ABSTRACT
RESUMEN El hematoma disecante del esófago es poco frecuente y solo existen pocos casos registrados en la literatura. Generalmente, se presenta después de un trauma asociado a procedimientos endoscópicos o de forma espontánea. Se describe clínicamente con la triada clásica de dolor torácico, odinofagia, disfagia o hematemesis. Se ha relacionado con un aumento rápido de la presión intraesofágica o un mecanismo de deglución anómala particularmente en presencia de trastornos de la hemostasia. La mayoría de los pacientes tienen un buen pronóstico pues resuelven con tratamiento conservador. Presentamos el caso clínico de un paciente con diagnóstico de hematoma disecante de esófago con ruptura a cavidad abdominal que causó hemoperitoneo importante. Se realiza una revisión del tema(AU)
ABSTRACT Dissecting hematoma of the esophagus is a rare condition and there are only few cases reported by the literature. Generally, it occurs after trauma associated with endoscopic procedures or spontaneously. It is described clinically with the classic triad of chest pain, odynophagia, dysphagia or hematemesis. It has been associated with a rapid increase in intra-esophageal pressure or an abnormal swallowing mechanism particularly in the presence of haemostasis disorders. Most patients have a good prognosis because they obtain a solution by means of a conservative treatment. We present the clinical case of a patient with a diagnosis of dissecting hematoma of the esophagus with rupture to the abdominal cavity causing significant hemoperitoneum. A review of the subject is carried out(AU)
Subject(s)
Humans , Male , Adult , Esophagoscopes/adverse effects , Hematoma/diagnostic imaging , Abdomen, Acute/diagnostic imaging , Deglutition Disorders/drug therapy , Hematemesis/therapyABSTRACT
To determine the correlation of ABRI with treatment intervention and outcome as discharged or expired in patients of acute variceal bleed. Cross-sectional study Records of all the patients admitted in Medical Unit-IV, Civil Hospital Karachi with acute variceal bleeding during January 2004 to October 2006 were retrieved. Use of vasoactive agents [Terlipressin/Octreotide], endoscopic band ligation [EBL] and outcome [Discharged/Expired] were noted. ABRI was calculated by the following formula: ABRI= Blood Units Transfused/ [[Final Hematocrit - Initial Hematocrit] + 0.01] Mean ABRI were compared by Student's 't' test according to vasoactive therapy, EBL and outcome. Correlation of ABRI with the same variables was also studied by plotting Receiver Operative Curves [ROC]. Seventy six patients fulfilling inclusion criteria were selected. No statistically significant difference was observed in the mean ABRI scores when compared according to vasoactive drug administration, EBL and outcome. Significant correlation with mortality was seen on ROC plot with significantly larger area under the curve. ABRI correlated significantly with mortality in this study. Larger prospective studies with appropriate power are required to evaluate its association with other variables
Subject(s)
Humans , Esophageal and Gastric Varices/mortality , Hematemesis/therapy , Hematemesis/mortality , Treatment Outcome , Cross-Sectional Studies , Blood Transfusion , Hematocrit , Lypressin/analogs & derivatives , Octreotide , Hemostasis, Endoscopic , Hypertension, Portal , Acute Disease , Gastrointestinal HemorrhageABSTRACT
This article present a case of hematemesis caused by a leech infesting the floor of the mouth, which was managed in Princess Haya Hospital in Aqaba/Jordan in October-2003. This pathological condition is extremely rare in urban areas but is frequent in endemic rural areas. We also highlighted some very interesting features of Leech due to chemicals they possess and their medicinal use
Subject(s)
Humans , Male , Hematemesis/etiology , Hematemesis/parasitology , Hematemesis/therapy , Gastrointestinal HemorrhageABSTRACT
A hemorragia digestiva pode ocorrer em qualquer idade e constituir uma situaçao de emergência. O autor aborda suas causas em 4 grupos conforme faixa etária; descreve também os métodos diagnósticos e enfoca o tratamento a ser utilizado.
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Gastrointestinal Hemorrhage , Hematemesis , Endoscopy, Digestive System , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Hematemesis/diagnosis , Hematemesis/etiology , Hematemesis/therapyABSTRACT
La hemorragia del tracto gastrointestinal alto constituye un real desafio para el cirujano. Su tratamiento requiere un bien coordinado trabajo interdisciplinario. La endoscopia representa un notable avance y su utilizacion ha hecho posible el diagnostico precoz, la identificacion de las lesiones de alto riesgo de sangrado recurrente y el tratamiento intervencionista no operatorio de muchas de ellas. La radiologia intervencionista es muy efectiva en casos bien seleccionados. El doble concepto de pacientes de alto riesgo, o sea, aquellos que toleran mal la cirugia o un episodio de resangrado, y de lesiones de alto riesgo, esto es, aquellas con sangrado activo o con vaso visible indicativas de alta tasa de resangrado (29), permite la toma de decisiones prontas y racionales en cuanto al tratamiento quirurgico. En el cuadro siguiente se resumen los pasos que deben seguirse y la evolucion, de acuerdo con la condicion individual del paciente, en el tratamiento de la hemorragia gastrointestinal alta, segun el esquema aceptado en el Centro Medico de los Andes de la Fundacion Santa Fe de Bogota. Es similar al de Gau y Freeark (22): tratamiento de la HGIA: 1.- evacuacion del estomago.2.-bloqueadores H2. 3.- irrigacion con solucion salina. 4.- Endoscopia de urgencia.5.- infusion de vasopresina. 6.- embolizacion angiografica. 7.- Cirugia
Subject(s)
Adult , Humans , Male , Female , Embolization, Therapeutic/methods , Gastrointestinal Hemorrhage/therapy , Hematemesis/therapy , Gastrointestinal Hemorrhage , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/physiopathology , Gastrointestinal Hemorrhage/surgery , Melena/therapyABSTRACT
Se estudian 10 casos con sangrado de tubo digestivo alto (S.T.D.A.) que fueron internados en el Servicio de Urgencias de Medicina Interna del Hospital Nacional Homeopatico, Mexico; diagnosticandose la lesiones mediante endoscopia y en los que se emplearon exclusivamente medicamentos homeopaticos, habiendose cohibido el sangrado (hematemesis y/o melena) en un tiempo promedio de 72 horas empleando como maximo 5 dias para negativizar la sangre oculta en heces fecales en ocho pacientes. Los dos casos restantes en que no desaparecio totalmente la sangre oculta fue uno con diagnostico de Telangiectasia hereditariay otro con probable Carcinoma gastrico. No se presento ningun nuevo sangrado en el periodo de hospitalizacion y la evolucion fue sin complicaciones. Se concluyeque la Tereapeutica Homeopatica muestra sus grandes beneficios y es de gran uti lidad en S.T.D.A. a nivel de Servicios de Urgencia