Capillary Hemangioma of the Jejunum as a Cause of Acute Bleeding: Case Report and Literature Review / Hemangioma capilar del yeyuno como causa de sangrado agudo: reporte de caso y revisión de la literatura

Abstract Bleeding from the small intestine is an uncommon cause of gastrointestinal tract bleeding. Most cases are secondary to angiodysplasias; however, they are rarely associated with hemangiomas of the small intestine, which are benign vascular neoplasms primarily diagnosed using capsule endoscopy and balloon-assisted enteroscopy in stable patients preoperatively. To date, only one case has been published with hemodynamic instability at the time of diagnosis. This report presents the case of a 21-year-old woman who presented with acute bleeding and hemorrhagic shock secondary to capillary hemangioma of the jejunum, which was diagnosed via intraoperative enteroscopy and successfully managed with surgical resection.

Resumen El sangrado del intestino delgado es una causa poco frecuente de sangrado en el tracto gastrointestinal. La mayoría de casos son secundarios a angiodisplasias; sin embargo, rara vez se asocia a hemangiomas del intestino delgado, los cuales son una neoplasia vascular benigna que se diagnostica principalmente con cápsula endoscópica y enteroscopia asistida por balón en pacientes estables de forma preoperatoria. Hasta la fecha solo se había publicado un caso con inestabilidad hemodinámica al momento del diagnóstico. Se reporta el caso de una mujer de 21 años que debuta con sangrado agudo y choque hemorrágico secundario a hemangioma capilar del yeyuno, el cual fue diagnosticado mediante una enteroscopia intraoperatoria y manejado con resección quirúrgica de forma exitosa.

Post hysterectomy fallopian tubal prolapse: a diagnostic dilemma

Fallopian tubal prolapse into the vaginal vault is a relatively rare postoperative complication after hysterectomy with adnexal preservation. The exact incidence is not known due to failure to diagnose and under-reporting. We hereby report a case who presented with unexplained vaginal bleeding post-hysterectomy, which was subsequently diagnosed and managed successfully.

Diagnostic comparison of ultrasonography, hysteroscopy and histopathology in abnormal uterine bleeding

Background: The objective of the study was to do diagnostic comparison of ultrasonography, hysteroscopy and histopathological examination in evaluation of abnormal uterine bleeding.Methods: An observational prospective study is conducted amongst 219 married women between age of 25 years to 59 years with Abnormal uterine bleeding admitted for diagnostic hysteroscopy at Obstetrics and Gynecology Department, Apollo Hospital, Bilaspur, Chhattisgarh from November 2022 to October 2023. Statistical analysis was assessed by chi square test.Results: Myoma is best diagnosed by Sonography. The exact size, shape, type of fibroid and location can be accurately diagnosed by USG. Endometrial hyperplasia, endometrial polyp, submucous fibroid, growth, septum, flimsy adhesions, focal lesions and intracavitary intrauterine lesions are best diagnosed by hysteroscopy. Endometrial carcinoma is best diagnosed by histopathology.Conclusions: Hysteroscopy has important role in diagnosis of intrauterine and endocervical canal abnormalities. Addition of hysteroscopy with histopathological examination of endometrial and cervical biopsy sample along with transvaginal ultrasonography enhances the accuracy of diagnosis. Use of hysteroscopy, ultrasonography and histopathology were not competitive rather complementary for diagnosing patients with abnormal uterine bleeding. Diagnostic tools like ultrasonography, hysteroscopy and histopathology helps in accurate, early diagnosis of endometrial and cervical cancer which prevents further damage and further spread and metastasis of disease to adjacent tissues/ organs. Early diagnosis and cure increases life expectancy and decreases morbidity and mortality.

