Linfoma malt gástrico: presentación de un caso y revision de literatura / Gastric malt lymphoma: case report and literature review

Escolar masculino de 9 años, con mielomeningocele corregido e hidrocefalia, enfermedad actual de 3 años de evolución, caracterizada por epigastralgia intermitente, recibe tratamiento sin mejoría. Dos días antes del ingreso se asocian vómitos, hematemesis y fiebre. Al examen físico, signos de desnutrición crónica, anemia, hepatomegalia y dolor en epigastrio. Se realiza endoscopia digestiva superior, revela reflujo gastroesofágico, tumoración gástrica ulcerada y duodenitis inespecífica; se realizan ecosonograma abdominal, Rx esófago-estomago-duodeno contrastado y tomografía abdominal, donde se evidenció tumor en antro pilórico de 6 por 7 cm, estenosante y distensión gástrica. Recibe hemoderivados, por anemia aguda. Se realiza laparotomía exploradora, se evidencia gran tumoración friable, se extraen muestras para biopsia gástrica que reveló fragmento fibroadiposo con inflamación crónica y granulosa, reacción gigantocelular de tipo Langhans y tipo cuerpo extraño, necrosis y reagudización focal, las biopsias de ganglios, hígado y epiplón revelaron signos de inflamación crónica multifocal. Hemocultivos negativos, Anticore y Antigeno de superficie VHB negativos, PCR para CMV, estudio para BK y hongos negativos, examen de heces Blastocystis hominis, títulos de IgG contra Helicobacter pylori positivo 1.61 U/L, se inicio terapia con Metronidazol, Claritromicina y Omeprazol VEV, con remisión del tumor gástrico, todo lo cual sugiere Linfoma MALT gástrico o MALTOMA...

Masculine student of 9 years, with mielomeningocele correted and hydrocephaly, present disease of 3 years of evolution, characterized by intermittent epigastralgia, receives treatment without improvement. Two days before the entrance vomits, hematemesis and fever are associated. To the physical examination, signs of chronic undernourishment, anemia, hepatomegalia and pain in epigastrio. Superior digestive endoscopia is made, reveals gastroesfágico ebb tide, ulcerada gastric tumoración and unspecific duodenitis; ecosonograma abdominal, Rx resisted esophagus-stomach-duodeno and tomography abdominal are made, where it demonstrated tumor in pyloric caven of 6 by 7 cm, estenosante and gastric distension. It receives hemoderivados by acute anemia. Exploratory laparotomía is made, demonstrated great coldable tumoración, samples for gastric biopsy are extracted that revealed fibroadiposo fragment with chronic and granular inflammation, reaction to gigantocelular of Langhans type and type strange body, necrosis and focal reagudización, the biopsies of ganflia, liver and epiplón revealed signs of multifocal chronic inflammation. Hemocultivos negative, Anticore and Antigeno of surface VHB negative, negative PCR for CMV, study for BK and fungi, examination Blastocystis hominis and Giardia lamblia positive, titles of IgG and biopsy Helicobacter pylori positive , beginning therapy with Metronidazol, Clarotromicina and Omeprazol VEV, remission of the gastric tumor, which suggests gastric Linfoma MALT or MALTOMA...

Upper gastrointestinal bleeding in children in southern Iran.

Objective. To find out whether the causes of upper GI bleeding in our center in a developing country differed from developed countries. Methods. Children presenting to our center with upper GI bleeding from March 2002 to March 2007, were retrospectively evaluated. Informations were retrieved from patient’s history and physical examination and results of upper GI endoscopy regarding etiology of bleeding, managements, use of medications which might predispose patient to bleeding, and the mortality rate. Results. From 118 children (67 boys; with age of 7.7±4.7 yrs) who underwent upper GI endoscopies, 50% presented with hematemesis, 14% had melena and 36% had both. The most common causes of upper GI bleeding among all patients were gastric erosions (28%), esophageal varices (16%), duodenal erosions (10%), gastric ulcer (8.5%), Mallory Weiss syndrome tear (7.8%), duodenal ulcer (6.8%), esophagitis (1.7%) and duodenal ulcer with gastric ulcer (0.8%). The causes of bleeding could not be ascertained in 20.5% of cases. No significant pre-medication or procedure related complications were observed. Endoscopic therapy was performed in 13.5% of patients. In 14.4% of patients, there was a history of consumption of medications predisposing them to upper GI bleeding. Two deaths occurred (1.7%) too. Conclusion. The findings in the present study showed that half of upper GI bleedings in pediatric patients from south of Iran, were due to gastric and duodenal erosions and ulcers. This study concludes that the causes of upper GI bleeding in children in our center of a developing country, are not different from those in developed ones.

