Hemorragia digestiva por úlcera duodenal pós-bypass gástrico em estômago excluso: abordagem endoscópica transgástrica por laparoscopia / Gastrointestinal bleeding by duodenal ulcer after gastric bypass in excluded stomach: endoscopic transgastric approach by laparoscopy

O Bypass Gástrico é uma das cirurgias bariátricas mais realizadas no Brasil e no mundo. Com o aumento exponencial da utilização desta técnica cirúrgica, complicações a longo prazo podem ocorrer. Nesse contexto, é necessário um bom conhecimento pós-operatório, principalmente em relação à fisiopatologia gastrointestinal destes pacientes. Uma complicação rara, porém, extremamente grave, é a úlcera duodenal sangrante. Uma razão para isto é o difícil acesso ao estômago excluso e ao duodeno através da endoscopia digestiva alta. Este relato demonstra uma úlcera duodenal sangrante em paciente pós-operatório de bypass gástrico laparoscópico.

Gastric bypass in Roux-Y is the most common bariatric surgery in Brazil and the world. With the exponential increase of this surgical technique, complications can occur. In this context, is required a great knowledge postoperatively, especially in relation to gastrointestinal pathophysiology of these patients. A rare complication, however, extremely severe, is a duodenal ulcer bleeding. One account for this is the difficult to access excluded stomach and the duodenum through the endoscopy. This case report shows a duodenal ulcer bleeding in a patient postoperative laparoscopic gastric bypass.

Long-term Successful Treatment of Massive Distal Duodenal Variceal Bleeding with Balloon-occluded Retrograde Transvenous Obliteration / 대한소화기학회지

Duodenal variceal bleeding in patients with portal hypertension due to cirrhosis or other causes is uncommon. We report on a case of a 55-year-old male with an ectopic variceal rupture at the distal fourth part of the duodenum who presented with massive hematochezia and shock. Shortly after achievement of hemodynamic stability, due to the limitation of an endoscopic procedure, we initially attempted to find the bleeding focus by abdominal computed tomography, which showed tortuous duodenal varices that drained into the left gonadal vein. He was treated with first-line balloon-occluded retrograde transvenous obliteration (BRTO), resulting in a favorable long-term outcome without rebleeding three years later. This case suggests that BRTO may be a first-line therapeutic option for control of ruptured duodenal varices, especially at a distal location.

A Case of Successful Treatment of a Bleeding Duodenal Ulcer with Endoscopic Hemoclipping in a Child / 대한소화기내시경학회지

Upper gastrointestinal bleeding in infant and children is much less common than that in adults. Upper gastrointestinal bleeding in infants and young children is most often acssociated with stress ulcer or erosions, but in older children it may also be caused by duodenal ulcer, esophagitis, and esophageal varices. Because the total blood volume of a child is relatively small and can deplete rapidly, gastrointestinal bleeding is a catastrophic event. However, it is not associated with significant mortality except in those with a severe primary illness. Data on therapeutic endoscopy for pediatric gastrointestinal bleeding are limited to case reports. The hemoclip has recently been added to armamentaria of endoscopic devices. This method has several advantages, including fewer complication and the fact that less expertise is needed to achieve permanent hemostasis. We report a case of successful endoscopic control of a bleeding duodenal ulcer using with a hemoclip in a 22-month-old boy. Endoscopic hemoclipping would be a safe and efficacious treatment for control of bleeding from peptic ulcers in children.

A Case of Bleeding Duodenal Varices in a Patient with Idiopathic Portal Hypertension / 대한소화기내시경학회지

Bleeding duodenal varices are a rare complication in patients with portal hypertension. Cirrhosis followed by portal vein obstruction and splenic vein obstruction are the most common causes. Although the prognosis of bleeding duodenal varices is usually poor, an awareness of its characteristic presentation may enable diagnostic and therapeutic proce- dures to be performed rapidly with an increased likelihood of a reaching successful out- come. In this study, we report a case of bleeding duodenal varices in a 23-year-old woman with idiopathic portal hypertension who was also suffering with recurrent melena. Panendoscopy identified prominant tortuous varices with central erosion in the 3rd portion of the duodenum and no esophageal and gastric varices. The varices were successfully treated by distal splenorenal shunt.

Fatal Doudenal Ulcer Bleeding in Status Asthmaticus Treated with Theophylline and Steroids

It is generally agreed that theophylline preparations and steroids should be given intravenously for status asthmaticus. Theophylline can potentially have adverse gastrointestinal effects including abdominal pain, nausea, vomiting, and hematemesis. Upper gastrointestinal bleeding in patients treated with corticosteroids without a past history of upper gastrointestinal bleeding has been reported rarely. But the etiologic significance of the stress of status asthmaticus, administration of theophylline or corticosteroids in the development of ulcer has been open to question. We report a case of 8-year-old boy with status asthmaticus treated with these medications and later found to have a bleeding duodenal ulcer for which emergency surgery was necessary.