Comportamiento de la hemorragia digestiva alta en el quinquenio 2009 a 2013 / Behavior of the high digestive bleeding in the five-year period 2009-2013

Introducción: la hemorragia digestiva alta constituye un problema frecuente de salud en el mundo; así se comporta en Cuba, en la provincia Matanzas y en el hospital de estudio. Actualmente es considerada como causa mayor de morbimortalidad. Objetivo: determinar el comportamiento de la hemorragia digestiva alta en el Hospital Militar de Matanzas. Materiales y Métodos: se realizó una investigación descriptiva, en un periodo de cinco años que incluyó a todos los pacientes ingresados con ese diagnóstico, y los que durante su ingreso por otra causa presentaron episodios de hemorragia. El índice de Rockall permitió evaluar la necesidad de cirugía, recidiva y mortalidad. Resultados: la mayoría de los pacientes pertenecieron al grupo de riesgo intermedio. Los hombres fueron los más afectados, el grupo de tercera edad presentó mayor incidencia. La gastritis hemorrágica fue la primera causa de sangrado. La hipertensión arterial resultó ser el factor de riesgo relevante y el tabaquismo el hábito tóxico más frecuente. Conclusiones: como beneficio relevante se demostró la importancia de la endoscopia precoz para el diagnóstico de la causa, tratamiento y pronóstico de la hemorragia. Se observó una buena correlación entre el pronóstico del paciente al ingreso y su estado al final del tratamiento (AU).

Introduction: the high digestive hemorrhage is a frequent health problem in the world; it behaves the same in Cuba, in the province of Matanzas and in the hospital where the study was carried out. Currently it is considered a major cause of morbi-mortality. Objective: to determine the behavior of the high digestive bleeding in the Military Hospital of Matanzas. Materials and Methods: a descriptive research was carried out in a five-year period. It included all the patients admitted with that diagnosis and those who presented episodes of hemorrhage even if they were admitted by any other cause. The Rockall index allowed to assess the necessity of surgery, the recidivism and mortality. Results: most of the patients belonged to the intermediate risk group. Male patients were the most affected one; the group of elder people showed higher incidence. Hemorrhagic gastritis was the first cause of bleeding. Arterial hypertension was the relevant risk factor and smoking the most frequent toxic habit. Conclusions: as a relevant benefit it was showed the importance of precocious endoscopy for the diagnosis of the hemorrhage cause, treatment and prognosis. It was observed a good correlation between the patient´s prognosis at the admission and his status at the end of the treatment (AU).

A Case of Conservatively Resolved Intramural Esophageal Dissection Combined with Pneumomediastinum / 대한소화기학회지

Intramural esophageal dissection (IED) is a rare form of esophageal injury. We report a rare case of spontaneous IED complicated with pneumomediastinum and successfully improved by conservative management. A 46-year-old man presented to the emergency department with chest pain and hematemesis. The endoscopic diagnosis was suspicious of IED. Chest CT scan performed to rule out complication noted IED combined with pneumomediastinum. He was managed conservatively with nil per oral, intravenous antibiotics and parenteral nutrition. Follow up study after 2 weeks later showed near complete resolution of IED. IED should be included in the differential diagnosis for unexplained acute chest pain, especially, associated with dysphagia and hematemesis. IED with pneumomediastinum or mediastinitis require prompt surgery. So far, there is no case report of IED combined with pneumomediastinum which resolved without surgical treatment. In this case, IED combined with pneumomediastinum has improved by conservative management, so we present a case report.

A Case of Jeujunogastric Intussusception Presented with Hematemesis after Distal Gastrectomy / 대한소화기학회지

Adult intussusception represents 5% of all cases of intussusception and accounts for only 1-5% intestinal obstructions. Intussusception is a rare complication after gastric surgery with an incidence estimated at 0.1%. Early diagnosis of the acute onset intussusception is critical because mortality rates increase abruptly with delay in surgical treatment. We present here a case of jejunogastric intussusception diagnosed by gastroscopy in a patient with a history of distal gastrectomy due to early gastric cancer who had experienced hematemesis.

Non-cirrhotic portal fibrosis associated with pulmonary arteriovenous communication and pulmonary arterial hypertension.

A case of non-cirrhotic portal fibrosis associated with pulmonary arteriovenous communication and pulmonary arterial hypertension is reported. The patient was a 7-year old boy who presented with hematemesis, cyanosis, hypoxemia and orthodeoxia. His liver pathology was compatible with non-cirrhotic portal fibrosis. His pulmonary angiography showed arteriovenous shunting and pulmonary arterial hypertension (mean pulmonary artery pressure 34 mmHg). His sister also had non-cirrhotic portal fibrosis with neither hypoxemia nor orthodeoxia. This report raises the possibility of non-cirrhotic portal fibrosis having a genetic etiology.

Aorta-oesophageal fistula: a rare cause of gastrointestinal haemorrhage

Primary aorto-oesophageal fistula is a rare cause of massive and usually fatal gastrointestinal haemorrhage. We herein present a case of a 62-year-old chronic alcohol abuser who had a small haematemesis after a week of persistent vomiting. He succumbed to an exsanguinating bleed 36 hours after admission. An aorto-oesophageal fistula was found at autopsy. We emphasize the need for a high index of suspicion and recognition of premonitory signs for accurate diagnosis and management of this condition.

Study of the fibrinolytic activity of gastric secretion in schistosomal hepatic fibrosis and its relation to hematemesis

Hematemesis due to rupture of gastro-esophageal varices is a common and serious problem in patients with schistosomal hepatic fibrosis. Factors that may lead to or augment this are still controversial. This work aimed at studying the fibrinolytic activity of gastric juice as a guide to its possible role in initiating or perpetuation bleeding in these patients. Thirty male patients with pure schistosomal hepatic fibrosis and gastro-esophageal varices were studied divided into two equal groups. One group had a history of repeated bleeding from these varices while the other had not such a history. Another 10 healthy male subjects were included as a control group. Gastric secretion of all subjects was examined for the presence of fibrin degradation products [FDPs] and is capability to shorten euglobulin clot lysis time [ECLT] of plasma of the same subject. FDPs were detected only in the two groups of patients with higher degree of positivity in the bleeding group. With gastric secretion ECLT was significantly shortened in bleeding group and ECLT in both groups of patients was significantly shorter than that of the control group. These results confirmed the presence of fibrinolytic activity in gastric secretion that is more evident in patients with tendency to bleeding from gastro-esophageal varices

Hemorragia digestiva alta / Upper tract digestive hemorrhage

Se revisaron 390 expedientes de casos de HDA aguda, atendidos en el C.G.B.J. de Cochabamba desde 1981 a 1986. La HDA aguda se presenta con mayor frecuencia en el sexo masculino y en el grupo etáreo comprendido entre los 51 a 60 años de edad. Aproximadamente en el 80 de los casos, el sangrado digestivo se detuvo antes de iniciar el manejo clínico e incluso antes de la consulta médica. Observandose persistencia del sangrado en los casos de úlcera péptica y várices esofágica. Está demostrado que el mejor método de diagnostico es la endoscopía alta, con una efectividad en el presente trabajo del 99; lograndose de este modo establecer como causas principales de HDA aguda a la úlcera péptica, la gastritis erosiva aguda y las várices esofágicas.