BACKGROUND While varices and variceal bleeds are well-known and feared complications of advanced cirrhosis and portal hypertension,omental variceal bleed are a rare sequala even in patients with known esophageal or ga...BACKGROUND While varices and variceal bleeds are well-known and feared complications of advanced cirrhosis and portal hypertension,omental variceal bleed are a rare sequala even in patients with known esophageal or gastric varices.While rare,omental varices pose a risk for hemoperitoneum if ruptured,which is a lifethreatening complication with high mortality rates despite surgical intervention.CASE SUMMARY This report reviews the case of a patient 36-year-old female with alcohol related cirrhosis decompensated by ascites,but no history of varices admitted for hemorrhagic shock from spontaneous rupture of omental varices requiring emergency surgery.She underwent the first documented successful orthotopic liver transplantation the same admission.CONCLUSION This case report and literature review stresses the importance of early consideration and identification of intraabdominal variceal sources in cirrhotic patients with refractory shock.展开更多
BACKGROUND Colonic diverticular bleeding is a significant cause of acute overt lower gastrointestinal hemorrhage.Colonoscopy is commonly performed in patients with colonic diverticular bleeding to identify and treat t...BACKGROUND Colonic diverticular bleeding is a significant cause of acute overt lower gastrointestinal hemorrhage.Colonoscopy is commonly performed in patients with colonic diverticular bleeding to identify and treat the source of bleeding,which is crucial for effective management.CASE SUMMARY We present the case of a 70-year-old male with acute painless hematochezia.Colonoscopy showed active bleeding originating from a diverticulum,and the EyeMax direct visualization system was used in the treatment of the colonic diverticular bleeding.No further evidence of bleeding was observed at the end of the procedure.The patient was discharged from hospital on the seventh day.CONCLUSION The EyeMax system proved advantageous in localizing the bleeding diverticulum,thereby facilitating successful hemostatic measures.展开更多
BACKGROUND Jejunal diverticula(JD)are rare clinical conditions that are typically incidentally detected and asymptomatic.When acute complications arise,surgical exploration may be necessary for accurate diagnosis and ...BACKGROUND Jejunal diverticula(JD)are rare clinical conditions that are typically incidentally detected and asymptomatic.When acute complications arise,surgical exploration may be necessary for accurate diagnosis and appropriate treatment.In this report,we present a case of multiple JD complicated by gastrointestinal bleeding and review the pathogenesis,diagnosis,and treatment of JD to increase clinician awareness of this condition.CASE SUMMARY A 70-year-old male patient with multiple JD presented with repeated massive gastrointestinal bleeding.The patient did not respond to symptomatic conservative treatment.Additional diagnostic investigations,including digestive endoscopy and abdominal angiography,did not reveal any relevant abnormalities.An exploratory laparotomy was subsequently performed,during which a segment of the bowel containing numerous diverticulum-like structures was surgically removed.Following successful discharge from the hospital,the patient did not experience any further episodes of gastrointestinal bleeding during subsequent follow-up.CONCLUSION Complications caused by JD are often difficult to diagnose,and surgical exploration is sometimes the most appropriate method.展开更多
BACKGROUND Postpancreatectomy hemorrhage is one of the most severe and life-threatening complications after pancreaticoduodenectomy.We present four cases of gastrointestinal bleeding patients to clarify its appropriat...BACKGROUND Postpancreatectomy hemorrhage is one of the most severe and life-threatening complications after pancreaticoduodenectomy.We present four cases of gastrointestinal bleeding patients to clarify its appropriate treatment and prevention.CASE SUMMARY The main symptoms included black stool,hematochezia,haematemesis,blood in the nasogastric tube,and hemorrhagic shock.The mean age was 66.25 years old and the median onset time was 340 d after the surgery.The bleeding location comprised gastrointestinal anastomosis,bile duct-jejunum anastomosis,and extraluminal bleeding.The possible causes included marginal ulcer,jejunal varix,and abdominal infection.Endoscopic hemostatic clips,as well as a covered stent using angiography,were utilized to stop the bleeding and three patients survived.Only one patient died of gastrointestinal bleeding,abdominal bleeding,abdominal infection,hypovolemic shock,and disseminated intravascular coagulation.CONCLUSION Early and effective endoscopic intervention is the key to successful hemostasis in patients with gastrointestinal bleeding after pancreatoduodenectomy.展开更多
BACKGROUND Lung cancer is the most prevalent malignant tumor in human body,and is characterized by a high level of malignancy.The most common metastatic sites include the liver,bone,brain,and adrenal gland,while lung ...BACKGROUND Lung cancer is the most prevalent malignant tumor in human body,and is characterized by a high level of malignancy.The most common metastatic sites include the liver,bone,brain,and adrenal gland,while lung cancer resulting in gastrointestinal tract metastasis is uncommon.CASE SUMMARY A 74-years-old man with lung cancer was hospitalized owing to blood in the stool,The cause was identified as metastasis to the small intestine,and the patient subsequently underwent radical resection of the small intestine tumor.Currently,the overall condition of the patient is good,and undergoing combined chemotherapy.CONCLUSION Early intervention in patients with metastatic tumors can significantly improve prognosis.展开更多
BACKGROUND Juvenile polyps(JPs)are non-neoplastic polyps.In adults,JPs present with hematochezia in only approximately half the patients and are often found incidentally during endoscopic screening.JPs have no mucosal...BACKGROUND Juvenile polyps(JPs)are non-neoplastic polyps.In adults,JPs present with hematochezia in only approximately half the patients and are often found incidentally during endoscopic screening.JPs have no mucosal fascia at the tip,and spontaneous shedding and massive gastrointestinal hemorrhage may occur.Thus,the JP bleeding detected in this case by extravascular contrast leakage on computed tomography scans and treated with endoscopic clipping is rare.CASE SUMMARY A previously healthy 31-year-old male patient presented with a 2-day history of bloody stools.Upon hospital arrival,rectal examination revealed fresh blood,and abdominal computed tomography scans showed extravascular contrast leakage from the lower rectum’s left-side wall.His blood pressure was slightly low at 104/62 mmHg.However,his pulse rate(69 bpm)and oxygen level(99%on room air)were within normal limits.Emergency endoscopy revealed a pedunculated lesion in the rectum covered by a non-neoplastic mucosal epithelium.No neoplastic lesions were observed at the tip of the polyp;however,pulsatile bleeding was detected at the distal end.We performed endoscopic hemostasis by clipping the stem and then performed a polypectomy above the stem to examine the lesion tissue.Histopathological evaluation revealed a cystically dilated gland without neoplastic lesions.A subsequent total colonoscopy revealed two JPs with characteristic edematous,smooth,and reddish surfaces close to the hemorrhagic lesion.Subsequent histopathological evaluation indicated findings characteristic of JP,such as severe inflammatory cell infiltration of the stroma and cystic dilatation of the glandular ducts.CONCLUSION There are no reports of adult JPs presenting with contrast extravasation where endoscopic hemostasis was successful,as in this case.展开更多