Ormeloxifene in the management of abnormal uterine bleeding in tertiary care centre South Kerala

Background: AUB is the most common presentation in the reproductive age group. Many females suffer from AUB and its related effects. A study on the effectiveness of an easily available drug (ormeloxifene) with an easy dosing schedule was done and its wonderful role in controlling the symptoms and improvement of quality of life of a female with no financial burdens and surgical morbidity was studied.Methods: A hospital based prospective observational study was conducted among women attending the outpatient clinic of OBG department at Dr Somervell Memorial CSI Medical College, Karakonam, Trivandrum district.Results: Total 50 women with AUB took part in the study. 62% had menstrual duration of <7 days with regular cycles (84%). 86% of them had history of passage of clots. 48% of them had dysmenorrhea. Efficacy of ormeloxifene was assessed by using PBAC score and haemoglobin level measurement. A repeated measures ANOVA with a Greenhouse-Geisser correction determined mean PBAC score differed significantly between months. Post hoc analysis with a Bonferroni adjustment revealed PBAC score was statistically significantly decreased from pre-intervention to 3 months to 6 months. There is statistically significant difference with respect to haemoglobin level improvement.Conclusions: Ormeloxifene is an excellent drug in controlling AUB as evidenced by the PBAC score and haemoglobin levels. Ormeloxifene has better compliance and acceptability. It is cost effective with a simple dosage schedule. A significant decrease in the menstrual blood loss and marked improvement in the hemoglobin concentration.

Successful outcome in a ruptured heterotopic pregnancy

A heterotopic pregnancy is a simultaneous intrauterine pregnancy and an ectopic pregnancy. It is a rare condition; however, the increasing use of artificial reproductive techniques is increasing the incidence of heterotopic pregnancy. Most of the patients with heterotopic pregnancy have a previous history of infertility or tubal diseases. Diagnosis of ectopic pregnancy should not be missed out as quite often it is a precious pregnancy and a ruptured ectopic can change the outcome of intrauterine pregnancy as well. A 30-year-old female primigravida with 3 months of gestational age, (in vitro fertilization (IVF) conception) presented to casualty with complaints of bleeding per vaginum since morning. Patient was of gestational age 9 weeks 2 days by a 6 weeks scan at the time of presentation. A Provisional diagnosis of threatened abortion was made, 36 hours later, patient started complaining of acute pain in abdomen. In view of examination findings and ultrasound scan, decision was taken to perform emergency laparotomy. Intra-op findings were consistent with a right ruptured ectopic pregnancy which was missed on previous scans. Histopathology report confirmed findings of right ectopic pregnancy. Heterotopic pregnancy can occur even if the earlier scans are unable to detect the ectopic pregnancy. Patient presenting with symptoms of pain in abdomen and bleeding per vaginum should not be neglected especially in cases of IVF conception. Clinicians should keep in consideration for possibility of heterotopic pregnancy. Early diagnosis and prompt management can increase the survival of intrauterine pregnancy and decrease maternal morbidity and mortality.

Endometritis por Actinomyces en una adolescente: a propósito de un caso / Actinomyces endometritis in an adolescent girl: a case report

La actinomicosis pélvica es una infección poco común del tracto genital inferior y la pelvis. La especie causal más frecuente es la bacteria Actinomyces israelii, y se debe sospechar en toda paciente que presente dolor crónico pélvico y hemorragia uterina. Aunque se manifiesta excepcionalmente en mujeres sin antecedentes de portar dispositivos intrauterinos, es importante considerarla como diagnóstico. Se presenta el caso clínico de una paciente de 12 años con hemorragia uterina anormal resistente al tratamiento, que requirió intervención quirúrgica, incluyendo biopsia endometrial. El diagnóstico resultante fue actinomicosis endometrial. Este caso aporta la actualización del conocimiento sobre esta rara enfermedad y su presentación poco frecuente en adolescentes(AU)

Pelvic actinomycosis is a rare infection of the lower genital tract and pelvis. The most common causative species is the bacterium Actinomyces israelii, and it should be suspected in any patient who presents with chronic pelvic pain and uterine bleeding. Although it occurs exceptionally in women without a history of carrying intrauterine devices, it is important to consider it as a diagnosis. It is presented the clinical case of a 12-year-old patient with abnormal uterine bleeding resistant to treatment, which required surgical intervention, including endometrial biopsy. The resulting diagnosis was endometrial actinomycosis. This case contributes to updating knowledge about this rare disease and its uncommon presentation in adolescents(AU)

Comparative evaluation of the efficacy and safety of ormeloxifene and norethisterone in abnormal uterine bleeding

