Symptoms Of Gastrointestinal Bleeding Research Articles

Lactate to albumin ratio as a prognosis predictor in gastrointestinal bleeding in the emergency department.

Gastrointestinal bleeding (GIB) is a common cause of emergency department (ED) visits, and has various prognoses. This study aimed to verify the prognostic ability of the lactate/albumin (L/A) ratio in patients with GIB compared with the AIMS65 score and blood urea nitrogen/albumin (B/A) ratio. This retrospective study included patients with GIB symptoms who visited the ED in 2019. Baseline characteristics and laboratory data were obtained to calculate the L/A and B/A ratios and AIMS65 score. Each score was evaluated as a predictor of intensive care unit (ICU) admission and in-hospital mortality by using the area under the receiver operating characteristic (AUROC) curve. The multivariate logistic regression analysis revealed that the L/A ratio significantly predicted ICU admission and in-hospital mortality. The AUROC curve for predicting ICU admission were 0.788, 0.695, and 0.586 for the L/A, B/A, and AIMS65 scores, respectively, while the AUROC curve for predicting in-hospital mortality were 0.807, 0.799, and 0.683 for the L/A, B/A, and AIMS65 scores, respectively. The L/A ratio, which consists of the serum lactate and albumin levels, showed superior performance relative to the B/A ratio and AIMS65 score in predicting the prognosis of patients with GIB.

Clinical characteristics and literature review of ectopic gastric mucosa in the small intestine

The study aims to summarize the clinical characteristics of patients with ectopic gastric mucosa in the small intestine, comparing clinical presentation differences between domestic and foreign patients through literature review. The clinical characteristics of cases diagnosed with ectopic gastric mucosa in the small intestine at Peking Union Medical College Hospital from January 2000 to January 2024 were retrospectively analyzed. By searching databanks, such as PubMed, EMBASE, the Cochrane Library, Wanfang, VIP, CNKI, and etc (the inclusion period was from the establishment of the database to January 1, 2024). The literature review was conducted on ectopic gastric mucosa in the small intestine. A total of 10 cases were included, all male, age [M (Q1, Q3)] was 27 (13-69) years old. Gastrointestinal bleeding was the first manifestation in most cases, with severe cases leading to hemorrhagic shock. Abdominal CT indicated local intestinal wall thickening and luminal narrowing in 3 cases. Four cases lesions were located at the beginning of the jejunum and 6 lesions were located in the end segment of ileum. All cases underwent local lesion resection, with postoperative pathology confirming ectopic gastric mucosa. Symptoms disappeared postoperatively, with a follow-up period of 0.5-3.0 years. Literature review indicates that the main clinical manifestation of gastric mucosa ectopia in the small intestine in China is gastrointestinal bleeding, while foreign patients are often complicated with intestinal duplication and intussusception, with abdominal pain and vomiting as the primary and main symptoms. The occurrence rate of intestinal obstruction in female patients, both domestically and abroad, is higher than that in male patients. The occurrence rate of ileal lesions with intestinal obstruction and small intestinal duplication is higher than that of duodenal lesions in both domestic and foreign patients. Local small intestine resection is an effective treatment method with generally good prognosis. Ectopic small intestinal mucosa is relatively rare, with symptoms of gastrointestinal bleeding and intestinal obstruction being common presentations, which can serve as one of the differential diagnoses for unexplained gastrointestinal bleeding.