BACKGROUND Gastrointestinal stromal tumors(GISTs)are rare mesenchymal tumors that rarely present with gastrointestinal(GI)bleeding due to tumor erosion.GISTs com-Core Tip:Gastrointestinal stromal tumors(GISTs)are rare...BACKGROUND Gastrointestinal stromal tumors(GISTs)are rare mesenchymal tumors that rarely present with gastrointestinal(GI)bleeding due to tumor erosion.GISTs com-Core Tip:Gastrointestinal stromal tumors(GISTs)are rare mesenchymal tumors that rarely cause gastrointestinal(GI)bleeding.Mucosal ulceration and unfavorable tumor locations are risk factors for tumor progression and malignancy.We present a case of GI bleeding in a 42-year-old man complaining of melena over five days,which was diagnosed as a benign,ulcerated,jejunal GIST on histopathology and immunohistochemistry.Prompt evaluation using specialized diagnostic tools to locate obscure bleeding sources and complete surgical resection are key to favorable outcomes.GI bleeding in GIST is associated with a poor prognosis.Hence,detailed follow-ups are essential to detect and prevent tumor recurrence.INTRODUCTION Gastrointestinal stromal tumors(GISTs)are generally recognized as spindle cell,epithelioid,or occasionally pleomorphic tumors that usually develop in the gastrointestinal(GI)tract.Originating from mesenchymal cells of the GI tract,GISTs make up 1%-3%of all GI malignancies and progress to malignancy in approximately 10%to 30%of cases[1,2].A greater risk of tumor progression is linked to GISTs associated with mucosal ulceration and those that develop outside of the stomach[1,3].Many GISTs carry mutations in the genes encoding type III receptor tyrosine kinases,particularly KIT or PDGFRA,which is the case in up to 85%of instances.A significant majority,about 95%,of these tumors are positive for the KIT protein when tested with immunohistochemistry[4].The most common places where GIST arises are the stomach,followed by the small bowel[2].In 19%of cases,GISTs manifest asymptomatically,particularly in cases of smaller tumors of the intestinal tract.Studies show that around 10%of these cases were caught at autopsy and 20%during abdominal surgery for other conditions,making them a common incidental finding rather than a clinical suspicion[5,6].Patients who are symptomatic may exhibit non-specific symptoms such as nausea,vomiting,abdominal distension,early satiety,abdominal pain,and,in rare cases,a palpable abdominal mass.Obstruction of the GI lumen by endophytic growth or compression of the GI tract by exophytic growth may result in dysphagia,obstructive jaundice,or constipation in larger tumors,contingent upon the mass's specific location[1].Very rarely do these tumors present as an acute,severe,life-threatening GI bleeding[7].Herein,we describe a case report of a rather unusual presentation of GIST,i.e.,symptomatic GI bleeding caused by an ulcerated jejunal GIST,which was found to be benign in nature.This case report emphasizes the importance of maintaining a high suspicion of this disease when all routine workups for GI bleeding show no obvious findings.展开更多
BACKGROUND Gastrointestinal bleeding due to metastasis of an invasive mole to the small intestine is very rare.Most reported cases of metastatic invasive mole are diagnosed after surgery,and lack rich illustrations,wh...BACKGROUND Gastrointestinal bleeding due to metastasis of an invasive mole to the small intestine is very rare.Most reported cases of metastatic invasive mole are diagnosed after surgery,and lack rich illustrations,which leads to insufficient understanding by clinicians,misdiagnosis,and unnecessary surgeries.CASE SUMMARY A 22-year-old female patient presented with bloody stool and elevated human chorionic gonadotropin.The transvaginal gynecological ultrasound ruled out pregnancy.Upper gastrointestinal endoscopy and colonoscopy were performed,but no bleeding focus was detected.The contrast-enhanced computed tomography was unremarkable.The capsule endoscopy suggested jejunal protuberant lesions with dark red blood clots.Therefore,oral single-balloon enteroscopy was performed,and two connected protuberant lesions were detected,with blood clot traces and local ulceration.The enteroscopic biopsy revealed trophoblastic cells with a probable diagnosis of trophoblastic tumor.The patient underwent surgical resection of the diseased jejunum.Intraoperative endoscopy was performed,and the findings were the same as those of the small intestine endoscopy.The postoperative pathology confirmed the preoperative diagnosis of invasive mole.CONCLUSION In non-pregnant women with elevated human chorionic gonadotropin and gastrointestinal bleeding,metastatic trophoblastic neoplasia should be considered.展开更多
BACKGROUND Esophagomediastinal fistula is a very rare complication of tuberculosis in otherwise healthy adults, and mediastinal bronchial artery aneurysm is even rarer. In this case report, we describe a rare case of ...BACKGROUND Esophagomediastinal fistula is a very rare complication of tuberculosis in otherwise healthy adults, and mediastinal bronchial artery aneurysm is even rarer. In this case report, we describe a rare case of tuberculosis complication that presented with acute upper gastrointestinal(GI) bleeding. It also highlights the benefits of chest computed tomography(CT) as an excellent adjunct diagnostic tool to endoscopy and bronchoscopy and the role of trans-arterial embolization as a minimal invasive therapy alternative to surgery.CASE SUMMARY A 19-year-old medically free male patient presented with acute multiple episodes of hematemesis for 1 d. Upper GI endoscopy, bronchoscopy, and chest CT with IV contrast confirmed esophagomediastinal fistula with mediastinal bronchial artery aneurysm. After resuscitating patient with IV fluid and blood product transfusion, trans catheter embolization was performed for mediastinal bronchial artery aneurysm.CONCLUSION We successfully treated a patient with acute upper GI bleeding due to tuberculous esophagomediastinal fistula and mediastinal bronchial artery aneurysm using transcatheter coil embolization.展开更多
BACKGROUND Rubber band ligation(RBL) using rigid anoscope is a commonly recommended therapy for grade Ⅰ-Ⅲ symptomatic internal hemorrhoids. Severe complications of RBL include pain, hemorrhage and sepsis. Flexible e...BACKGROUND Rubber band ligation(RBL) using rigid anoscope is a commonly recommended therapy for grade Ⅰ-Ⅲ symptomatic internal hemorrhoids. Severe complications of RBL include pain, hemorrhage and sepsis. Flexible endoscopic RBL(ERBL) is now more commonly used in RBL therapy but few severe complications have been reported. Here we report on a case of massive bleeding after ERBL.CASE SUMMARY A 31-year-old female was admitted to the department of gastroenterology with a chief complaint of discontinuous hematochezia for 2 years. No previous history, accompanying diseases or drug use was reported. Physical examination and colonoscopy showed grade Ⅱ internal hemorrhoids. The patient received ERBL therapy. Five days after ligation, the patient presented with mild hematochezia. On days 7 and 9 after ligation, she presented with a large amount of rectal bleeding, dizziness and weakness. Emergency colonoscopy revealed active bleeding and an ulcer in the anal wound. The patient received two sessions of hemoclipping on days 7 and 9 to treat the bleeding. No further bleeding was reported up to day 15 and she was discharged home. Although the hemorrhoid prolapse disappeared after ERBL, she was dissatisfied with the subsequent complications.CONCLUSION ERBL therapy is an effective treatment for symptomatic internal hemorrhoids with satisfactory short and long-term recovery. Pain and anal bleeding are the most frequently reported postoperative complications. Coagulation disorders complicate the increased risk of bleeding. Although rarely reported, our case reminds us that those patients without coagulation disorders are also at risk of massive life-threatening bleeding and need strict follow-up after ligation.展开更多