Background: Abnormal uterine bleeding is a typical condition for women of reproductive age. It can be painful and uncomfortable, create social disgrace, and have a considerable impact on health-related quality of life. Several studies have shown that ormeloxifene and norethisterone are useful in the treatment of abnormal uterine bleeding, however there is a scarcity of data comparing the efficacy and safety of these medicines. Methods: A prospective comparative study was conducted over 100 women, age group of 30-50 years, attending the gynecology outpatient department with subjective complaints of heavy menstrual bleeding at a tertiary care hospital, in Hyderabad. Group A (n=50) received 60 mg of ormeloxifene and Group B (n=50) received 5mg of norethisterone, respectively. Ethical approval was taken from the institutional ethical committee. Results: 38% aged 41-45, 86% had irregular cycles, 76% reported subjective improvement in group A, and 38% in group B. Group A showed a mean difference of 80.22 in decreasing PBAC score, 0.70 in hemoglobin rise, and 3.5 in decreasing ET, while group B showed 53.70 in PBAC decrease, 0.28 in hemoglobin rise, and 1.76 in endometrial thickness reduction. Both groups have no notable side effects and no significant p value. Conclusions: Reducing PBAC score, subjective improvement, hemoglobin, and endometrial thickness with ormeloxifene and norethisterone works. Ormeloxifene has a far greater effect than norethisterone and has fewer adverse effects.

Terapéutica quirúrgica en divertículos duodeno-yeyunales hemorrágicos, reporte de caso y revisión bibliográfica / Surgical therapy in hemorrhagic duodenal-jejunal diverticula, case report and bibliographic review

RESUMEN Introducción: Los divertículos son dilataciones saculares intestinales; pueden clasificarse en falsos o verdaderos, congénitos o adquiridos. Las complicaciones pueden ser graves, el sangrado es el signo más característico. Reporte de caso: Femenino 68 años, inició padecimiento con sangrado digestivo alto, estudios endoscópicos no evidenciaron sitio de sangrado; tránsito intestinal reportó 2 divertículos duodenales. Debido a múltiples transfusiones y hospitalizaciones se programó cirugía. Se encontraron 2 divertículos duodenales y múltiples en yeyuno. Se realizó diverticulectomías duodenales y resección segmentaria de yeyuno con entero-entero anastomosis. Durante posquirúrgico presentó fistula intestinal, se resolvió con nutrición mixta. Discusión: El tránsito intestinal evidenció divertículos como probable causa de sangrado. Al no contar con opciones de mínima invasión como determinan las guías, se otorgó tratamiento quirúrgico menos mórbido. Conclusiones: En caso de falta de opciones endoscópicas o endovasculares, la intervención quirúrgica es una opción viable, sin embargo, se debe individualizar cada caso para ofrecer la menor tasa de morbimortalidad.

ABSTRACT Introduction: Diverticula are intestinal saccular dilations; They can be classified as false or true, congenital or acquired. Complications can be serious, bleeding is the most characteristic sign. Case report: Female, 68 years old, the condition began with upper digestive bleeding, endoscopic studies did not show any bleeding site; intestinal transit reported 2 duodenal diverticula. Due to multiple transfusions and hospitalizations, surgery was scheduled. Two duodenal diverticula and multiple diverticula were found in the jejunum. Duodenal diverticulectomies and segmental resection of the jejunum with entero-entero anastomosis were performed. During the post-surgery period she presented intestinal fistula, which was resolved with mixed nutrition. Discussion: Intestinal transit revealed diverticula as a probable cause of bleeding. Since there were no minimally invasive options as determined by the guidelines, less morbid surgical treatment was provided. Conclusions: In the absence of endoscopic or endovascular options, surgical intervention is a viable option; however, each case must be individualized to offer the lowest morbidity and mortality rate.