Non-traumatic gallbladder hemorrhage with shock in Asia: A case report

Gallbladder hemorrhage, rare due to trauma, iatrogenic factors, or conditions like liver/kidney dysfunction or cancer, presents with symptoms such as right upper abdominal pain and fever. In severe cases, gallbladder blood may enter the gastrointestinal tract, causing melena or hematemesis, necessitating surgical intervention. Delay can lead to life-threatening hemorrhagic shock. Diagnosing in the emergency room is challenging, with delayed recognition risking severe outcomes. Ultrasound is vital for diagnosis. A 64-year-old female presented with three days of epigastric pain and nausea, denying trauma, fever, respiratory or chest symptoms. Unstable vital signs were noted. Blood tests showed no abnormalities; ultrasound revealed a distended gallbladder without stones. Post-cholecystectomy confirmed acute hemorrhagic cholecystitis, highlighting ultrasound’s pivotal role. Gallbladder hematoma, rare with vague symptoms, poses diagnostic challenges linked to trauma, tumors, anticoagulant use, or liver/renal disease. Initial symptoms include right upper quadrant pain, tenderness, nausea, and vomiting, resembling cholecystitis. Persistent bleeding may result in dark or bloody stools. Laboratory tests may reveal abnormalities, but sensitivity is limited. Diagnosis is complex, delayed recognition in the emergency department can lead to severe shock and increased mortality. The literature review emphasizes the association with liver/kidney dysfunction and anticoagulant use, presenting symptoms akin to gallbladder inflammation and occasional gastrointestinal bleeding. Ultrasound is pivotal for diagnosis, showcasing features like uneven echoes and localized wall thickening. Treatment approaches vary, with some cases opting for deferred surgical intervention after conservative treatment. Non-traumatic gallbladder hematoma is linked to risk factors like liver/kidney diseases and chronic anticoagulant use. Gallbladder inflammation and gastrointestinal bleeding symptoms coexist, underscoring ultrasound’s crucial role. This study establishes early detection and diagnosis protocols for emergency room settings.

Emergency Endoscopic Interventions in Acute Upper Gastrointestinal Bleeding: A Cohort Study

Introduction: Acute upper gastrointestinal bleeding is a common cause of emergency department admissions. The standard approach for the diagnosis and treatment of acute upper gastrointestinal bleeding (AUGIB) involves an endoscopy of the upper gastrointestinal tract. While daytime emergency endoscopy has been well studied, there is limited evidence regarding its effectiveness during the nighttime. Patients and Methods: We conducted a retrospective cohort study at a single center, analyzing adult patients with AUGIB referred for emergency endoscopy outside of regular hospital hours. Patients treated with endoscopic hemostatic methods were categorized into day-hours and night-hours groups based on the timing of the gastroscopy. The primary clinical endpoint was 120-day all-cause mortality, with secondary endpoints including hemostasis and recurrence. Results: In the population of 752 enrolled patients with acute upper gastrointestinal bleeding symptoms, 592 had a gastroscopy during the day hours between 8.00 a.m. and 10.00 p.m., while 160 had procedures performed at night between 10:00 p.m. and 8:00 a.m. In the day-hours group, the median time from symptom onset to endoscopy was 10 h (IQR 6–15), compared to 6 h (IQR 4–16) in the night-hours group. The gastroscopy duration (time to reach hemostasis during endoscopy) was significantly shorter during the night hours (p < 0.001). In both groups, endoscopic intervention after the sixth hour from symptom onset yielded improved outcomes, while treatment before the fifth hour resulted in poorer outcomes. Although the night-hours group had higher 120-day all-cause mortality, the difference was not statistically significant. Conclusions: Our findings indicate that emergency therapeutic gastroscopy for acute upper gastrointestinal bleeding is similarly effective during both day and night hours, particularly when performed after the sixth hour from symptom onset.

Cystic artery pseudo aneurysm in a patient with xanthogranulomatous cholecystitis: a multi-disciplinary approach towards management

Cystic artery pseudo aneurysm is a rare clinical entity, mostly occurring as a complication of laparoscopic cholecystectomy or following calculus cholecystitis. Patient presents with acute symptoms including upper gastro intestinal bleeding symptoms, abdominal pain and jaundice, the triad of symptoms termed as Quincke's triad, when there is a ruptured cystic artery pseudoaneurysm (CAP). Unruptured cases are mostly diagnosed incidentally. Here we present a 58-year-old patient presented to the emergency department with severe abdominal pain, malena and jaundice. CECT of abdomen was done which showed CAP. The patient was immediately taken up for radiological intervention and coiling of the pseudo aneurysm, which was unsuccessful. A covered stent was placed across the pseudoaneurysm in the right hepatic artery. Patient underwent Laparoscopic cholecystectomy and had an uneventful recovery. Owing to the fact that CAPs are rare entities, a high index of suspicion is required for diagnosis of the condition and when diagnosed, the patient can be managed by radiological intervention followed by definitive surgery which can be either open or laparoscopic.

