential advantages for performing these examinations. DECT may eliminate the need for a noncontrast acquisition by allowing the creation of virtual noncontrast (VNC) images from contrast-enhanced data, affording significant radiation dose reduction while maintaining diagnostic accuracy. VNC images can help radiologists to differentiate active bleeding, hyperattenuating enteric contents, hematomas, and enhancing masses. Additional postprocessing techniques such as low-kiloelectron voltage virtual monoenergetic images, iodine maps, and iodine overlay images can increase the conspicuity of contrast material extravasation and improve the visibility of subtle causes of GI bleeding, thereby increasing diagnostic confidence and assisting with problem solving. GI bleeding can also be diagnosed with routine single-phase DECT scans by constructing VNC images and iodine maps. Radiologists should also be aware of the potential pitfalls and limitations of DECT. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.

Stent-assisted coil embolization of ruptured superior mesenteric vein aneurysm: A case report

Visceral venous aneurysms are uncommon and account for 3% of all venous aneurysms, the most common being portal and mesenteric aneurysms. We present a case of an idiopathic superior mesenteric vein aneurysm in an elderly male with severe gastrointestinal bleeding due to a ruptured venous aneurysm.

A Henoch-Schönlein Purpura Case with Clinical Manifestation of Gastrointestinal Bleeding: A Case Report

Background: Henoch-schӧnlein purpura (HSP) or also known as immunoglobulin A (IgA) vasculitis, is an autoimmune vasculitis of small blood vessels. The incidence of HSP in adults is only 5 in 100,000 adult patients. One of the causes of these low incidences is due to misdiagnosed or underdiagnosed. This is inevitable as in adults, and the disease usually presents with atypical signs and symptoms. One of the rare manifestations of this disease is gastrointestinal tract bleeding. This study aimed to describe a case of Henoch-schӧnlein purpura with gastrointestinal bleeding and the treatment.
 Case presentation: A rare case of a 20-year-old adult male diagnosed with HSP with the chief complaint of severe abdominal pain and gastrointestinal bleeding was presented. The patient also complained of arthralgia. Upon closer examination, the patient had palpable purpura on both the ankle and trunk. Urinalysis showed protein (+2) with erythrocyte 25-50 cells. Esophagogastroduodenoscopy showed erosive pangastritis, bile reflux, and duodenal submucosal bleeding with a normal duodenal bulb. The patient was diagnosed with HSP and was given methylprednisolone and azathioprine. On 1 month follow-up, the patient's complaints subside.
 Conclusion: Henoch-schӧnlein purpura should be considered in adult patients, especially in patients with skin lesions without thrombocytopenia accompanied by multiorgan involvement (gastrointestinal, renal, and joint).

Pancreatic head cancer with gastrointestinal bleeding as the initial manifestation: a case report and literature review

Gastrointestinal bleeding (GIB) as the initial symptom is rare in patients with pancreatic cancer, which is prone to misdiagnosis and should be paid attention to by clinicians. Here, we present a patient with pancreatic head cancer whose first symptom was only severe upper gastrointestinal bleeding, which initially led to misdiagnosis. However, subsequent imaging revealed a mass in the pancreatic head which was considered a malignant tumor. After surgical resection, the pathology confirmed that the mass in the pancreatic head was pancreatic ductal adenocarcinoma, and the duodenal bulb’s full thickness was infiltrated. A literature review found that pancreatic cancer can present gastrointestinal bleeding by invading the digestive tract and blood vessels, left-sided portal hypertension (LSPH), digestive tract metastasis, and canceration of ectopic pancreatic tissue in the digestive tract. For these cases, clinicians should utilize multidisciplinary diagnosis and treatment based on digestive endoscopy, imaging, interventional therapy, and surgery to control bleeding, identify etiology, and remove tumors.

International on-line questionnaire about severe lower gastrointestinal bleeding management: Do we have it clear?

International on-line questionnaire about severe lower gastrointestinal bleeding management: Do we have it clear?