ABSTRACT
@#Intraductal papillary mucinous neoplasm (IPMN) is a rare pancreatic neoplasm. The presentation varies from recurrent pancreatitis, steatorrhea and weight loss to incidental findings during imaging studies. The recognition of IPMN is crucial in deciding for prompt surgical intervention, which is the best treatment modality for this precancerous condition. Here, we report a case of 55-year-old man with massive upper gastro intestinal bleeding arising from a huge fungating duodenal mass. In view of massive bleeding, a decision for emergency Whipple's pancreaticoduodenectomy was made. Final histological diagnosis confirmed as IPMN. To the best of our knowledge, this is the first case of IPMN presented with a huge fungating duodenal mass causing massive UGIB requiring surgical intervention.
ABSTRACT
Clinically missed Dieulafoy's lesion is a significant cause of gastro-intestinal bleeding with a poor prognosis. We hereby compare an autopsy case of a similar nature; thereby highlighting the importance of autopsy. 69 years old male living in a retirement home was being managed for anemia. He was admitted with a preliminary diagnosis of septicemia with deteriorating renal function. He was found dead and referred for autopsy to our institute. At autopsy, 3 small defects at the gastroesophageal junction measuring about 5-7 mm were seen, which on microscopy revealed a relatively large artery at the submocosal level with rupture. There was about 2 liters of blood in the stomach. This was a Dieulafoy's lesion, the cause of sudden massive gastrointestinal bleeding and subsequent shock. This signifies that autopsy still holds its value in this modern era of diagnostics.
ABSTRACT
BACKGROUND/AIMS: Bleeding peptic ulcer in elderly patients is believed to differ from that found in younger patients. The purpose of this study was to evaluate the characteristics of bleeding peptic ulcer in elderly Korean patients. METHODS: We retrospectively evaluated 113 patients who were admitted to an emergency room for peptic ulcer bleeding from January 2006 to August 2008. For each patient, we investigated the clinical manifestations, the treatments and the hospital course. RESULTS: Peptic ulcer bleeding was more prevalent in elderly patients (n=63) than in younger patients (n=50). The elderly group had a higher incidence of comorbidities such as hypertension, stroke and ischemic heart disease, which might have be attributable to higher usage of aspirin and antiplatelet agents. There were no differences in the chief complaints or laboratory findings. The rate of Helicobacter pylori infection was lower in the elderly patients than that in the younger patients (41.3% vs. 62.0%, respectively, p=0.029). Four elderly patients and one younger patient died while in hospital, with one patient in each group dying due to bleeding. CONCLUSIONS: Peptic ulcer bleeding in elderly patients was associated with higher usage of aspirin and antiplatelet agents. There were no significant differences between the elderly and younger patients for the initial clinical presentation, the hospital course or the mortality due to bleeding.
Subject(s)
Aged , Humans , Aspirin , Comorbidity , Emergencies , Helicobacter pylori , Hemorrhage , Hypertension , Incidence , Myocardial Ischemia , Peptic Ulcer , Platelet Aggregation Inhibitors , Referral and Consultation , Retrospective Studies , StrokeABSTRACT
On 30.08.2003, a 20-year-old boy met with a vehicular accident and sustained spinal injury and left upper limb fracture. He was immediately hospitalized and seemed to recover well after treatment for a period of 15 days, when just before discharge he suddenly had hematemesis and bleeding per rectum and succumbed within another 24 hours. The case is discussed in detail.