Divertículo de Meckel complicado. Experiencia de 15 años en un hospital interzonal / Complicated Meckel's diverticulum. Fifteen years of experiencein an interzonal hospital in the Province of Buenos Aires

Introducción: el divertículo de Meckel es la anomalía congénita más frecuente del tracto gastrointestinal. Puede presentarse con hemorragia, obstrucción intestinal o diverticulitis, complicaciones que disminuyen con la edad, por lo que en el adulto el diagnóstico suele ser incidental. El tratamiento de las complicaciones es quirúrgico, mediante diverticulectomía o resección segmentaria del intestino delgado, dependiendo de sus características morfológicas. Objetivo: analizar nuestra experiencia en el manejo del divertículo de Meckel complicado en un período de 15 años. Diseño: estudio descriptivo, observacional, transversal, retrospectivo. Material y métodos: se revisaron las historias clínicas de los pacientes operados por divertículo de Meckel complicado en el Servicio de Cirugía General del Hospital San Roque durante el periodo 2007-2022. Se registraron datos demográficos, presentación clínica, diagnóstico preoperatorio, tratamiento quirúrgico, complicaciones postoperatorias y hallazgos histopatológicos. Resultados: se incluyeron 25 pacientes, 21 (84%) hombres, 3 menores de 18 años. La presentación clínica fue un síndrome de fosa iliaca derecha en el 80% de los casos, obstrucción intestinal en el 16% y hemorragia en el 4%. En solo 2 casos se realizó el diagnóstico preoperatorio, confirmado mediante tomografía computada. Se realizó diverticulectomía en el 68% de los pacientes y resección segmentaria el 32%. El abordaje fue laparotómico en el 64%, principalmente en el periodo inicial y laparoscópico en el 36%. Hubo una complicación IIIb de Clavien-Dindo en un paciente pediátrico tratado con drenaje percutáneo. En un solo paciente (4%), que se presentó con hemorragia digestiva masiva, se encontró epitelio de tipo gástrico y páncreas ectópico en el divertículo. Conclusiones: En nuestra experiencia el divertículo de Meckel complicado se presentó predominantemente en hombres. La complicación más frecuente en el adulto fue la diverticulitis. El diagnóstico preoperatorio fue infrecuente y realizado por tomografía computada. La diverticulectomía es suficiente en la mayoría de los casos. Actualmente, la laparoscopia es una herramienta segura, rentable y eficiente que permite el diagnóstico y tratamiento oportunos de esta entidad. (AU)

Introduction: Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract. It can present with bleeding, intesti-nal obstruction or diverticulitis, complications that decrease with age, so in adults the diagnosis is usually incidental. Treatment of complications is surgical, through diverticulectomy or segmental resection of the small intestine, depending on its morphological characteristics. Objective: to analyze our experience in the management of complicated Meckel's diverticulum over a period of 15 years. Design: descriptive, observational, cross-sectional, retrospective study. Materials and methods: the medical records of patients operated on for complicated Meckel's diverticulum in the General Surgery Service of the San Roque Hospital during the period 2007-2022 were reviewed. Demo-graphic data, clinical presentation, preoperative diagnosis, surgical treatment, postoperative complications, and histopathological findings were recorded. Results: twenty-five patients were included, 21 (84%) men, 3 under 18 years of age. The clinical presentation was a right iliac fossa syndrome in 80% of cases, intestinal obstruction in 16% and hemorrhage in 4%. In only 2 cases was the preoperative diagnosis made, confirmed by computed tomography. Diverticulectomy was performed in 68% of patients and segmental resection in 32%. The approach was by laparotomy in 64%, mainly in the initial period, and by laparoscopy in 36%. There was a Clavien-Dindo IIIb complication in a pediatric patient treated with percutaneous drain-age. In only one patient (4%), who presented with massive gastrointestinal bleeding, gastric-type epithelium and ectopic pancreas were found in the diverticulum. Conclusions: In our experience, complicated Meckel's diverticulum occurred predominantly in men. The most frequent complication in adults was diverticulitis. Preoperative diagnosis was infrequent and was made by computed tomography. Diverticulectomy is sufficient in most cases. Currently, laparoscopy is a safe, profitable and efficient tool that allows for the timely diagnosis and treatment of this entity. (AU)