BACKGROUND Splenic artery aneurysm(SAA)and pseudoaneurysm are rare vessel’s lesions.Pseudoaneurysm is often symptomatic and secondary to pancreatitis or trauma.True SAA is the most common aneurysm of visceral vessels...BACKGROUND Splenic artery aneurysm(SAA)and pseudoaneurysm are rare vessel’s lesions.Pseudoaneurysm is often symptomatic and secondary to pancreatitis or trauma.True SAA is the most common aneurysm of visceral vessels.In contrast to pseudoaneurysm,SAA is usually asymptomatic until the rupture,with high mortality rate.The clinical onset of SSA’s rupture is a massive life-threatening bleeding with hemodynamic instability,usually into the free peritoneal space and more rarely into the gastrointestinal tract.CASE SUMMARY We describe the case of a 35-year-old male patient,with negative past medical history,who presented to the emergency department for massive upper gastrointestinal bleeding,severe anemia and hypotension.An esophagogastroduodenoscopy performed in emergency showed a gastric bulging in the greater curvature/posterior wall with a small erosion on its surface,with a visible vessel,but no active bleeding.Endoscopic injection therapy with cyanoacrylate glue was performed.Urgent contrast-enhanced computed tomography was carried out due to the clinical scenario and the unclear endoscopic aspect:The radiological examination showed a giant SAA which was adherent to posterior stomach wall,and some smaller aneurysms of the left gastric and ileocolic artery.Because of the high risk of a two-stage rupture of the giant SAA with dramatic outcome,the patient underwent immediate open surgery with aneurysmectomy,splenectomy and distal pancreatectomy with a good postoperative outcome.CONCLUSION The management of a ruptured giant SAA into the stomach can be successful with surgical approach.展开更多
BACKGROUND Dieulafoy's lesion is a rare vascular abnormality characterized by a small abnormally dilated artery that runs a tortuous course in the submucosa.There is usually no ulcer present in Dieulafoy's les...BACKGROUND Dieulafoy's lesion is a rare vascular abnormality characterized by a small abnormally dilated artery that runs a tortuous course in the submucosa.There is usually no ulcer present in Dieulafoy's lesions and the overlying mucosa is most often normal.Bleeding caused by a Dieulafoy's lesion is usually urgent,massive,life-threatening and prone to recurrence.Dieulafoy's lesions have been reported throughout the digestive tract although the majority of them have been found in the upper digestive tract especially the stomach and duodenum.However,a Dieulafoy's lesion occurring inside a duodenal diverticulum is very rare.CASE SUMMARY A 74-year-old Asian male with epigastric pain,hematemesis and melena was admitted to our clinic.Before admission,the patient had vomited 500 m L of dark red blood,and passed 200 g of black tarry stool.Conservative management was first undertaken as the patient had not been fasting.However,hemorrhage recurred and the patient went into shock.Urgent endoscopy was performed and a diverticulum of 1.8 cm×1.2 cm×0.8 cm was found on the anterior wall of the descending duodenum.The diverticulum was covered with a blood clot.After the clot was removed,an artery stump was observed in the diverticulum with a diameter of 2-3 mm.Two titanium hemostatic clips were inserted to clamp the vessel stump.The patient was discharged 7 d post-endoscopy and followed for 6 mo with no recurrence.CONCLUSION This case was diagnosed with a Dieulafoy's lesion inside a duodenal diverticulum which has rarely been reported.Hematemesis was stopped by clamping the vessel stump with titanium clips.No complications occurred.展开更多
BACKGROUND Rectal Dieulafoy's lesions (DLs) are very rare;however, they can be life threatening when presented with massive hemorrhage. CASE SUMMARY A 44-year-old female with medical history of chronic renal failu...BACKGROUND Rectal Dieulafoy's lesions (DLs) are very rare;however, they can be life threatening when presented with massive hemorrhage. CASE SUMMARY A 44-year-old female with medical history of chronic renal failure who was on renal replacement therapy presented with lower gastrointestinal hemorrhage. Physical examination revealed signs of hypovolemic shock and massive rectal bleeding. Complete blood count revealed abrupt decrease in hematocrit. After hemodynamic stabilization, an urgent colonoscopy was performed. A rectal DL was diagnosed, and it was successfully treated with two hemoclips. There were no signs of recurrent bleeding at thirty days of follow-up. CONCLUSION Rectal DLs represent an unusual cause of lower gastrointestinal bleeding. Massive hemorrhage can increase the morbidity and mortality of these patients. Endoscopic management continues to be the reference standard in the diagnosis and therapy of these lesions. Thermal, mechanical (hemoclip or band ligation), or combination therapy (adrenaline injection combined with thermal or mechanical therapy) should be considered the first choice for treatment.展开更多
BACKGROUND Duodenal varices are a lesser-known complication with non-cirrhotic portal hypertension. We report a circuitous route from missed diagnosis of duodenal varices to correction. An extremely rare case of duode...BACKGROUND Duodenal varices are a lesser-known complication with non-cirrhotic portal hypertension. We report a circuitous route from missed diagnosis of duodenal varices to correction. An extremely rare case of duodenal variceal bleeding secondary to idiopathic portal hypertension(IPH) is expounded in this study, which was controlled by transjugular intra-hepatic porto-systemic shunt(TIPS) plus embolization. CASE SUMMARY A 46-year-old woman with anemia for two years was frequently admitted to the local hospital. Upon examination, anemia was attributed to gastrointestinal tract bleeding, which resulted from duodenal variceal bleeding detected by repeated esophagogastroduodenoscopy. At the end of a complete workup, IPH leadingto duodenal varices was diagnosed. Portal venography revealed that the remarked duodenal varices originated from the proximal superior mesenteric vein. TIPS plus embolization with coils and Histoacryl was performed to obliterate the rupture of duodenal varices. The anemia resolved, and the duodenal varices completely vanished by 2 mo after the initial operation. CONCLUSION TIPS plus embolization may be more appropriate to treat the bleeding of large duodenal varices.展开更多
BACKGROUND Intercostal arterial bleeding is unusual complication of percutaneous chest procedures.However,intercostal arterial bleeding is likely to result in critical complications such as abnormalities in vital sign...BACKGROUND Intercostal arterial bleeding is unusual complication of percutaneous chest procedures.However,intercostal arterial bleeding is likely to result in critical complications such as abnormalities in vital signs,hypovolemic shock,and death due to massive bleeding.Therefore,it is very important to establish the diagnosis of intercostal arterial bleeding and to initiate treatment.CASE SUMMARY We report a case in which a 59-year-old woman who was hospitalized at intensive care unit with multiple trauma had a massive hemothorax after the removal of a percutaneous catheter.She sustained a refractory right pleural effusion due to biloma caused by a traumatic injury to the liver,despite persistent intraperitoneal drainage.As a result,atelectasis persisted in the dependent portion of the right lung.Therefore,we performed right percutaneous catheter drainage(8.5-F pigtail catheter)for pleural effusion drainage at the 7th intercostal space.After percutaneous catheter removal,portable chest radiography and vital signs of the patient assisted in establishing a diagnosis of intercostal arterial bleeding.Intercostal arterial bleeding was also confirmed using transarterial angiography;and embolization was performed.The patient’s condition progressively improved,and no further intervention was required.CONCLUSION Massive hemothorax is a rare complication of percutaneous catheter removal.Clinicians should carefully examine and diagnose patients to improve prognosis.And interventional selective angiography may be a feasible and minimally invasive treatment for intercostal arterial bleeding control.展开更多