Pulsation of visible vessel or adherent clot in duodenal ulcer may indicate pseudoaneurysm: Case series.

Owing to the anatomical characteristics of the duodenum, gastroduodenal artery (GDA) pseudoaneurysms can be caused by duodenal ulcers, which may rupture and lead to massive or repeated bleeding. Pseudoaneurysms are usually diagnosed using enhanced computerized tomography or angiography, whereas endoscopic signs have rarely been reported. Three patients aged 18 to 83 years with bleeding duodenal ulcers and GDA pseudoaneurysms were treated. All patients had symptoms of gastrointestinal bleeding, and endoscopy revealed duodenal ulcers with visible vessels or adherent clot pulsations. Angiography confirmed the presence of a GDA pseudoaneurysm, which had an adjacent relationship with the duodenum. The GDA pseudoaneurysm was embolized in each patient. Through transcatheter arterial embolization, endoscopic treatment, and traditional treatment, hematemesis or melena was gradually stopped and all patients were discharged. The pulsation of visible vessels or adherent clots observed during endoscopy in patients with duodenal ulcer may indicate the formation of a gastroduodenal artery pseudoaneurysm. Therefore, we suggest that such patients receive enhanced computerized tomography or angiography to assess whether they need timely endovascular intervention treatment to avoid bleeding caused by a pseudoaneurysm.

Digestive pseuodpolyposis as a form of presentation of digestive metastases of primary gastric leiomyosarcoma.

A 71-year-old male was diagnosed with gastric leiomyosarcoma in 2020 after biopsies of an ulcerated gastric lesion. Despite oncological treatment, he presented bone, liver and lung progression. Fourth line treatment with Pazopanib was started in 2022 with no evidence of intestinal or peritoneal metastases. He was attended in the Emergency Department in February 2023 due to symptoms of gastrointestinal bleeding with clinical and analytical repercussion with hemoglobin 5.8g/dl. Initially he presented hematemesis and subsequently hematochezia. An upper and lower endoscopic study was performed, revealing multiple sessile polypoid lesions with an irregular mucosal pattern of between 5-30 mm distributed throughout all explored sections at the gastric, duodenal and colic mucosal; some of them ulcerated with fibrin deposits on the surface and signs of recent hemostasis. The histological study demonstrated infiltration by spindle-shaped mesenchymal cells with atypical nuclei, a Ki-67 proliferation index >80%, and an immunohistochemical profile consistent with digestive metastases of primary gastric leiomyosarcoma. CT scan was performed confirming tumor progression with pulmonary, digestive, hepatic, bone, muscle and peritoneal dissemination of gastric leiomyosarcoma.

Role of octreotide in small bowel bleeding.

Gastrointestinal bleeding accounts for a drastic negative impact on the quality of the patients’ lives as it requires multiple diagnostic and therapeutic interventions to identify the source of the bleeding. Small bowel bleeding is the least common cause of gastrointestinal bleeding. However, it is responsible for the majority of complaints from patients with persisting or recurring bleeding where the primary source of bleeding cannot be identified despite investigation. A somatostatin analog known as octreotide is among the medical treatment modalities currently used to manage small bowel bleeding. This medication helps control symptoms of gastrointestinal bleeding by augmenting platelet aggregation, decreasing splanchnic blood flow, and antagonizing angiogenesis. In this review article, we will highlight the clinical efficacy of octreotide in small bowel bleeding and its subsequent effect on morbidity and mortality.

Gastrointestinal bleeding in COVID patients

In the present study we report 10 hospitalized patients with COVID-19 infection with gastrointestinal bleeding. The PCR result was 4 positive and the others had negative PCR, but hadevidence of COVID-19 and had symptoms of gastrointestinal bleeding. Bleeding of 7 people was controlled.