Clinical features of an outbreak of extensive drug resistant typhoid fever / 中华传染病杂志

Objective:To analyze the clinical features of an outbreak of extensive drug resistant typhoid fever, and to provide experience for the diagnosis and treatment of drug resistant typhoid fever.Methods:Seven patients with confirmed diagnosis of extensive drug resistant typhoid fever who visited Beijing You′an Hospital, Capital Medical University, from January 27 to February 15, 2022 were included. The clinical characteristics, drug sensitivity tests, consultation and treatment history and prognosis of the patients were analyzed through descriptive study.Results:Of the seven extensive drug resistant typhoid fever patients, three were male and four were female, one of whom was pregnant (at 32-week gestation), aged (29.8±6.8) years, with a range of 22 to 42 years. There were seven cases with fever, and the course of fever ranged from six to 20 days. There were five cases with diarrhea and lack of typhoid-specific manifestations such as rose spot, apathetic facial expression and relatively slow pulse. Four cases were complicated with intestinal bleeding and six cases developed liver function injury. Six cases had loss or decrease in eosinophil ratio and two cases had decreased white blood cell count. The results of drug susceptibility tests showed that seven strains of Salmonella typhi were resistant to chloramphenicol, ampicillin, sulfamethoxazole-trimethoprim, quinolones, ceftriaxone, cefepime, ceftazidime, cefuroxime, and sensitive to carbapenem antibiotics, tigecycline and piperacillin/tazobactam. All seven cases had a history of antimicrobial use before admission. One case was administered with intravenous ceftizoxime for seven days after admission. After discharge, cefixime was administered orally for seven days. Six patients were given intravenous piperacillin sodium/tazobactam sodium for 14 days. All blood/fecal cultures were negative and the patients were cured and discharged. During the follow-up, one patient developed splenic abscess. All the seven patients were residents of the same apartment in Beijing City, and there were water cuts and turbid odors in the incubation period, which were considered as typhoid fever outbreak caused by waterborne transmission. Conclusions:With the use of antimicrobial agents, the typical clinical manifestations of typhoid fever are absent, and the drug resistance rates to quinolone and third-generation cephalosporins increase. Appropriate antimicrobial agents should be selected and the anti-infection course should be prolonged.

Colonoscopic findings in patients aged 50 years and older: a critical analysis of 1614 exams / Achados colonoscópicos em pacientes a partir dos 50 anos: uma análise crítica de 1614 exames

ABSTRACT Introduction: Colonoscopy has shown to be useful in the diagnosis of various pathologies. By allowing the direct visualization of the mucosa, colonoscopy allows the adoption of therapeutic methods, such as the removal of polyps, dilation of stenoses, and biopsies. This method can also be applied in the detection of colorectal cancer, which currently represents an important cause of mortality in the world. Individuals considered to be at medium risk for the development of colorectal cancer should start screening at 50 years of age in order to detect early disease. Objective: To describe the main results of the exams for patients at least 50 years old who underwent colonoscopy. Method: Descriptive, case-series study of 1614 colonoscopies performed from 2014 to 2017 at a referral hospital in Salvador, Bahia. Results: The main indications for the study were intestinal bleeding (26.5%), neoplasia screening (20.7%), and abdominal pain (10.2%). The main results were diverticular disease (38.9%), polyps (38.8%), and normal examination (23.2%). Patients with indications for neoplasia screening had the presence of polyps (41.3%) as their main diagnosis. For patients with normal examination, 28.8% presented intestinal bleeding as an indication. There were 70 (4.3%) patients with a colonoscopic diagnosis of neoplasia. Conclusion: The present study, which demonstrated a majority of exams with considerable alterations, shows the usefulness of the examination, besides other advantages, as a form of diagnosis of colorectal cancer.