An analytical study of annual bleeding rates in haemophilia patients receiving low dose factor prophylaxis and those receiving episodic factor doses

Background: This study aimed to assess the impact of low dose factor prophylaxis on haemophilia patients with respect to annual bleeding rates and severity of bleeding events. Methods: This is an analytical study. All patients of HAEMOPHILIA A AND B who are registered with CPRH haemophilia treatment centre from January 2022 to December 2022 were included and were followed up every month from January 2022. The study population was divided into two groups: those receiving regular low dose factor prophylaxis and those receiving episodic factor treatment. Both the group participants were matched for severity of factor deficiency and age. The collected data was compared with respect to the annual bleeding rate as well as severity of bleeding episodes in the two defined groups. Results: There were 100 study patients, and 16 of them are receiving regular low dose factor prophylaxis. The average bleeding episodes were found to be more in patients receiving episodic factor doses (ABR in moderate haemophilia= 3.511+/-0.81, ABR in severe haemophilia=5.38+/-4, 53) as compared to those receiving prophylactic factor doses (ABR in moderate haemophilia = 0.16+/-0.32, ABR in severe haemophilia=0.3+/-0.29). The incidence of severe bleeds (those requiring hospitalisation) was higher in patients receiving episodic factor therapy (15) as compared to those receiving regular low dose factor prophylaxis (1). Conclusions: Haemophilia patients receiving episodic factor doses have higher Annual Bleeding Rate as compared to patients receiving regular low dose factor prophylaxis. Also, patients receiving prophylaxis face less severe forms of bleeding episodes as compared to other group of patients.

Low dose estrogen progestin pill is better than cyclical progestin as medical management of abnormal uterine bleeding due to ovulatory dysfunction in premenopausal women

Background: In abnormal uterine bleeding due to ovulation dysfunction, unopposed estrogen causes persistent proliferative or hyperplastic endometrium and periods of amenorrhea followed by excessive bleeding. This is managed medically by cyclical use of some hormonal agents. The aim of the study was to compare the effectiveness and acceptability of cyclical progestin alone and low dose estrogen progestin pill as medical management of AUB-O in premenopausal women.Methods: The study composed of 57 premenopausal women with anovular type of bleeding. The study participants were randomly allocated to take either norethisterone 10 mg daily from 16th to 25th day of menstrual cycle or low dose estrogen progesterone pill, one pill daily from 1st day of menstrual cycle up to 24th day. These patients were followed up after three and six months to assess subjectively the persistence of abnormal uterine bleeding, patient’s satisfaction, need for hysterectomy and any side effects.Results: The symptomatic improvement was more apparent with estrogen progestin pill than cyclical norethisterone. More patients chose hysterectomy in the norethisterone group because they were not satisfied with medical management.Conclusions: Symptomatic improvement is more with low dose estrogen progestin pill than cyclical norethisterone in women with AUB-O. More women decline hysterectomy as they accept estrogen progestin pill.

Antiplatelet Therapy and Kidney Function in Non-Dialysis Chronic Kidney Disease: A Two-Centre Observational Study in Nigeria

Antiplatelet therapy used in preventing cardiovascular events in chronic kidney disease may be associated with higher risks of bleeding, low efficacy from fewer occlusive atherosclerotic disease), attenuation of the inflammatory process, and changes in the haemogram. We prospectively determined the kidney function, the haemogram, and the lipid profile of participants with and without antiplatelet therapy. The population with a mean age of 69.21 ± 11.73 years, had more women (65.88%), p=0.001. Participants' age was positively correlated with the CKD stage, p<0.001. Bleeding was more common with clopidogrel than aspirin and, less common with advancing CKD. Cardiovascular events were more common in CKD stage 5. The men had higher eGFR but lower platelet count and platelet neutrophil ratio (PNR) than the women, p=0.004, p<0.001, and p<0.001 respectively. The eGFR, bicarbonate, and HDL cholesterol were higher with versus without antiplatelets, p=0.04, p<0.001, and p=0.001 respectively. The platelet count and PNR were higher with antiplatelet therapy and with higher CKD stage, p<0.001 and p<0.001 and, p<0.001 and p<0.001 respectively. Higher platelet count (OR-0.410, 95% CI-0.02-1.04), lower uric acid levels (OR-0.550, 95% CI-0.271-0.948), higher HDL-C (OR-0.486, 95% CI-0.093-1.013), lower LDL-C (OR-0.572, 95% CI-0.082-1.002) and lower triglycerides (OR-1.274, 95% CI-0.755-1.493) were independently associated with antiplatelet therapy. The benefits of antiplatelet therapy in CKD are anchored on its anti-inflammatory, lipid-lowering, and kidney function-improving effects, these synergistically lead to lower cardiovascular events. The increased risk and consequences of bleeding, and reductions in leucocytes and erythrocytes population should be borne in mind to prevent heightening morbidity and mortality rates.