A59 A RARE PRESENTATION OF COLLAGENOUS GASTRODUODENITIS WITH 10 YEAR FOLLOW UP

Abstract Background Collagenous gastritis(CG) is a rare form of gastritis defined histologically by the presence of >10um of subepithelial surface collagen deposition. CG can further be categorized in childhood onset CG and adult onset CG. The prevalence of childhood CG is 2.1/100,000 in children aged younger than 18. Adult onset CG remains a rare entity. Here, we describe a rare presentation of collagenous gastroduodenitis in an adult patient and the interval progression over a 10 year period. Aims To increase awareness of a rare condition with limited data on available treatment modalities and clinical outcomes in adults. Methods Case Report Results A 35 year old female with no past medical history presented with worsening fatigue and increased shortness of breath with no overt gastrointestinal bleeding symptoms. There was no previous history of radiation exposure or family history of autoimmune disease. Laboratory investigations revealed iron deficiency anemia with a hemoglobin of 69 and a ferritin of 11. TTG serology and anti-parietal antibody was also negative. Esophagogastroduodenoscopy biopsies confirmed the diagnosis of collagenous gastritis localized to the gastric body with the presence of acute and chronic inflammatory changes. The patient was started on proton pump inhibitor therapy. In the interval period, the patient denies any new onset of gastrointestinal symptoms other than occasional heartburn. She remains iron deficient and requires regular iron infusions. Follow up endoscopy 10 years later now demonstrates diffuse mucosal abnormalities with a nodular contour involving the entire stomach and extending into the duodenal bulb. Biopsies showed features compatible with collagenous gastroduodenitis with active inflammation and pyloric metaplasia(Figure 1). There was atrophy of the stomach mucosa with no parietal cells identified and no endocrine hyperplasia. Immunostaining for Helicobacter pylori was negative. Flexible sigmoidoscopy was also performed revealing endoscopically normal colonic mucosa to the descending colon. Conclusions CG is a rare disease entity with unclear pathogenesis. Multiple case reports describe some association with autoimmune disease such as celiac disease. To date, no standard treatment has been identified for the management of CG. CG presents endoscopically with nodular changes, mucosal atrophy and collagen deposition. Over time, adult onset CG can progress to involve the entire stomach. Clinically, adult onset CG usually presents with a diarrhea predominant phenotype with associated collagenous colitis. Treatment modalities that have been trialed include PPI, corticosteroids, sucralfate, azathioprine,5-aminosalicylates, iron supplementation and hypoallergenic diets. Here we describe a rare presentation of collagenous gastroduodenitis and subsequent 10 year follow up in order to better understand this disease entity. Funding Agencies None

A patient with Crohn’s disease – from diagnosis to therapy onset. Therapeutic standards vs. reality – a case report

Crohn’s disease is a nonspecific inflammatory bowel disease. The first symptoms tend to be non-specific, which can cause diagnostic difficulties. Full-thickness inflammation of the bowel wall, which may involve any part of the gastrointestinal tract, is a landmark of this disorder. Terminal ileum is the most commonly affected area, as also described in the presented case. Surgical treatment should be as least invasive as possible due to the high probability of another surgical intervention. We present a case of a patient previously repeatedly treated for anal abscess in an outpatient setting in the USA. The patient was admitted to the surgical ward due to perineal phlegmon in the course of recurrent anal abscess. He was qualified for abscess incision. During hospital stay, the patient developed symptoms of gastrointestinal bleeding. Diagnostic endoscopy of the large bowel revealed macroscopic lesions typical of Crohn’s disease. Repeated attempts to transfer the patient to a unit specialised in the treatment of inflammatory bowel diseases (IBDs) have been unsuccessful. Due to the deteriorating general condition and progressive anaemisation, the patient was qualified for surgery. The end section of the ileum was resected and an end ileostomy was created. After stabilisation of the general condition, the patient was discharged home having been recommended to continue treatment in a gastroenterology clinic, in a centre specialised in the treatment of inflammatory bowel diseases.