RESUMO Introdução: A colonoscopia mostra-se útil no diagnóstico de diversas patologias. Ao permitir a visualização direta da mucosa, possibilita a tomada de medidas terapêuticas, como a remoção de pólipos, dilatação de estenoses e realização de biopsias. Tal método pode ser empregado também no rastreio do câncer colorretal, que atualmente representa importante causa de mortalidade no mundo. Os indivíduos considerados de médio risco para o desenvolvimento do câncer colorretal, devem iniciar a triagem a partir dos 50 anos de idade, a fim de detectar precocemente a doença. Objetivo: Descrever os principais achados e indicações dos exames daqueles pacientes que realizaram colonoscopia com idade ≥ 50 anos. Método: Estudo descritivo, em série de casos, referente a 1.614 colonoscopias realizadas no período de 2014 a 2017 em hospital de referência em Salvador, BA. Resultados: As principais indicações para realização do exame foram sangramento intestinal (26,5%), rastreio de neoplasia (20,7%) e dor abdominal (10,2%). Os principais resultados encontrados foram doença diverticular (38,9%), pólipos (38,8%) e exame normal (23,2%). Os pacientes com indicação de rastreio de neoplasia tiveram como principal achado, a presença de pólipos (41,3%). Dos pacientes com exame normal; 28,8% apresentaram sangramento intestinal como indicação. Houve 70,0 (4,3%) pacientes com diagnóstico colonoscópico de neoplasia. Conclusão: O presente estudo, ao demonstrar uma maioria de exames com alterações consideráveis, evidencia a utilidade do exame, além de outras vantagens, como uma forma de diagnóstico do câncer colorretal.

Intraductal Papillary Mucinous Neoplasm Presenting as Bleeding Duodenal Mass: A Surgical Rarity

@#Intraductal papillary mucinous neoplasm (IPMN) is a rare pancreatic neoplasm. The presentation varies from recurrent pancreatitis, steatorrhea and weight loss to incidental findings during imaging studies. The recognition of IPMN is crucial in deciding for prompt surgical intervention, which is the best treatment modality for this precancerous condition. Here, we report a case of 55-year-old man with massive upper gastro intestinal bleeding arising from a huge fungating duodenal mass. In view of massive bleeding, a decision for emergency Whipple's pancreaticoduodenectomy was made. Final histological diagnosis confirmed as IPMN. To the best of our knowledge, this is the first case of IPMN presented with a huge fungating duodenal mass causing massive UGIB requiring surgical intervention.

Duplicación intestinal como causa inusual de sangrado digestivo bajo

Intestinal duplications are rare congenital anomalies that can occur anywhere along the gastrointestinal tract. Diagnosis and treatment may be difficult in some patients. We present the case of a patient who was hospitalized for rectal bleeding, with a history of recurrent abdominal pain, in whom intestinal duplication was finally diagnosed as a surgical finding. At the same time we analyze the clinical characteristics, management and treatment of intestinal duplications

Las duplicaciones intestinales son anomalías congénitas raras que pueden ocurrir en cualquier lugar a lo largo del tracto gastrointestinal. El diagnóstico y tratamiento puede ser difícil en algunos pacientes. Presentamos el caso de un paciente hospitalizado por sangrado rectal, con antecedente de dolor abdominal recurrente, en quien se diagnosticó una duplicación intestinal como hallazgo quirúrgico. A la vez analizamos las características clínicas, manejo y tratamiento

Hookworm Infection Caused Acute Intestinal Bleeding Diagnosed by Capsule: A Case Report and Literature Review