BACKGROUND Intestinal lipomas are rare benign gastrointestinal(GI)tumors,usually asymptomatic,but may become symptomatic as the result of some complications such as intussusception,intestinal obstruction,volvulus or b...BACKGROUND Intestinal lipomas are rare benign gastrointestinal(GI)tumors,usually asymptomatic,but may become symptomatic as the result of some complications such as intussusception,intestinal obstruction,volvulus or bleeding.They can occur at any site along the entire GI tract,more frequent in colon and rarely in small intestine.The patient reported here is a very rare case of jejunal lipoma,ulcerated and intussuscepted,diagnosed in an adult investigated for a chronic iron deficiency anemia(IDA),and successfully managed by segmental jejunal resection.CASE SUMMARY A 63-year-old male was referred to“St.Spiridon”Hospital,Institute of Gastroenterology and Hepatology,Iasi,to investigate an obscure GI bleeding with an IDA.After upper GI endoscopy and colonoscopy were performed,excluding potentially bleeding lesions,videocapsule endoscopy was then carried out,revealing fresh blood and a protruding lesion in proximal jejunum,findings confirmed by a single-balloon enteroscopy.Multiple biopsies were taken from the lesion,but histological results were inconclusive.Then,contrast-enhanced computed tomography was performed showing jejunal polypoid mass with homogenous fat density,suggestive for lipoma.A week later a laparotomy was performed revealing the intussuscepted jejunal segment which was resected enbloc,and sent for further histopathologic analysis.The patient made an uneventful recovery and was discharged seven days later,and at six months follow-up he had no complains and his hemoglobin returned to normal value.CONCLUSION Lipomas are very rarely located in the jejunum,usually asymptomatic,but they may lead to complications such as intussusception and bleeding.Surgical resection remains the treatment of choice.展开更多
BACKGROUND Acquired factor V deficiency is a rare secondary hemorrhagic disease,which can lead to a severe bleeding disorder.CASE SUMMARY We report a 47-year-old hemodialysis patient who presented with severe hemorrha...BACKGROUND Acquired factor V deficiency is a rare secondary hemorrhagic disease,which can lead to a severe bleeding disorder.CASE SUMMARY We report a 47-year-old hemodialysis patient who presented with severe hemorrhagic pleural effusion and hemorrhagic pericardial effusion associated with lymphatic leakage.The laboratory examination revealed decreased factor V activity (2% of population average value).With decreased lymphatic leakage,factor V activity increased (to 46%).Lymph drainage correlated with prothrombin time and active partial thrombin time.The cause of the disease favored an acquired disease.The common causes which trigger factor V inhibitors were excluded.An inhibitor was not detected.It is possible that there was a clotting factor inhibitor leaking with the lymph in the drainage.Inhibitor production may be due to immune dysfunction caused by persistent lymphatic drainage,or that coagulation inhibitors were produced,drained with the lymph,and partly cleared by hemodialysis.CONCLUSION In this case,we have firstly reported factor V deficiency associated with lymphatic leakage in a hemodialysis patient.展开更多
BACKGROUND Lymphangioma is a benign lesion that rarely involves the gastrointestinal tract,especially in adults.Small bowel lymphangioma is a rare cause of gastrointestinal bleeding.Here,we report a case of an adult d...BACKGROUND Lymphangioma is a benign lesion that rarely involves the gastrointestinal tract,especially in adults.Small bowel lymphangioma is a rare cause of gastrointestinal bleeding.Here,we report a case of an adult diagnosed with jejunal lymphangioma presenting with melena,anemia and hypogammaglobulinemia.We also summarize and analyze all 23 reported cases from 1961 to 2019,and propose an algorithm for identification and management of small bowel lymphangioma.CASE SUMMARY A case of a 29-year-old woman presented with persistent melena and irondeficiency anemia,accompanied by hypogammaglobulinemia.No lesions were found in the initial workup with esophagogastroduodenoscopy,colonoscopy and computed tomography(CT)enterography.Ultimately,capsule endoscopy and double-balloon enteroscopy revealed a 3 cm×2 cm primary lesion with intensive white lymphatic dilatatory changes and visible fresh blood stains,accompanied by a small satellite lesion.The patient underwent complete surgical resection of these lesions,and histopathological examination confirmed a diagnosis of cavernous lymphangioma of the jejunum.The patient showed no evidence of disease at the time of this report.CONCLUSION We recommend CT,capsule endoscopy and enteroscopy to identify the lesions of lymphangioma.Laparoscopic surgery with histological diagnosis is an ideal curative method.展开更多
BACKGROUND Vascular complications of transradial percutaneous coronary intervention(PCI)are rare and usually occur at the access site below the elbow.Life-threatening vascular complications during transradial PCI ther...BACKGROUND Vascular complications of transradial percutaneous coronary intervention(PCI)are rare and usually occur at the access site below the elbow.Life-threatening vascular complications during transradial PCI therapy,such as vessel perforation and dissection in the brachiocephalic,subclavian,internal mammary,and thyrocervical arteries,are rarely reported.Subclavian artery bleeding is a potentially serious complication of vascular interventional procedures leading to tracheal obstruction,hemothorax,respiratory failure,hemorrhagic shock,and death if not diagnosed early and treated promptly.CASE SUMMARY A male patient with typical angina pectoris underwent coronary angiography and stent implantation.During the procedure,the patient felt pharyngeal pain and tightness,which we mistook for myocardial ischemia.After PCI,swelling in the right neck and supraclavicular area was observed.The patient experienced dyspnea,emergency endotracheal intubation was performed,and then a sudden drop in blood pressure was observed.Ultrasound and contrast-enhanced computed tomography scans demonstrated a cervical hematoma severely compressing the trachea due to subclavian artery bleeding.Brachiocephalic angiography revealed a vascular injury site at the root of the right subclavian artery at the intersection of the right common carotid artery.A covered stent was deployed to the right subclavian artery with successful sealing of the perforation,and a bare stent was implanted in the junction of the right common carotid and brachiocephalic arteries to prevent obstruction of blood flow to the brain.CONCLUSION Subclavian artery bleeding is a lifethreatening complication of PCI.Early prevention,rapid recognition,and prompt treatment may improve the prognosis.展开更多