Bleeding hands in a young girl

Hematohidrosis is a rare disorder involving the spontaneous excretion of sweat contaminated by blood cells. We reported the case of an 8-year-old girl with unusual painless bleeding from her fingertips with no underlying disease or psychotic disorder. On examination, it disappeared as soon as it was wiped without leaving any sign of trauma and reappeared within a few seconds. Her secretions were confirmed as blood with a benzidine test and blood components were observed on microscopic examination of the fluid. Thus, a diagnosis of hematohidrosis was made and her symptoms decreased after treatment with oral propranolol.

Sangrado uterino anormal como presentación inicial de malignidades hematológicas / Abnormal uterine bleeding as the initial presentation of hematologic malignancies

El sangrado uterino anormal tiene una etiología variable, que va desde causas estructurales hasta causas funcionales, que se describen clásicamente en el acrónimo PALM-COEIN. No obstante, hay una pobre sensibilización de este síntoma como un marcador de enfermedades graves. En esta revisión se describe la relación de la hemorragia uterina anormal como síntoma clave o de presentación de malignidad hematológica, así como la posible relación con la hemofilia adquirida secundaria a neoplasia hematológica como causal del evento hemostático. Se realizó búsqueda en la literatura, con la mayoría de los artículos obtenidos de Medline, 24 de los cuales cumplieron con los objetivos para resolver la pregunta de investigación. Se encontraron diferentes malignidades hematológicas asociadas a sangrado uterino anormal, de las cuales la hemofilia adquirida y la trombocitopenia como potenciales causales de esta; la mayor correlación fue con leucemia, seguido de linfomas, y en menor cuantía la asociación con mieloma múltiple.

Abnormal uterine bleeding has a variable etiology, ranging from structural to functional causes, classically described by the acronym PALM-COEIN. However, there is poor awareness of this symptom as a marker of serious disease; in this review, we describe the relationship of abnormal uterine bleeding as a key symptom or debut of hematologic malignancy, as well as its possible relationship to acquired hemophilia secondary to hematologic neoplasia as causative of the hemostatic event. A literature search was performed, with most of the articles obtained from Medline, 24 of which met the objectives to solve the research question. Different hematological malignancies associated with abnormal uterine bleeding were found, of which acquired hemophilia and thrombocytopenia were found as potential causes; the highest correlation was with leukemia, followed by lymphomas, and to a lesser extent the association with multiple myeloma.

FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in non-gravid women

Background: Abnormal uterine bleeding is one of the most common problems of the women of reproductive age group leading to increased number of hospital visits. International federation of gynecology and obstetrics (FIGO) has suggested a new etiological classification system polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified, known by the acronym PALM-COEIN to standardize the terminology, investigations, diagnosis and management of abnormal uterine bleeding (AUB) in non-pregnant women of reproductive age group.Methods: This is a retrospective study on 150 patients of abnormal uterine bleeding to categorize them on the basis of PALM-COEIN classification. Patients were grouped under these categories after detailed history, examination, investigations and histopathological reports.Results: Ovulatory dysfunction was the most common cause of AUB in patients presenting to the gynecology outpatient department (n=42, 28%). It was followed by leiomyoma (n=37, 24.67%) and endometrial causes (n=23, 15.33%). They constitute the top 3 causes of AUB. Adenomyosis (n=22, 14.67%), not known (n=10, 6.67%), iatrogenic (n=5, 3.33%), polyp (n=6, 4%), coagulopathy (n=1, 0.67%) and malignancy (n=4, 2.66%) contributing least to the PALM-COEIN classification as an etiology for AUB.Conclusions: The PALM COEIN classification system is useful in understanding various etiological causes of AUB, facilitates accurate diagnosis and hence helps in optimizing the treatment.