Hookworm infections are rare causes of acute gastrointestinal bleeding. We report a middle aged man with primary nephrotic syndrome and pulmonary embolism. During the treatment with steroids and anticoagulants, the patient presented acute massive hemorrhage of the gastrointestinal tract. The results of gastroscopy showed red worms in the duodenum. Colonoscopy and CT angiogram of abdomen were unremarkable. Capsule endoscopy revealed fresh blood and multiple hookworms in the jejunum and ileum. Hookworms caused the acute intestinal bleeding. The patient responded well to albendazole. Hematochezia was markedly ameliorated after eliminating the parasites. Hence, hookworm infection should be considered in the differential diagnosis of a patient with obscure gastrointestinal bleeding. Capsule endoscopy may offer a better means of diagnosis for intestinal hookworm infections.

Tumores del estroma gastrointestinal: revisión de nuestra experiencia / Surgery of gastrointestinal stromal tumors: review of our experience in the last five years

Objective: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. Surgical resection is the standard treatment for localized primary GISTs. The aim of the study is to present our 5-year surgical experience, as well as the results obtained in terms of survival and disease progression. Material and Method: We conducted a descriptive, retrospective study of primary GISTs treated in our center between 2009-2013. We analyze the most relevant variables, criteria of risk of progression according Fletcher's classification from National Institutes of Health and the Miettinem's classification from the Armed Forces Institute of Pathology, as well as analysis of relapse-free survival (RFS) with Kaplan-Meier survival curves. Results: We present a series of 30 patients. Mean age 65 years (40-84 years). The most common location was the stomach (n = 14, 46.6 percent). The surgery was R0 in 23 cases of 30. The mean tumor diameter was 5.3 cm (0.5-18). 14 patients received adjuvant treatment with Imatinib. After an average follow-up of 31.2 months (6-62 months), it was found relapse in 4 patients, progression and exitus in 1, exitus in 3 and exitus in the immediate postoperative period in 1. RFS at one year was 96.7 percent, and 89.2 percent at 4 years. Mean survival time was 56.2 months (95 percent CI 51.8-60.6). Conclusion: The recommended attitude after radical surgery is follow-up. In selected patients with risk of relapse, adjuvant treatment with Imatinib delays the progression of the disease and increases the survival.

Objetivo: Los tumores del estroma gastrointestinal son las neoplasias mesenquimales más frecuentes del tubo digestivo. La resección quirúrgica es el tratamiento estándar en los GISTs primarios localizados. El objetivo del estudio es presentar nuestra experiencia quirúrgica en 5 años, así como los resultados obtenidos en cuanto supervivencia y progresión de la enfermedad. Material y Método: Serie de casos, estudio observacional descriptivo retrospectivo, que analiza los resultados obtenidos en cuanto al tratamiento quirúrgico de GIST primarios sometidos a resección quirúrgica en nuestro centro entre 2009-2013. Todas las intervenciones fueron realizadas por personal del Staff y dentro de los protocolos de las unidades de cirugía hepato-biliar y esófago-gástrica. Se analizan las variables de mayor relevancia, criterios de riesgo de progresión según la clasificación de Fletcher del National Institutes of Health y la clasificación de Miettinem del Armed Forces Institute of Pathology, así como análisis de la supervivencia libre de recaída (SLR) con curvas de Kaplan-Meier. Resultados: Presentamos una serie de 30 pacientes. Edad media de 65 años (40-84 años). La localización más frecuente fue estómago (n = 14, 46,6 por ciento). La cirugía fue R0 en 23 de los 30 pacientes. El diámetro tumoral medio fue de 5,3 cm (0,5-18, con una mediana de 4 cm. Catorce pacientes recibieron tratamiento adyuvante con Imatinib. Tras un seguimiento medio 31,2 meses (6-62 meses), se detectó recaída en 4 pacientes, progresión y exitus en 1, exitus en 3 y exitus en el postoperatorio inmediato en 1. La SLR al año fue del 96,7 por ciento, siendo del 89,2 por ciento a los 4 años. El tiempo medio de supervivencia fue de 56,2 meses (IC 95 por ciento 51,8-60,6). Conclusiones: La actitud recomendada tras una cirugía radical es el seguimiento. En pacientes seleccionados con riesgo de recaída el tratamiento adyuvante con Imatinib retrasa la progresión de la enfermedad y aumenta la supervivencia.