BACKGROUND Plasma-cell neoplasms rarely involve the gastrointestinal tract and manifest as gastrointestinal bleeding. Plasmablastic myeloma is an aggressive plasma cell neoplasm associated with poor outcomes. A small ...BACKGROUND Plasma-cell neoplasms rarely involve the gastrointestinal tract and manifest as gastrointestinal bleeding. Plasmablastic myeloma is an aggressive plasma cell neoplasm associated with poor outcomes. A small number of cases with gastrointestinal involvement is reported in the literature and therefore high index of suspicion is essential for avoiding delays in diagnosis and treatment.CASE SUMMARY Our aim is to present our experience of a 70-year-old patient with a secondary presentation of plasmablastic myeloma manifesting as unstable upper gastrointestinal bleeding and to review the literature with the view to consolidate and discuss information about diagnosis and management of this rare entity. In addition to our case, a literature search(Pub Med database) of case reports of extramedullary plasma cell neoplasms manifesting as upper gastrointestinal bleeding was performed. Twenty-seven cases of extramedullary plasmacytoma(EMP) involving the stomach and small bowel presenting with upper gastrointestinal bleeding were retrieved. The majority of patients were males(67%). The average age on diagnosis was 62.7 years. The most common site of presentation was the stomach(41%), followed by the duodenum(15%). The most common presenting complaint was melena(44%). In the majority of cases, the EMPs were a secondary manifestation(63%) at the background of multiple myeloma(26%), plasmablastic myeloma(7%) or high-grade plasma cell myeloma(4%). Oesophagogastroscopy was the main diagnostic modality and chemotherapy the preferred treatment option for secondary EMPs.CONCLUSION Despite their rare presentation, upper gastrointestinal EMPs should be considered in the differential diagnosis of patients with gastrointestinal bleeding especially in the presence of systemic haematological malignancy.展开更多
文摘BACKGROUND While varices and variceal bleeds are well-known and feared complications of advanced cirrhosis and portal hypertension,omental variceal bleed are a rare sequala even in patients with known esophageal or gastric varices.While rare,omental varices pose a risk for hemoperitoneum if ruptured,which is a lifethreatening complication with high mortality rates despite surgical intervention.CASE SUMMARY This report reviews the case of a patient 36-year-old female with alcohol related cirrhosis decompensated by ascites,but no history of varices admitted for hemorrhagic shock from spontaneous rupture of omental varices requiring emergency surgery.She underwent the first documented successful orthotopic liver transplantation the same admission.CONCLUSION This case report and literature review stresses the importance of early consideration and identification of intraabdominal variceal sources in cirrhotic patients with refractory shock.
文摘BACKGROUND Colonic diverticular bleeding is a significant cause of acute overt lower gastrointestinal hemorrhage.Colonoscopy is commonly performed in patients with colonic diverticular bleeding to identify and treat the source of bleeding,which is crucial for effective management.CASE SUMMARY We present the case of a 70-year-old male with acute painless hematochezia.Colonoscopy showed active bleeding originating from a diverticulum,and the EyeMax direct visualization system was used in the treatment of the colonic diverticular bleeding.No further evidence of bleeding was observed at the end of the procedure.The patient was discharged from hospital on the seventh day.CONCLUSION The EyeMax system proved advantageous in localizing the bleeding diverticulum,thereby facilitating successful hemostatic measures.
文摘BACKGROUND Jejunal diverticula(JD)are rare clinical conditions that are typically incidentally detected and asymptomatic.When acute complications arise,surgical exploration may be necessary for accurate diagnosis and appropriate treatment.In this report,we present a case of multiple JD complicated by gastrointestinal bleeding and review the pathogenesis,diagnosis,and treatment of JD to increase clinician awareness of this condition.CASE SUMMARY A 70-year-old male patient with multiple JD presented with repeated massive gastrointestinal bleeding.The patient did not respond to symptomatic conservative treatment.Additional diagnostic investigations,including digestive endoscopy and abdominal angiography,did not reveal any relevant abnormalities.An exploratory laparotomy was subsequently performed,during which a segment of the bowel containing numerous diverticulum-like structures was surgically removed.Following successful discharge from the hospital,the patient did not experience any further episodes of gastrointestinal bleeding during subsequent follow-up.CONCLUSION Complications caused by JD are often difficult to diagnose,and surgical exploration is sometimes the most appropriate method.
文摘BACKGROUND Postpancreatectomy hemorrhage is one of the most severe and life-threatening complications after pancreaticoduodenectomy.We present four cases of gastrointestinal bleeding patients to clarify its appropriate treatment and prevention.CASE SUMMARY The main symptoms included black stool,hematochezia,haematemesis,blood in the nasogastric tube,and hemorrhagic shock.The mean age was 66.25 years old and the median onset time was 340 d after the surgery.The bleeding location comprised gastrointestinal anastomosis,bile duct-jejunum anastomosis,and extraluminal bleeding.The possible causes included marginal ulcer,jejunal varix,and abdominal infection.Endoscopic hemostatic clips,as well as a covered stent using angiography,were utilized to stop the bleeding and three patients survived.Only one patient died of gastrointestinal bleeding,abdominal bleeding,abdominal infection,hypovolemic shock,and disseminated intravascular coagulation.CONCLUSION Early and effective endoscopic intervention is the key to successful hemostasis in patients with gastrointestinal bleeding after pancreatoduodenectomy.
文摘BACKGROUND Lung cancer is the most prevalent malignant tumor in human body,and is characterized by a high level of malignancy.The most common metastatic sites include the liver,bone,brain,and adrenal gland,while lung cancer resulting in gastrointestinal tract metastasis is uncommon.CASE SUMMARY A 74-years-old man with lung cancer was hospitalized owing to blood in the stool,The cause was identified as metastasis to the small intestine,and the patient subsequently underwent radical resection of the small intestine tumor.Currently,the overall condition of the patient is good,and undergoing combined chemotherapy.CONCLUSION Early intervention in patients with metastatic tumors can significantly improve prognosis.
文摘BACKGROUND Juvenile polyps(JPs)are non-neoplastic polyps.In adults,JPs present with hematochezia in only approximately half the patients and are often found incidentally during endoscopic screening.JPs have no mucosal fascia at the tip,and spontaneous shedding and massive gastrointestinal hemorrhage may occur.Thus,the JP bleeding detected in this case by extravascular contrast leakage on computed tomography scans and treated with endoscopic clipping is rare.CASE SUMMARY A previously healthy 31-year-old male patient presented with a 2-day history of bloody stools.Upon hospital arrival,rectal examination revealed fresh blood,and abdominal computed tomography scans showed extravascular contrast leakage from the lower rectum’s left-side wall.His blood pressure was slightly low at 104/62 mmHg.However,his pulse rate(69 bpm)and oxygen level(99%on room air)were within normal limits.Emergency endoscopy revealed a pedunculated lesion in the rectum covered by a non-neoplastic mucosal epithelium.No neoplastic lesions were observed at the tip of the polyp;however,pulsatile bleeding was detected at the distal end.We performed endoscopic hemostasis by clipping the stem and then performed a polypectomy above the stem to examine the lesion tissue.Histopathological evaluation revealed a cystically dilated gland without neoplastic lesions.A subsequent total colonoscopy revealed two JPs with characteristic edematous,smooth,and reddish surfaces close to the hemorrhagic lesion.Subsequent histopathological evaluation indicated findings characteristic of JP,such as severe inflammatory cell infiltration of the stroma and cystic dilatation of the glandular ducts.CONCLUSION There are no reports of adult JPs presenting with contrast extravasation where endoscopic hemostasis was successful,as in this case.
