Treatment Of Massive Gastrointestinal Bleeding Research Articles

Efficacy of Intra‐Arterial Treatment for Massive Gastrointestinal Bleeding in Hemodialysis Patients

The incidence of acute nonvariceal massive gastrointestinal bleeding (GIB) is higher in hemodialysis (HD) patients than in healthy individuals, and this is often a life-threatening event. We evaluated the efficacy of intra-arterial treatment for GIB in HD patients. Between January 2006 and June 2012, eight HD patients with GIB were treated with superselective transarterial embolization. Of the eight cases, one was duodenal bleeding, two were jejunal bleeding, one was ileocecum bleeding, two were ascending colonic bleeding, and two were sigmoid colonic bleeding. After examining the site of bleeding by endoscopy or contrast-enhanced computed tomography (CT), embolizations with microcoils, gelatin sponges, or N-butyl cyanoacrylate were performed through interventional radiology (IVR). In all cases, blood transfusions were frequently administered. Six of the eight patients with GIB were successfully salvaged by transarterial embolization. In one case, duodenal bleeding was refractory to endoscopic treatment. Embolization was performed twice in this case; however, the patient died of an aneurysm rupture at the embolization site 24 days after the embolizations. In another case, massive jejunal bleeding and disseminated intravascular coagulation were identified at the time of the first examination, and the patient died of multiorgan failure 26 days after the embolization. On the basis of our experience, we established an effective treatment strategy for HD patients with acute nonvariceal massive GIB, by immediately identifying the exact site and degree of bleeding using contrast-enhanced computed tomography and performing early treatment with transarterial embolization.

Surgical treatment for massive gastrointestinal bleeding caused by thrombotic thrombocytopenic purpura: A case report

Surgical treatment for massive gastrointestinal bleeding caused by thrombotic thrombocytopenic purpura: A case report

Surgical treatment for massive gastrointestinal bleeding caused by thrombotic thrombocytopenic purpura: A case report

Thrombotic thrombocytopenic purpura (TTP) is a syndrome of unknown cause characterized by thrombocytopenia, hemolytic anemia, and various organ dysfunctions such as neurologic disorder and kidney failure. At one time TTP was a fatal disease with rapid development of hematologic deterioration after the onset of symptoms. However, introduction of plasma exchange and plasma infusion during the past three decades has brought dramatic change in the clinical course and outcome.1,2 This has encouraged clinicians to diagnose and treat patients with suspected TTP.