Are the blood urea nitrogen/creatinine ratio and the mean platelet volume able to act as predictors of mortality and morbidity in patients with upper gastrointestinal bleeding?

Background: Upper gastrointestinal (GI) bleeding originates above the Treitz ligament and blood urea nitrogen (BUN)/Creatinine (Cr) ratio ≥30 was shown to indicate the presence of upper GI bleeding and it might be an independent risk factor for mortality. The mean platelet volume (MPV) was reported as an indicator of platelet function and activation and was shown to be useful in the diagnosis and follow-up of vascular-origin disorders. In the present study, we aimed to investigate whether BUN/Cr ratio and MPV were predictors of mortality and morbidity in patients with upper GI bleeding.
 Material and Method: This retrospective study enrolled a total of 141 patients admitted to the Emergency Department with symptoms of upper GI bleeding and had undergone endoscopy between January 2013-January 2015. Demographics, hemoglobin, hematocrit, MPV, BUN/Cr, the hospitalization unit, the duration of stay, outcome, and the endoscopy reports of the patients were recorded. Statistical analysis was performed using SPSS 17.0.
 Results: It was found that the MPV level did not predict mortality and morbidity in our patients with upper GI bleeding. The likelihood of active bleeding was higher in patients with a BUN/Cr ratio of above 30 when compared to those with a ratio of below 30.
 Conclusion: In patients presenting to the emergency department with symptoms of GI bleeding but without signs of renal failure, calculation of admission BUN/Cr ratio may be beneficial for making treatment and follow-up plans.

Hemorragia de vías digestivas altas por presentación atípica de adenocarcinoma endometrial metastásico en el estómago. Tipificación diagnóstica con recursos endoscópicos

El cáncer de endometrio es la neoplasia ginecológica maligna más frecuente en el sexo femenino. Su presentación metastásica se limita principalmente a los órganos vecinos y ganglios cercanos, y es infrecuente la invasión al tubo digestivo superior. En el presente artículo se presenta una paciente que ingresó al servicio de urgencias con cuadro de hemorragia de vías digestivas altas, enfocado inicialmente como un tumor estromal gastrointestinal (GIST) de la pared gástrica, pero que luego de la realización de una adecuada historia clínica, complementada con imágenes diagnósticas y avances ecoendoscópicos, se logró el diagnóstico de metástasis de cáncer de endometrio.

S1958 Esophageal Neuroendocrine Tumor: A Rare Cause of Malignant Dysphagia

INTRODUCTION: The incidence of gastrointestinal (GI) neuroendocrine tumors (NETs) has risen in recent decades; however, esophageal NETs are exceedingly rare, with an estimated prevalence of 0.04% of all NETs. We present a patient with esophageal NET and highlight the unique features of this rare disease. CASE DESCRIPTION/METHODS: A 58-year-old previously health Caucasian man presented with shortness of breath, hypoxia, and 3-week history of progressive solid food dysphagia. The patient denied weight loss, anemia, or GI bleeding symptoms, and hemoglobin was 14. CT scan revealed 9 cm × 7.6 cm posterior mediastinal mass contiguous with a markedly thickened esophageal wall of 2.5 cm. The mass contacted the heart and the pericardium with a pericardial effusion. Additional findings included pleural effusions, bulky mediastinal lymphadenopathy, lower esophageal mass of 6.4 cm × 5.9 cm, and 9 cm conglomeration of gastrohepatic lymphadenopathy. Positive malignant cytology of suspected GI origin was obtained from the thoracentesis and the pericardiocentesis, both needed for hemodynamic improvement. EGD identified a 20 cm long malignant appearing esophageal stricture extending to the GE junction. Esophageal biopsy revealed high grade NET with positive CAM 5.2, pancytokeratin, synaptophysin, CD 56, CDX2 positive staining pattern consistent with NET of GI origin. The malignant dysphagia was palliated with a 23 mm × 155 cm esophageal stent. The patient is undergoing chemotherapy with carboplatin and etoposide. DISCUSSION: Esophageal NET is an exceedingly rare tumor, estimated prevalence of 1.4% of all GI-NETs, and hence there are few reports about clinical features. Reported findings suggest 80% male predominance, and a majority of patients are either asymptomatic (31%) or present with solid food dysphagia (26.9%). Weight loss (11.5%) and melena (7.7%) were less frequent symptoms in esophageal NETs. The mean tumor size ranged from 0.5 cm to 7 cm. This case illustrates: (1) Weight loss and anemia are not common findings with esophageal NET, when compared to more common esophageal malignancies, (2) A 20-cm long esophageal stricture is a length that has not previously been reported in the medical literature, (3) The extra-esophageal tumor burden without associated weight loss is not typical of common esophageal malignancies. These unusual features should prompt Gastroenterologists to consider rare causes of esophageal malignancies.