文摘BACKGROUND Gastrointestinal stromal tumors(GISTs)are rare mesenchymal tumors that rarely present with gastrointestinal(GI)bleeding due to tumor erosion.GISTs com-Core Tip:Gastrointestinal stromal tumors(GISTs)are rare mesenchymal tumors that rarely cause gastrointestinal(GI)bleeding.Mucosal ulceration and unfavorable tumor locations are risk factors for tumor progression and malignancy.We present a case of GI bleeding in a 42-year-old man complaining of melena over five days,which was diagnosed as a benign,ulcerated,jejunal GIST on histopathology and immunohistochemistry.Prompt evaluation using specialized diagnostic tools to locate obscure bleeding sources and complete surgical resection are key to favorable outcomes.GI bleeding in GIST is associated with a poor prognosis.Hence,detailed follow-ups are essential to detect and prevent tumor recurrence.INTRODUCTION Gastrointestinal stromal tumors(GISTs)are generally recognized as spindle cell,epithelioid,or occasionally pleomorphic tumors that usually develop in the gastrointestinal(GI)tract.Originating from mesenchymal cells of the GI tract,GISTs make up 1%-3%of all GI malignancies and progress to malignancy in approximately 10%to 30%of cases[1,2].A greater risk of tumor progression is linked to GISTs associated with mucosal ulceration and those that develop outside of the stomach[1,3].Many GISTs carry mutations in the genes encoding type III receptor tyrosine kinases,particularly KIT or PDGFRA,which is the case in up to 85%of instances.A significant majority,about 95%,of these tumors are positive for the KIT protein when tested with immunohistochemistry[4].The most common places where GIST arises are the stomach,followed by the small bowel[2].In 19%of cases,GISTs manifest asymptomatically,particularly in cases of smaller tumors of the intestinal tract.Studies show that around 10%of these cases were caught at autopsy and 20%during abdominal surgery for other conditions,making them a common incidental finding rather than a clinical suspicion[5,6].Patients who are symptomatic may exhibit non-specific symptoms such as nausea,vomiting,abdominal distension,early satiety,abdominal pain,and,in rare cases,a palpable abdominal mass.Obstruction of the GI lumen by endophytic growth or compression of the GI tract by exophytic growth may result in dysphagia,obstructive jaundice,or constipation in larger tumors,contingent upon the mass's specific location[1].Very rarely do these tumors present as an acute,severe,life-threatening GI bleeding[7].Herein,we describe a case report of a rather unusual presentation of GIST,i.e.,symptomatic GI bleeding caused by an ulcerated jejunal GIST,which was found to be benign in nature.This case report emphasizes the importance of maintaining a high suspicion of this disease when all routine workups for GI bleeding show no obvious findings.
文摘BACKGROUND Gastrointestinal bleeding due to metastasis of an invasive mole to the small intestine is very rare.Most reported cases of metastatic invasive mole are diagnosed after surgery,and lack rich illustrations,which leads to insufficient understanding by clinicians,misdiagnosis,and unnecessary surgeries.CASE SUMMARY A 22-year-old female patient presented with bloody stool and elevated human chorionic gonadotropin.The transvaginal gynecological ultrasound ruled out pregnancy.Upper gastrointestinal endoscopy and colonoscopy were performed,but no bleeding focus was detected.The contrast-enhanced computed tomography was unremarkable.The capsule endoscopy suggested jejunal protuberant lesions with dark red blood clots.Therefore,oral single-balloon enteroscopy was performed,and two connected protuberant lesions were detected,with blood clot traces and local ulceration.The enteroscopic biopsy revealed trophoblastic cells with a probable diagnosis of trophoblastic tumor.The patient underwent surgical resection of the diseased jejunum.Intraoperative endoscopy was performed,and the findings were the same as those of the small intestine endoscopy.The postoperative pathology confirmed the preoperative diagnosis of invasive mole.CONCLUSION In non-pregnant women with elevated human chorionic gonadotropin and gastrointestinal bleeding,metastatic trophoblastic neoplasia should be considered.
文摘BACKGROUND Esophagomediastinal fistula is a very rare complication of tuberculosis in otherwise healthy adults, and mediastinal bronchial artery aneurysm is even rarer. In this case report, we describe a rare case of tuberculosis complication that presented with acute upper gastrointestinal(GI) bleeding. It also highlights the benefits of chest computed tomography(CT) as an excellent adjunct diagnostic tool to endoscopy and bronchoscopy and the role of trans-arterial embolization as a minimal invasive therapy alternative to surgery.CASE SUMMARY A 19-year-old medically free male patient presented with acute multiple episodes of hematemesis for 1 d. Upper GI endoscopy, bronchoscopy, and chest CT with IV contrast confirmed esophagomediastinal fistula with mediastinal bronchial artery aneurysm. After resuscitating patient with IV fluid and blood product transfusion, trans catheter embolization was performed for mediastinal bronchial artery aneurysm.CONCLUSION We successfully treated a patient with acute upper GI bleeding due to tuberculous esophagomediastinal fistula and mediastinal bronchial artery aneurysm using transcatheter coil embolization.
文摘BACKGROUND Rubber band ligation(RBL) using rigid anoscope is a commonly recommended therapy for grade Ⅰ-Ⅲ symptomatic internal hemorrhoids. Severe complications of RBL include pain, hemorrhage and sepsis. Flexible endoscopic RBL(ERBL) is now more commonly used in RBL therapy but few severe complications have been reported. Here we report on a case of massive bleeding after ERBL.CASE SUMMARY A 31-year-old female was admitted to the department of gastroenterology with a chief complaint of discontinuous hematochezia for 2 years. No previous history, accompanying diseases or drug use was reported. Physical examination and colonoscopy showed grade Ⅱ internal hemorrhoids. The patient received ERBL therapy. Five days after ligation, the patient presented with mild hematochezia. On days 7 and 9 after ligation, she presented with a large amount of rectal bleeding, dizziness and weakness. Emergency colonoscopy revealed active bleeding and an ulcer in the anal wound. The patient received two sessions of hemoclipping on days 7 and 9 to treat the bleeding. No further bleeding was reported up to day 15 and she was discharged home. Although the hemorrhoid prolapse disappeared after ERBL, she was dissatisfied with the subsequent complications.CONCLUSION ERBL therapy is an effective treatment for symptomatic internal hemorrhoids with satisfactory short and long-term recovery. Pain and anal bleeding are the most frequently reported postoperative complications. Coagulation disorders complicate the increased risk of bleeding. Although rarely reported, our case reminds us that those patients without coagulation disorders are also at risk of massive life-threatening bleeding and need strict follow-up after ligation.
