Metachronous metastatic renal cell carcinoma to the jejunum presenting with massive lower gastrointestinal bleeding

Metastatic renal cell carcinoma [MRCC] is a rare cause of massive lower gastrointestinal bleeding [LGIB]. We report a 51-year man who underwent left nephrectomy for renal cell carcinoma [RCC] 6 years ago. presenting with massive LGIB. Preoperative abdominal computed tomography [CT] revealed small bowel mass. Exploration of the abdomen revealed jejunal mass. Resection of the mass along with the jejunal segment with end-to-end anastomosis was performed. Histopathology of the jejunal mass confirmed MRCC. MRCC should be expected as a source of massive LGIB in a patient with history of RCC. Surgical intervention should not be delayed in a hemodynamically unstable patient and persistent bleeding

Impact of weekend admission on the outcome of patients with acute gastro-esophageal variceal hemorrhage

Objectives: To evaluate the impact of weekend admission on the outcome of patients with acute variceal hemorrhage [AVH] Design: Retrospective study Setting: Department of Surgery, College of Medicine, King Saud University, KSA Main Outcome Measures: AVH, weekend admission and clinical outcome

Subjects: Nine hundred and thirty-seven admitted during the period 1[st] January 2005 to 31[st] July 2013 and documented to have AVH. The selected patients were divided into two groups based on the admission day [weekday or weekend admission]. The data regarding patients characteristics and outcome in both the groups were retrieved from medical records and compared by using c2 test / Fisher's exact and student T- test

Results: Weekday admissions included 685 patients, while the weekend group comprised of 252 patients. The demographic, clinical and laboratory characteristics of patients admitted with AVH in both the groups were comparable. Statistically, there was no significant difference in the need for blood transfusion [46% versus 48%, p = 0.5868], and surgical intervention [5.4% versus 4.7%; p = 0.6595] between the groups. There was a little, but statistically significant delay in endoscopic intervention in the weekend group [7.56 +/- 7.8 hours versus 9 +/- 2.32; p = < 0.0001]. However, this delay did not lead to adverse outcome for patients [mortality rate 6.8% versus 5.25%; p = 0.389]

Conclusions: The weekend admissions were not associated with increased mortality in patients with AVH. Moreover, the length of hospital stay, need for blood transfusion, and rate of surgical intervention were similar in weekdays and weekend admissions