Superselective transcatheter arterial embolization for acute small bowel bleeding: clinical outcomes and prognostic factors for ischemic complications.

Small bowel bleeding (SBB) accounts for 5%-10% of all cases of acute gastrointestinal bleeding. Transcatheter arterial embolization (TAE) plays an important role in the treatment of SBB. To evaluate the safety and efficacy of superselective TAE exclusively for SBB and to assess factors associated with clinical outcomes. From January 2006 to April 2017, 919 patients were admitted with signs and symptoms of gastrointestinal bleeding; 74 patients (mean age = 57.5 years; age range = 14-82 years) with positive angiographic findings for SBB were retrospectively analyzed. The technical success of TAE and clinical outcomes, including recurrent bleeding, major complications, and in-hospital mortality were evaluated. The associations of various clinical and technical factors with clinical outcomes were analyzed. The bleeding foci were in the ileum in 48 (65%) patients and the jejunum in 26 (35%). Technical success was achieved in 72 (97%) patients. The rates of recurrent bleeding, major complications, and in-hospital mortality were 12% (7/57), 21% (15/71), and 25% (18/72), respectively. Superselective embolization was a significant prognostic factor associated with fewer major complications (OR = 0.069; P = 0.003). The increased number of embolized vasa recta was significantly associated with a higher probability of major complications (OR = 2.64; P < 0.001). The use of N-butyl cyanoacrylate was associated with lower rates of major complication (OR = 0.257; P = 0.027). TAE is a safe and effective treatment modality for SBB. In addition, whenever possible, TAE should be performed in a superselective manner to minimize ischemic complications.

Effect of the Coronavirus 2019 Pandemic on Outcomes for Patients Admitted With Gastrointestinal Bleeding in New York City

Effect of the Coronavirus 2019 Pandemic on Outcomes for Patients Admitted With Gastrointestinal Bleeding in New York City

A randomized controlled trial of the effects of local tranexamic acid on mortality, rebleeding, and recurrent endoscopy need in patients with upper gastrointestinal hemorrhage.

Tranexamic acid (TXA) is an antifibrinolytic agent used to control bleeding in different circumstances. We conducted a randomized controlled trial to assess the efficacy and safety of locally administered TXA in upper gastrointestinal hemorrhage. This single-center, double-blind, randomized controlled trial was performed in a tertiary emergency department (ED) in patients presenting with upper gastrointestinal bleeding symptoms between 2016 and 2018. The patients received either 2000 mg of 5% TXA in 100 mL of isotonic saline solution or 100 mL isotonic saline (control group) via the nasogastric route. As a composite outcome, recurrent endoscopy need, rebleeding, surgery need, recurrent admission to the ED, and mortality parameters were evaluated at the end of a one-month period. During the study period, 78 patients were randomized into the TXA group, and 79 patients were randomized into the isotonic saline group. The majority of the bleedings (61%) were in Forrest class 3, and the most frequent cause was peptic ulcer disease. The composite outcome occurred in 25 of the TXA patients (32.1%) and 23 of the isotonic saline patients (29.1%); no statistically significant difference was found between the groups (P = 0.690). In addition, no statistically significant differences were observed between the TXA and control groups regarding mortality (10.3 vs 12.7%; P = 0.637), recurrent ED admission (17.9 vs 12.7%; P = 0.357), or thromboembolic complications (3.8 vs 1.3%; P = 0.367). Locally administered TXA confers no additional benefit over standard care in patients with upper gastrointestinal hemorrhage.