Várices ectópicas en yeyuno proximal asociadas a sangrado recurrente en paciente sin cirrosis hepática / Ectopic Varices in the Proximal Jejunum Associated with Recurrent Bleeding in a Patient without Cirrhosis of the Liver

Las várices ectópicas (VE) en yeyuno son alteraciones vasculares infrecuentes, asociadas en mayor medida a la hipertensión portal (5%). Cuando se presenta sin esta asociación son aún menos frecuentes. Presentamos un caso de sangrado crónico intestinal de varios años, sin hipertensión portal proveniente de várices localizadas en yeyuno proximal, su curso clínico, los elementos de diagnóstico empleados y terapia quirúrgica.

Ectopic varices (EV) in the jejunum are a rare vascular disorder which is associated with portal hypertension (5%). It is even rarer when it occurs without associated portal hypertension. We report a case of a patient without portal hypertension who had had chronic intestinal bleeding from varices located in the proximal jejunum for several years. We report the patient’s clinical development, elements used for diagnosis and the surgical treatment.

Not to be Missed Entity: Dieulafoy's Lesion!

Clinically missed Dieulafoy's lesion is a significant cause of gastro-intestinal bleeding with a poor prognosis. We hereby compare an autopsy case of a similar nature; thereby highlighting the importance of autopsy. 69 years old male living in a retirement home was being managed for anemia. He was admitted with a preliminary diagnosis of septicemia with deteriorating renal function. He was found dead and referred for autopsy to our institute. At autopsy, 3 small defects at the gastroesophageal junction measuring about 5-7 mm were seen, which on microscopy revealed a relatively large artery at the submocosal level with rupture. There was about 2 liters of blood in the stomach. This was a Dieulafoy's lesion, the cause of sudden massive gastrointestinal bleeding and subsequent shock. This signifies that autopsy still holds its value in this modern era of diagnostics.

Analysis of signs of digital subtraction angiography of small intestinal stromal tumor / 中华消化外科杂志

Objective To summarize the features of signs of digital subtraction angiography (DSA) of small intestinal stromal tumor (SIST) with different invasion risk degrees.Methods The clinical data of 15 patients with SIST who were admitted to the West China Hospital of Sichuan University from September 2008 to June 2010 were retrospectively analyzed.The signs of DSA of SIST with different invasion risk degrees were analyzed.Results The result of DSA showed that 1 patient with low-invasive SIST presented draining veins and clear edge with homogeneously stained tumor in arterial phase.Enlarged tumors vessels,sharp edges and uniform tumor staining were observed in 4 patients with low-invasive risks.Enlarged and disordered tumor vessels and irregular shape were observed in 4 patients with moderate-invasive risks,and 3 of them showed heterogeneity stained tumor.Obvious enlarged and disordered tumor vessels,unclear edge and uniform tumor staining were showed in 6 patients with high-invasive risks.Conclusions The higher invasive risks correlates with more irregular and disorder tumor vessels.The tumors with lower-invasive risks have more regular and trim blood vessels.

Delirium associated with acute anemia in elderly: case report / Delirium associado com anemia aguda em idoso: relato de caso

Um episódio de delirium após sangramento intestinal agudo é relatado em paciente masculino com 90 anos de idade. O local de sangramento, um pólipo adenomatoso no colon direito, foi identificado por de cintilografia com eritrócitos marcados com tecnécio. O paciente recebeu hemotransfusões e haloperidol, com rápida melhora antes daressecção endoscópica do pólipo. Este relato visa a aumentar o alerta dos clínicos gerais acerca do delirium, uma condição comum entre idosos, que pode representar alta morbidade e mortalidade. A anemia deve ser incluída entre os principais fatores de risco de alterações cognitivas em idosos.