Role of thyroid abnormality in perimenopausal abnormal uterine bleeding

Background: Diagnosing and treating abnormal uterine bleeding (AUB) presents special problems during the perimenopausal era, which often need for a thorough study of contributory variables. Comprehending the relationship between perimenopausal AUB and thyroid function has important therapeutic ramifications that might influence customized treatment plans and enhance patient outcomes.Methods: This prospective research sought to determine the significance of thyroid anomalies in perimenopausal AUB. It was carried out at the Department of Obstetrics and Gynecology, Rajashri Chatrapati Shahu Government Medical College, and Chatrapati Pramila Raje hospital. Data was carefully collected over a 6-month period, from April to September 2018, and placed into excel spreadsheets for statistical analysis. The goal of the research is to clarify the connection between perimenopausal AUB and thyroid dysfunction by using the proper statistical tests.Results: Out of 120 individuals with severe menstrual bleeding, 80 had hypothyroidism. Hyperthyroidism affected 45 hypomenorrhea and irregular menstrual cycle individuals. Thyroid issues are commonly ignored, and patients are given estrogen progesterone tablets without thyroid function testing.Conclusions: By providing insights into its complex etiology and opening the door for more focused therapy approaches in this patient population, this study aims to further our understanding of AUB.

Abordaje reconstructivo para un defecto de periimplantitis / Reconstructive approach for a peri-implantitis defect

Si bien el conocimiento científico para el tratamiento de la periimplantitis ha avanzado significativamente en los últimos años, sigue en discusión qué tipo de abordaje quirúrgico genera los mejores resultados clínicos y si el uso de biomateriales da mejoras significativas en dicho tratamiento. Este reporte de caso describe un abordaje quirúrgico reconstructivo de un defecto intraóseo por periimplantitis en una paciente que refería dolor y un intenso sangrado en sus implantes dentales, empleando un sustituto óseo anorgánico mineral bovino, sin el uso de una membrana o barrera, y con un protocolo de descontaminación de la superficie del implante mecánico y químico. Posteriormente, a las 20 semanas de realizado el procedimiento, se hizo la evaluación del defecto, obteniendo profundidades al sondeo menores a 5 mm, ausencia de sangrado al sondeo en todos los sitios y un llenado óseo radiográfico de aproximadamente 90%; cumpliendo con los criterios de éxito de la terapia periimplantaria. Lo anterior muestra que la terapia reconstructiva para los defectos por periimplantitis puede ser posible mediante el uso de un sustituto óseo xenogénico únicamente y con una correcta descontaminación de la superficie del implante (AU)

Although scientific knowledge for the treatment of peri-implantitis have advanced significantly in recent years, the type of surgical approach that generates the best clinical results is still under discussion and whether the use of biomaterials gives significant improvements in said treatment. This case report describes a reconstructive surgical approach for a periimplantitis intrabony defect using an anorganic bovine bone substitute, without the use of a membrane or barrier, and with a mechanical and chemical implant surface decontamination protocol. Twenty weeks after the procedure, the defect was reassessed, obtaining probing depths of less than 5 mm, no bleeding on probing in all sites, and radiographic bone filling of approximately 90%; meeting the success criteria for the peri-implant therapy. This shows that reconstructive therapy for periimplantitis defects may be possible using a xenogeneic bone substitute only and proper decontamination of the implant surface (AU)

Endometrial study of abnormal uterine bleeding in perimenopausal women

Background: AUB accounts for 70% of gynecological pathology. Prevalence of AUB is 3%-30% among reproductive aged women. Early diagnosis by endometrial biopsy is the most effective way to rule out malignancy in peri-menopausal women with AUB. TVS can be used as an aided diagnostic tool. Aims and objectives of this study is to evaluate endometrial causes of abnormal uterine bleeding in perimenopausal women and to correlate transvaginal sonography findings with histopathology by endometrial biopsy.Methods: This prospective observational study was conducted on 80 perimenopausal women with abnormal uterine bleeding. Uterine pathology, endometrial thickness, was assessed by TVS. Endometrium was considered hyperplastic if thickness is ?10 mm in perimenopausal women and was taken up for endometrial sampling. Endometrial biopsy by Pipelle’s curette was done as an outpatient procedure and sent for HPE.Results: Total of 80 women with perimenopausal bleeding were examined during the study. Majority of the patients with AUB presented in 40-44 years age group and belonged to second parity. As per the TVS findings, 42 (52.5%) subjects had normal findings, 25 (31.3%) showed endometrial hyperplasia and remaining had other benign uterine pathology. Majority of women had ET 10 mm. The most common finding on histopathological examination was Proliferative endometrium.Conclusions: Trans vaginal scan when incorporated along with bimanual pelvic examination and Pipelle’s aspiration can enhance our anatomic diagnosis. This study proves that transvaginal findings correlate well with the histopathology findings.

