Recent Update of Embolization of Upper Gastrointestinal Tract Bleeding

Nonvariceal upper gastrointestinal (UGI) bleeding is a frequent complication with significant morbidity and mortality. Although endoscopic hemostasis remains the initial treatment modality, severe bleeding despite endoscopic management occurs in 5-10% of patients, necessitating surgery or interventional embolotherapy. Endovascular embolotherapy is now considered the first-line therapy for massive UGI bleeding that is refractory to endoscopic management. Interventional radiologists need to be familiar with the choice of embolic materials, technical aspects of embolotherapy, and the factors affecting the favorable or unfavorable outcomes after embolotherapy for UGI bleeding.

A Case of Acute Lower Gastrointestinal Bleeding from Appendiceal Ulcer / 대한소화기내시경학회지

The common causes of acute lower gastrointestinal bleeding include diverticulosis, colonic vascular ectasia, neoplasm and colitis. Acute lower gastrointestinal bleeding from the appendix is a very rare malady and the causes are reported as angiodysplasia, diverticulum, appendicitis and endometriosis. We report here on the case of a 47-year-old man, who was taking enteric coated aspirin, with severe lower gastrointestinal bleeding that was due to appendiceal ulcer. An active bleeding was identified as coming from the appendiceal orifice during colonoscopy. He was treated by simple appendectomy. Histologic evaluation showed ulceration with both acute and chronic inflammation, along with thickened vessel walls in the submucosa of the appendix.

Laparoscopy-assisted Surgical Removal of a Retained Wireless Capsule Endoscopy: A case report

Occult bleeding of the gastrointestinal tract is a major cause of iron deficiency anemia. Even with endoscopic evaluation of the upper and the lower gastrointestinal tract in these patients, in 30~50% of the cases, the cause of bleeding still remains undiscovered. Wireless capsule endoscopy (WCE) is a novel method of evaluating the small bowel mucosa by using a small capsule equipped with a camera and transmission device. Complications of WCE include impaction within the gastrointestinal tract, sometimes requiring surgical removal. The authors report a case of capsule impaction in the small bowel in a patient evaluated for anemia due to occult gastrointestinal tract bleeding. The patient is a 19 year-old female with a history of anemia since age 4. The stool guaiac test was positive, but upper and lower gastrointestinal tract endoscopy showed no abnormalities, so WCE was done. A short segment of circular ulcers with lumen narrowing were seen in the distal jejunum. Seven days after ingestion of the capsule, the patient denied passage of the capsule. Small bowel enteroclysis was performed, and the capsule was seen along with a segment of lumen narrowing distal to the site of retention. Surgery was done, and upon laparoscopic examination, the entire bowel appeared normal. Retrieval of the capsule was done along with a resection of an 8 cm segment of the small bowel. Three linear ulcers were seen in the resected bowel specimen. Pathology revealed no evidence of Crohn's disease or tuberculosis. The patient is still on iron supplements, but her hemoglobin level remains stable at 11~12 g/dl.

Analysis on correlated clinical factors of upper gastrointestinal tract bleeding induced by acute organophosphorus pesticide poisoning / 中国实用内科杂志

Objective To investigate the correlated clinical factors of upper gastrointestinal hemorrhage induced by acute organophosphorus pesticide poisoning(AOPP) and look for effective method for the prevention and treatment of upper gastrointestinal tract bleeding(UGTB).Methods 49 patients with severe AOPP were divided into UGTB group(group A,26 cases)and non-UGTB group(group B,23 cases).The time,frequency and causes of UGTB were observed.We also observed the differences in acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ),blood glucose and cholinesterase in serum.Results The causes of UGTB induced by AOPP were poison damage of stomach mucous membrane,gastric lavage damage and irritability ulcer;APACHE Ⅱ scores of group A were more than those of group B obviously;the level of cholinesterase was lower in group A.Correlation analysis showed that the APACHE Ⅱ scores had positive correlation and the level of cholinesterase had negative correlation with UGTB induced by AOPP.Conclusion Both the APACHE Ⅱ scores and level of cholinesterase can reflect the UGTB induced by AOPP.Active treatment of the primary disease and stress status and often the operation of gastric lavage are important ways to prevent and treat UGTB induced by AOPP.