Endoscopic Ultrasound-Guided Treatment of Gastric Varices Using Coils and Cyanoacrylate Glue Injections: Results after 1 Year of Experience.

Background and Aims: Gastric varices (GVs) occur in 20% of patients with portal hypertension. GVs are associated with a 65% risk of bleeding over the course of 2 years and have a mortality rate of up to 20%. The standard treatment for GVs is obliteration with cyanoacrylate (CYA). This study presents our experience with combined therapy (vascular coils and CYA) under endoscopic ultrasound (EUS) guidance. Methods: 16 patients (9 male and 7 female) were included into our study. Etiology of portal hypertension included: portal vein thrombosis (PVT) (31.0%), isolated splenic vein thrombosis (SVT) (25.0%), alcoholic cirrhosis (12.5%), hepatitis C cirrhosis (19.0%), and alcoholic cirrhosis with PVT (12.5%). Varices type GOV-2 were diagnosed in 8 patients, type IGV-1 and IGV-2 in 6 and 2 patients, respectively. Indications for treatment were based on endoscopic and endosonographic evaluations of GVs. Inclusion and exclusion criteria were also specified. Technique depended on the size of varices (different size of coils + CYA additionally). The results were based on the achievement of technical success, therapeutic effects, and number of adverse events. Average follow-up period was 327 days. Results: From January to August 2017, 16 patients were treated with EUS-guided obliteration of GVs using vascular coils only or coils with CYA injections. 6 (37.5%) and 10 (62.5%) patients underwent primary and secondary prophylaxis for hemorrhage, respectively. Technical success was achieved in 15 patients (94.0%). Mean numbers of implanted coils and CYA volume during one procedure were 1.7 and 2 mL, respectively. Therapeutic success was achieved in all patients treated with the combination. There were no serious complications such as embolization or death due to the procedure. Three patients (19.0%) had transient abdominal pain and two (12.5%) had transient fever. 1 patient had clinical symptoms of gastrointestinal bleeding. Conclusions: Based on our retrospective research we have concluded, that EUS-guided implantation of intravascular coils combined with cyanoacrylate injections is an effective method of treatment with an acceptable number of complications.

Acquired Hemophilia A with Gastrointestinal Bleeding

Peptic ulcer disease is the most common cause of acute gastrointestinal bleeding, followed by variceal bleeding, Mallory–Weiss syndrome, and malignancy. On the contrary, acquired hemophilia A is a very rare hemorrhagic disease, which usually manifests with musculocutaneous bleeding, caused by autoantibodies against coagulation factor VIII.A 78-year-old man presented to the Emergency Department with melena. Dieulafoy’s lesions were observed on, and endoscopic cauterization was performed. However, the patient complained of back pain and symptoms indicative of upper gastrointestinal bleeding. Abdominopelvic computed tomography was performed, and hematoma in the psoas muscle was detected. Antibodies against coagulation factor VIII were confirmed with a blood test, and the diagnosis of acquired hemophilia A was made. Here, we report a case of acquired hemophilia A presenting with upper gastrointestinal bleeding symptoms and present a brief review of literature.

An Abdominal Mass in a Patient With Neurofibromatosis Type 1

A 42-year-old woman with neurofibromatosis type 1 presented with severe abdominal pain and a 15-pound unintentional weight loss for 2 months. The patient denied gastrointestinal bleeding symptoms. On examination, she had normal vital signs with café-au-lait spots on her extremities. Her abdomen was soft and tender in the epigastrium. Her hemoglobin level was normal and chemistry showed a cholestatic pattern. Upper endoscopy with ultrasound showed a large lobulated periampullary mass (Figure A) without local lymph node involvement, and a common bile duct dilated to 2.4 cm.