A mysterious hematochezia in an adolescent boy: atypical presentation of childhood systemic lupus erythematosus

Thrombosis is a well-known entity in presence of antiphospholipid antibody (APLA) associated with systemic lupus erythematosus (SLE) as a hematological complication. Bleeding manifestations instead of thrombosis is hardly found in literature in presence of APLA seromarkers in SLE. Since these can range from minor bleeding like epistaxis to major life-threatening intracranial bleeding, early diagnosis and prompt treatment is essential to manage such condition. We report a 12 years old boy with no significant past history presented with hematochezia and epistaxis along with pallor requiring blood transfusion. Hematological investigations were normal except for elevated PT, aPTT and INR. Common causes of coagulopathy were ruled out. Upon suspecting systemic diseases, the investigations were carried out which revealed ANA 4+ along with high titre of dsDNA, low C3 and C4 complement and positive anti-?2 glycoprotein, anticardiolipin antibody and lupus anticoagulant. Diagnosis of SLE was made according to ACR-EULAR criteria with no renal involvement. Immunological basis was considered for coagulopathy in this child. He was started on oral prednisolone, hydroxychloroquine and methotrexate. He is now under close monitoring of the coagulation profile for titration of steroid dose. We want to create awareness about the uncommon hematological manifestation of SLE presenting as bleeding diathesis instead of thrombosis through this case report and that can be life threatening too if not treated promptly. A high index of suspicion and careful follow-up may help in preventing adverse outcome of the disease.

Hemorragia digestiva por intususcepción de un lipoma ulcerado en yeyuno / Gastrointestinal bleeding due to ulcerated intussuscepted jejunal lipoma

RESUMEN Los lipomas yeyunales son tumores gastrointestinales benignos e infrecuentes, de origen mesenquimático, compuestos por adipocitos que suelen estar confinados a la submucosa. Generalmente son asintomáticos y se descubren de manera incidental al realizar estudios por imágenes o endoscópicos. Sin embargo, aquellos mayores de 2 cm pueden presentar síntomas como resultado de complicaciones, como intususcepción intestinal, obstrucción o rara vez, hemorragias. Presentamos un caso infrecuente de intususcepción de un lipoma yeyunal ulcerado en un adulto, diagnosticado en el contexto de un cuadro de hemorragia digestiva.

ABSTRACT Jejunal lipomas are rare benign mesenchymal tumors made up of adipocytes confined to the submucosa layer. They are usually asymptomatic and are incidentally found during imaging or endoscopic tests. Those measuring > 2 cm may become symptomatic as a result of complications as intestinal intussusception, obstruction and bleeding. We herein report a rare case of intussusception of an ulcerated jejunal lipoma in an adult patient, that was diagnosticated in the setting of an intestinal hemorrhage.

Lower Gastrointestinal Bleeding Due to Rectal Dieulafoy's Lesion: A Case Report / Sangrado de tubo digestivo bajo por lesión de Dieulafoy rectal: a propósito de un caso

Abstract Dieulafoy's lesion is a 1-3 mm vascular lesion in the submucosa and represents 1-2% of total GI bleeding; 80% are located in the stomach and 15% in the duodenum, while its finding in the rest of the GI tract is <5%. This work presents the case of a 79-year-old male patient who went into hypovolemic shock due to GI bleeding secondary to a rectal Dieulafoy's lesion with endoscopic and subsequent surgical management.

Resumen La lesión de Dieulafoy es una lesión vascular de 1-3 mm en la submucosa y representa del 1%-2% del total de hemorragias digestivas; 80% se localiza en el estómago y 15% en el duodeno, mientras que su hallazgo en el resto del tubo digestivo representa < 5%. En el siguiente trabajo se presenta el caso de un paciente masculino de 79 años que presentó choque hipovolémico por sangrado de tubo digestivo secundario a lesión de Dieulafoy rectal con manejo endoscópico inicial y posteriormente quirúrgico.