An episode of delirium after an acute intestinal bleeding is reported in a 90-year-old male. The site of bleeding was detected by technetium-labeled erythrocyte scintigraphy, and was an adenomatous polyp of the right colon. The patient received blood transfusions and haloperidol, with rapid improvement before the endoscopic resection of the polyp. This report aims is to increase the awareness of general physicians about delirium, a common condition among the oldest old that may cause high morbidity and mortality. Anemia should be included among the main riskfactors of cognitive decline in elderly.

Hemorragia maciça do intestino grosso: o que está ao nosso alcance / massive large bowel bleeding. what is within our reach

A forma de avaliar e lidar com a hemorragia aguda digestiva baixa tem sido modificado com os recentes desenvolvimentos de novas técnicas e aparelhos. O nosso objetivo, por esse manuscrito, é demonstrar com simplicidade uma forma de condução dos pacientes com hemorragia digestiva baixa aguda, sobretudo para os sangramentos que parecem mais graves, principalmente quando nos faltam os recursos das avançadas tecnologias atuais. Doenças localizadas no intestino grosso respondem por » dos casos de hemorragias digestivas que são motivos para admissão hospitalar e têm como principais agentes etiológicos os divertículos, na moléstia diverticular, e as alterações vasculares, nas angiodisplasias. Na grande maioria das vezes o sangramento que pode parecer abundante cessa espontaneamente. Os distúrbios circulatórios graves não são comuns e os sinais mais frequentes são a queda do valor da hemoglobina observada na metade dos pacientes, e algumas alterações hemodinâmicas como a variação pressórica postural que pode ser vista em até 30 por cento dos casos; a síncope em 10 por cento e alguma forma de colapso circulatório, em 9 por cento. Contudo, a faixa etária em que ocorre, as condições da senilidade, as doenças eventualmente associadas e a falta de recursos materiais e humanos para lidar com esse tipo de problema são os motivos que mais causam preocupação. A abordagem clínica simples com uma história bem elaborada; o exame físico com atenção e objetividade, a inclusão do exame proctológico, a obrigatória disponibilidade de aparelho para a coloscopia e os conhecimentos básicos sobre o evento formam o conjunto necessário e, na maioria das vezes, suficiente para o correto desempenho profissional na elaboração dos cuidados que devem ser dados a esses pacientes.

The evaluation and management of the acute lower digestive hemorrhage has been modified with the recent development of new techniques and devices. The aim of this manuscript was to demonstrate with simplicity how to treat the patients with acute lower intestinal hemorrhage. Diseases of the large bowel account for the » of the cases of digestive hemorrhages on the hospital admission and have as main etiological agents the diverticula, in the diverticular disease, and small vascular malformation, in the angiodysplasias. Sometime, it can be seen as a life-threatening condition, however, most of the times, the hemorrhage stops spontaneously. The serious circulatory disturbances are not common; the most frequent signs are the decrease in hemoglobin occurring on about one half of patients and some form of circulatory disturbance as orthostatic changes in 30 percent; as syncope in 10 percent and as cardiovascular collapse in 9 percent. However, the age group, the conditions of the senility, the eventually associated diseases and the lack of material and human resources to handle with that kind of problem are the reasons for concern. The simple clinical approach with a well elaborated history; the physical examination released with attention and objectivity, the inclusion of the proctologic exam, the obligatory readiness for an endoscope for colonoscopy, the basic knowledge on the event are necessary and, in most of the times, enough for the good professional acting in the elaboration of the cares that it should be given to those patient ones.