文摘BACKGROUND Splenic artery aneurysm(SAA)and pseudoaneurysm are rare vessel’s lesions.Pseudoaneurysm is often symptomatic and secondary to pancreatitis or trauma.True SAA is the most common aneurysm of visceral vessels.In contrast to pseudoaneurysm,SAA is usually asymptomatic until the rupture,with high mortality rate.The clinical onset of SSA’s rupture is a massive life-threatening bleeding with hemodynamic instability,usually into the free peritoneal space and more rarely into the gastrointestinal tract.CASE SUMMARY We describe the case of a 35-year-old male patient,with negative past medical history,who presented to the emergency department for massive upper gastrointestinal bleeding,severe anemia and hypotension.An esophagogastroduodenoscopy performed in emergency showed a gastric bulging in the greater curvature/posterior wall with a small erosion on its surface,with a visible vessel,but no active bleeding.Endoscopic injection therapy with cyanoacrylate glue was performed.Urgent contrast-enhanced computed tomography was carried out due to the clinical scenario and the unclear endoscopic aspect:The radiological examination showed a giant SAA which was adherent to posterior stomach wall,and some smaller aneurysms of the left gastric and ileocolic artery.Because of the high risk of a two-stage rupture of the giant SAA with dramatic outcome,the patient underwent immediate open surgery with aneurysmectomy,splenectomy and distal pancreatectomy with a good postoperative outcome.CONCLUSION The management of a ruptured giant SAA into the stomach can be successful with surgical approach.
文摘BACKGROUND Dieulafoy's lesion is a rare vascular abnormality characterized by a small abnormally dilated artery that runs a tortuous course in the submucosa.There is usually no ulcer present in Dieulafoy's lesions and the overlying mucosa is most often normal.Bleeding caused by a Dieulafoy's lesion is usually urgent,massive,life-threatening and prone to recurrence.Dieulafoy's lesions have been reported throughout the digestive tract although the majority of them have been found in the upper digestive tract especially the stomach and duodenum.However,a Dieulafoy's lesion occurring inside a duodenal diverticulum is very rare.CASE SUMMARY A 74-year-old Asian male with epigastric pain,hematemesis and melena was admitted to our clinic.Before admission,the patient had vomited 500 m L of dark red blood,and passed 200 g of black tarry stool.Conservative management was first undertaken as the patient had not been fasting.However,hemorrhage recurred and the patient went into shock.Urgent endoscopy was performed and a diverticulum of 1.8 cm×1.2 cm×0.8 cm was found on the anterior wall of the descending duodenum.The diverticulum was covered with a blood clot.After the clot was removed,an artery stump was observed in the diverticulum with a diameter of 2-3 mm.Two titanium hemostatic clips were inserted to clamp the vessel stump.The patient was discharged 7 d post-endoscopy and followed for 6 mo with no recurrence.CONCLUSION This case was diagnosed with a Dieulafoy's lesion inside a duodenal diverticulum which has rarely been reported.Hematemesis was stopped by clamping the vessel stump with titanium clips.No complications occurred.
文摘BACKGROUND Rectal Dieulafoy's lesions (DLs) are very rare;however, they can be life threatening when presented with massive hemorrhage. CASE SUMMARY A 44-year-old female with medical history of chronic renal failure who was on renal replacement therapy presented with lower gastrointestinal hemorrhage. Physical examination revealed signs of hypovolemic shock and massive rectal bleeding. Complete blood count revealed abrupt decrease in hematocrit. After hemodynamic stabilization, an urgent colonoscopy was performed. A rectal DL was diagnosed, and it was successfully treated with two hemoclips. There were no signs of recurrent bleeding at thirty days of follow-up. CONCLUSION Rectal DLs represent an unusual cause of lower gastrointestinal bleeding. Massive hemorrhage can increase the morbidity and mortality of these patients. Endoscopic management continues to be the reference standard in the diagnosis and therapy of these lesions. Thermal, mechanical (hemoclip or band ligation), or combination therapy (adrenaline injection combined with thermal or mechanical therapy) should be considered the first choice for treatment.
基金Supported by National Natural Science Foundation of China under Grant No.81503437
文摘BACKGROUND Duodenal varices are a lesser-known complication with non-cirrhotic portal hypertension. We report a circuitous route from missed diagnosis of duodenal varices to correction. An extremely rare case of duodenal variceal bleeding secondary to idiopathic portal hypertension(IPH) is expounded in this study, which was controlled by transjugular intra-hepatic porto-systemic shunt(TIPS) plus embolization. CASE SUMMARY A 46-year-old woman with anemia for two years was frequently admitted to the local hospital. Upon examination, anemia was attributed to gastrointestinal tract bleeding, which resulted from duodenal variceal bleeding detected by repeated esophagogastroduodenoscopy. At the end of a complete workup, IPH leadingto duodenal varices was diagnosed. Portal venography revealed that the remarked duodenal varices originated from the proximal superior mesenteric vein. TIPS plus embolization with coils and Histoacryl was performed to obliterate the rupture of duodenal varices. The anemia resolved, and the duodenal varices completely vanished by 2 mo after the initial operation. CONCLUSION TIPS plus embolization may be more appropriate to treat the bleeding of large duodenal varices.
文摘BACKGROUND Intercostal arterial bleeding is unusual complication of percutaneous chest procedures.However,intercostal arterial bleeding is likely to result in critical complications such as abnormalities in vital signs,hypovolemic shock,and death due to massive bleeding.Therefore,it is very important to establish the diagnosis of intercostal arterial bleeding and to initiate treatment.CASE SUMMARY We report a case in which a 59-year-old woman who was hospitalized at intensive care unit with multiple trauma had a massive hemothorax after the removal of a percutaneous catheter.She sustained a refractory right pleural effusion due to biloma caused by a traumatic injury to the liver,despite persistent intraperitoneal drainage.As a result,atelectasis persisted in the dependent portion of the right lung.Therefore,we performed right percutaneous catheter drainage(8.5-F pigtail catheter)for pleural effusion drainage at the 7th intercostal space.After percutaneous catheter removal,portable chest radiography and vital signs of the patient assisted in establishing a diagnosis of intercostal arterial bleeding.Intercostal arterial bleeding was also confirmed using transarterial angiography;and embolization was performed.The patient’s condition progressively improved,and no further intervention was required.CONCLUSION Massive hemothorax is a rare complication of percutaneous catheter removal.Clinicians should carefully examine and diagnose patients to improve prognosis.And interventional selective angiography may be a feasible and minimally invasive treatment for intercostal arterial bleeding control.
文摘BACKGROUND Intestinal lipomas are rare benign gastrointestinal(GI)tumors,usually asymptomatic,but may become symptomatic as the result of some complications such as intussusception,intestinal obstruction,volvulus or bleeding.They can occur at any site along the entire GI tract,more frequent in colon and rarely in small intestine.The patient reported here is a very rare case of jejunal lipoma,ulcerated and intussuscepted,diagnosed in an adult investigated for a chronic iron deficiency anemia(IDA),and successfully managed by segmental jejunal resection.CASE SUMMARY A 63-year-old male was referred to“St.Spiridon”Hospital,Institute of Gastroenterology and Hepatology,Iasi,to investigate an obscure GI bleeding with an IDA.After upper GI endoscopy and colonoscopy were performed,excluding potentially bleeding lesions,videocapsule endoscopy was then carried out,revealing fresh blood and a protruding lesion in proximal jejunum,findings confirmed by a single-balloon enteroscopy.Multiple biopsies were taken from the lesion,but histological results were inconclusive.Then,contrast-enhanced computed tomography was performed showing jejunal polypoid mass with homogenous fat density,suggestive for lipoma.A week later a laparotomy was performed revealing the intussuscepted jejunal segment which was resected enbloc,and sent for further histopathologic analysis.The patient made an uneventful recovery and was discharged seven days later,and at six months follow-up he had no complains and his hemoglobin returned to normal value.CONCLUSION Lipomas are very rarely located in the jejunum,usually asymptomatic,but they may lead to complications such as intussusception and bleeding.Surgical resection remains the treatment of choice.
文摘BACKGROUND Acquired factor V deficiency is a rare secondary hemorrhagic disease,which can lead to a severe bleeding disorder.CASE SUMMARY We report a 47-year-old hemodialysis patient who presented with severe hemorrhagic pleural effusion and hemorrhagic pericardial effusion associated with lymphatic leakage.The laboratory examination revealed decreased factor V activity (2% of population average value).With decreased lymphatic leakage,factor V activity increased (to 46%).Lymph drainage correlated with prothrombin time and active partial thrombin time.The cause of the disease favored an acquired disease.The common causes which trigger factor V inhibitors were excluded.An inhibitor was not detected.It is possible that there was a clotting factor inhibitor leaking with the lymph in the drainage.Inhibitor production may be due to immune dysfunction caused by persistent lymphatic drainage,or that coagulation inhibitors were produced,drained with the lymph,and partly cleared by hemodialysis.CONCLUSION In this case,we have firstly reported factor V deficiency associated with lymphatic leakage in a hemodialysis patient.
基金Supported by the General Program of Natural Science Foundation of Beijing Municipality,No.7192172
文摘BACKGROUND Lymphangioma is a benign lesion that rarely involves the gastrointestinal tract,especially in adults.Small bowel lymphangioma is a rare cause of gastrointestinal bleeding.Here,we report a case of an adult diagnosed with jejunal lymphangioma presenting with melena,anemia and hypogammaglobulinemia.We also summarize and analyze all 23 reported cases from 1961 to 2019,and propose an algorithm for identification and management of small bowel lymphangioma.CASE SUMMARY A case of a 29-year-old woman presented with persistent melena and irondeficiency anemia,accompanied by hypogammaglobulinemia.No lesions were found in the initial workup with esophagogastroduodenoscopy,colonoscopy and computed tomography(CT)enterography.Ultimately,capsule endoscopy and double-balloon enteroscopy revealed a 3 cm×2 cm primary lesion with intensive white lymphatic dilatatory changes and visible fresh blood stains,accompanied by a small satellite lesion.The patient underwent complete surgical resection of these lesions,and histopathological examination confirmed a diagnosis of cavernous lymphangioma of the jejunum.The patient showed no evidence of disease at the time of this report.CONCLUSION We recommend CT,capsule endoscopy and enteroscopy to identify the lesions of lymphangioma.Laparoscopic surgery with histological diagnosis is an ideal curative method.
基金Supported by Scientific Research Program of Hebei Administration of Traditional Chinese Medicine,China,No.2021201Science and Technology Support Plan Project of Chengde,China,No.201701A072.
文摘BACKGROUND Vascular complications of transradial percutaneous coronary intervention(PCI)are rare and usually occur at the access site below the elbow.Life-threatening vascular complications during transradial PCI therapy,such as vessel perforation and dissection in the brachiocephalic,subclavian,internal mammary,and thyrocervical arteries,are rarely reported.Subclavian artery bleeding is a potentially serious complication of vascular interventional procedures leading to tracheal obstruction,hemothorax,respiratory failure,hemorrhagic shock,and death if not diagnosed early and treated promptly.CASE SUMMARY A male patient with typical angina pectoris underwent coronary angiography and stent implantation.During the procedure,the patient felt pharyngeal pain and tightness,which we mistook for myocardial ischemia.After PCI,swelling in the right neck and supraclavicular area was observed.The patient experienced dyspnea,emergency endotracheal intubation was performed,and then a sudden drop in blood pressure was observed.Ultrasound and contrast-enhanced computed tomography scans demonstrated a cervical hematoma severely compressing the trachea due to subclavian artery bleeding.Brachiocephalic angiography revealed a vascular injury site at the root of the right subclavian artery at the intersection of the right common carotid artery.A covered stent was deployed to the right subclavian artery with successful sealing of the perforation,and a bare stent was implanted in the junction of the right common carotid and brachiocephalic arteries to prevent obstruction of blood flow to the brain.CONCLUSION Subclavian artery bleeding is a lifethreatening complication of PCI.Early prevention,rapid recognition,and prompt treatment may improve the prognosis.
文摘BACKGROUND Plasma-cell neoplasms rarely involve the gastrointestinal tract and manifest as gastrointestinal bleeding. Plasmablastic myeloma is an aggressive plasma cell neoplasm associated with poor outcomes. A small number of cases with gastrointestinal involvement is reported in the literature and therefore high index of suspicion is essential for avoiding delays in diagnosis and treatment.CASE SUMMARY Our aim is to present our experience of a 70-year-old patient with a secondary presentation of plasmablastic myeloma manifesting as unstable upper gastrointestinal bleeding and to review the literature with the view to consolidate and discuss information about diagnosis and management of this rare entity. In addition to our case, a literature search(Pub Med database) of case reports of extramedullary plasma cell neoplasms manifesting as upper gastrointestinal bleeding was performed. Twenty-seven cases of extramedullary plasmacytoma(EMP) involving the stomach and small bowel presenting with upper gastrointestinal bleeding were retrieved. The majority of patients were males(67%). The average age on diagnosis was 62.7 years. The most common site of presentation was the stomach(41%), followed by the duodenum(15%). The most common presenting complaint was melena(44%). In the majority of cases, the EMPs were a secondary manifestation(63%) at the background of multiple myeloma(26%), plasmablastic myeloma(7%) or high-grade plasma cell myeloma(4%). Oesophagogastroscopy was the main diagnostic modality and chemotherapy the preferred treatment option for secondary EMPs.CONCLUSION Despite their rare presentation, upper gastrointestinal EMPs should be considered in the differential diagnosis of patients with gastrointestinal bleeding especially in the presence of systemic haematological malignancy.