Clinical Characteristics of Bleeding Peptic Ulcer in Elderly Patients: Experience at a Single Secondary Referral Center / 대한소화기내시경학회지

BACKGROUND/AIMS: Bleeding peptic ulcer in elderly patients is believed to differ from that found in younger patients. The purpose of this study was to evaluate the characteristics of bleeding peptic ulcer in elderly Korean patients. METHODS: We retrospectively evaluated 113 patients who were admitted to an emergency room for peptic ulcer bleeding from January 2006 to August 2008. For each patient, we investigated the clinical manifestations, the treatments and the hospital course. RESULTS: Peptic ulcer bleeding was more prevalent in elderly patients (n=63) than in younger patients (n=50). The elderly group had a higher incidence of comorbidities such as hypertension, stroke and ischemic heart disease, which might have be attributable to higher usage of aspirin and antiplatelet agents. There were no differences in the chief complaints or laboratory findings. The rate of Helicobacter pylori infection was lower in the elderly patients than that in the younger patients (41.3% vs. 62.0%, respectively, p=0.029). Four elderly patients and one younger patient died while in hospital, with one patient in each group dying due to bleeding. CONCLUSIONS: Peptic ulcer bleeding in elderly patients was associated with higher usage of aspirin and antiplatelet agents. There were no significant differences between the elderly and younger patients for the initial clinical presentation, the hospital course or the mortality due to bleeding.

A Case of Bleeding from a Jejunal Gastrointestinal Stromal Tumor Diagnosed by Double Balloon Enteroscopy / 대한소화기내시경학회지

Gastrointestinal bleeding from a small bowel lesion is uncommon, but it is the most common cause of obscure gastrointestinal bleeding and it can go undiagnosed using traditional upper endoscopy and colonoscopy. Recently, capsule endoscopy and double-balloon enteroscopy (DBE) were developed as new techniques for visualization of the entire small intestine and have improved access to the lesion site in patients with obscure gastrointestinal bleeding. In this report, we describe a 49-year male presenting with melena from a gastrointestinal stromal tumor (GIST) of the proximal jejunum that was diagnosed by DBE and resected by laparoscopic surgery.

Fatal gastro-intestinal bleeding: A complication following spinal injury.

On 30.08.2003, a 20-year-old boy met with a vehicular accident and sustained spinal injury and left upper limb fracture. He was immediately hospitalized and seemed to recover well after treatment for a period of 15 days, when just before discharge he suddenly had hematemesis and bleeding per rectum and succumbed within another 24 hours. The case is discussed in detail.

The application of intraoperative endoscopy during the emergency exploratory laparotomy in the patients with acute massive small intestinal bleeding / 中国医师杂志

Objective To evaluate the application of intraoperative endoscopy during the emergency exploratory laparotomy in the patients with acute massive small intestinal bleeding.Methods Twenty-six patients with acute massive small intestinal bleeding were examined by intraoperative endoscopy during the emergency exploratory laparotomy and the clinical data were analyzed.Results The hemorrhagic reasons were clarified in 25 patients(96.2%) through the application of intraoperative endoscopy.Of the 25 patients,the results showed that 2 cases were with duodenal leiomyoma,1 case duodenal Dieulafoy' disease,5 cases small bowel leiomyoma,2 cases small bowel leiomyosarcoma,2 cases ileum lymphoma,3 cases ileum ulcer,4 cases small bowel cavernous hemangioma,5 cases small bowel arteriovenous dysmorphosis and 1 case pancreaticojejunostomy cut bleeding.The average examination time was 15 min and no complications related to intraoperative endoscopy occurred in all patients.Conclusion The application of intraoperative endoscopy,which may increase the detection rate,is efficient and safe during the emergency exploratory laparotomy in the patients with acute massive small intestinal bleeding.

The so-called allergic intestinal bleeding syndrome in infants (case report)

The current medical literature was consulted for the description of the clinical feature, the so-called allergic intestinal bleeding syndrome, occurring in infants. There is paucity of reports on it. It is merely mentioned in pediatrics textbooks. This is probably the first case report of this syndrome in infants found in the local medical literatureA case is presented which, I think fits the clinical picture of this condition, and in which the patient developed hypersentiveness to goats milk. These was no determination of hypersensitiveness to cows milk, however, because cows milk was difficult to procure in the circumstances then prevailing. Abdominal "cramps" or discomfort and intestinal hemorrhage completely disappeared 56 hours after discontinuance of the goats milk feeding and subsequent shift to human breast milkIn recognizing this syndrome, a careful differential diagnosis is needed to exclude intestinal bleeding due to more serious causes, in order not to subject the infant to un-called for operation and at the same time not to deprive the child of the benefit of surgery, if it happens to be a case of Meckels diverticulitis or intussusception. Lastly, this condition should always be considered whenever cases of intestinal bleeding in infants who are artificially fed with either cows or goats milk are met with in practice, especially if a definite family history of allergy could be established. (Summary)

A Case of Crohn's Disease with Blood Pressure Falling Intestinal Bleeding / 대한소화기내시경학회지

Life-threatening gastrointestinal hemorrhage is a rare complication in Crohn's disease. The authors experienced a case of Crohn's disease manifested with massive lower intestinal bleeding. A 22-year-old woman, who had underwent small bowel resection for bowel perforation and intestinal fistula, was admitted with lower abdominal pain and massive hernatochezia. A radioisotope bleeding scan and mesenteric angiography revealed suspi- cious intestinal bleeding in the small bowel area. The colonoscopy showed multiple shallow ulcers at the terminal ileum and scars on the cecum. In spite of medical management with the diagnosis of Crohn's disease, she continuecl to rebleed and required fistuloplasty and ileal resection. In the surgical specimen was discovered multiple exposed small vessels and diffuse blood oozing at terminal ileum. After surgery, there were no more bleeding episodes and she recovered with the aid treatment of sulfasalazine and prednisolone.

Control study on diagnosis of intestinal bleeding by capsule endoscopy and operation / 中华消化内镜杂志

Objective To evaluate the diagnosis of intestinal bleeding by capsule endoscopy ( CE) , and compare with the result of operation. Methods All patients experienced CE had failed to get definite diagnosis from conventional endoscopy. Of 50 consecutive patients, 28 with intestinal bleeding episodes more than 5 times (group A) , 14 with 2-5 times(group B) and 8 with only oace (group C) ,totally 18 patients had received operation. Results Of these 50 patients, 39 ( 78. 0 % ) had abnormal findings, which could be considered as the etiology of bleeding. The detectable rate was 92. 9% , 71. 4% and 37. 5% in-group A, B, and C respectively (P

A Case of Parasitic Eosinophilic Granuloma of the Stomach Presenting with Upper Gastrointestinal Bleeding / 대한소화기내시경학회지

The localized eosinophilic granulomatous lesions of the stomach are rare benign tumorous conditions resembling submucosal tumors. They can be divided into two types. One is an inflammatory fibroid polyp. The other is an eosinophilic granuloma due to migration of Anisakis-type larva in the alimentary tract. The latter is usually found in the gastric body and anterior wall of the angle, and appears as a submucosal tumor. Histologically, the granuloma exhibits a characteristic lamellated structure consisting of a necrotic center with or without the worm, surrounded by layers of granulation tissue and eosinophilic infiltration. The present case is a 50 year-old male presenting with an episode of profuse melena. An emergency esophagogastroduodenoscopy revealed a 2x1.5cm sized, irregularly shaped ulcerative lesion with elevated margins and prominent folds convergence. Despite the endoscopic injection of hypertonic saline-epinephrine solution due to a recent bleeding stigmata, the patient experienced a rebleeding during hospitalization, The locally excised specimen showed an eosinophilic granuloma having a central necrosis. Although the larval body of Anisakis was not found, the lesion was diagnosed as a parasitic eosinophilic granuloma of the stomach.