Paediatric gastrointestinal endoscopy: experience in a Sudanese university hospital

We investigated the indications for and findings of gastrointestinal [GI] endoscopy in all children

A Case of Ischemic Skin Necrosis after Glypressin Therapy in Liver Cirrhosis / 대한소화기학회지

Terlipressin is a synthetic analogue of vasopressin, which has been used in the treatment of acute variceal hemorrhage. In contrast to vasopressin, terlipressin can be administered as intermittent injections instead of continuous intravenous infusion. Thus, it has a less adverse reaction than vasopressin. We report a case of ischemic skin complication in a cirrhotic patient treated with terlipressin. A 71-year-old man with liver cirrhosis was admitted because of hematemesis and melena. He was commenced on terlipressin at a dose 1 mg every 6 hours for the treatment of varicieal bleeding. After 36 hours of treatment, skin blistering and ecchymosis was noted on the skin of his upper thigh, scrotal area and trunk. We found that terlipressin was a possible cause of ischemic skin complication based on the skin biopsy finding. Terlipressin may induce a complication of the ischemic event. In spite of rarity, special attention needs to paid on the peripheral ischemic complication of terlipressin.

Primary small gut volvulus in adult presenting with hematemesis.

Small gut volvulus is rare in adults and usually presents with acute intestinal obstruction. We report a 25-year-old man with primary small gut volvulus who presented with hematemesis. The gangrenous gut was resected at laparotomy. He is well 3 months later.

A rare cause of haematemesis: retrograde jejunogastric intussusception.

Retrograde Jejunogastric intussusception is a well-recognised, rare but potentially fatal, long-term complication of gastro-jejunostomy or Billroth-II reconstruction. Only about 200 cases have been reported in literature to date. Diagnosis of this condition is difficult in most of the cases. To avoid mortality early diagnosis and prompt surgical intervention is mandatory. Since gastrojejunostomies with vagotomy are on a declining trend, it is extremely rare to come across such a complication. We report such a case that presented with haematemesis.

Giant splenic artery mycotic aneurysm presenting with massive hematemesis.

We report a 40-year-old man with rheumatic heart disease who presented with abdominal pain for three weeks and hematemesis for 24 hours. CT scan showed a large splenic artery aneurysm without evidence of pancreatitis. Mycotic aneurysm due to infective endocarditis was considered and confirmed by echocardiogram, which showed aortic and mitral valve regurgitation and vegetations. He was managed successfully with coil embolization of the aneurysm and antibiotics.

Malignant duodenal stromal tumor: the first case report in Thailand and review of the literature.

The authors presented a middle aged Thai patient with malignant duodenal stromal tumor identified at a tertially care centre in Thailand. The patient presented with obscure gastrointestinal bleeding and the small bowel endoscopy revealed a bleeding tumor mass at the fouth part of the duodenum. The patient underwent segmental duodenectomy with end to end anstosomis. The histopathology of the tumor composed of interlacing bundles of spindle cells with oval to elongated pleomorphic nuclei and eosinophilic cytoplasm. The immunohistochemistrical study confirmed the diagnosis of malignant stromal tumor with smooth muscle differentiation. The computer tomography scan (CT scan) of the abdomen showed no evidence of metastasis. Postoperatively, the patient's clinical condition showed continuous improvement without further gastrointestinal bleeding. The patient has remained healthy up to present (six months of follow-up). A high level of suspicion to detect this malignant tumor especially in a patient presenting with obscure gastrointestinal bleeding and effective surgical treatment allow better clinical outcome in this rare and fatal malignancy.

Hemorragia digestiva superior por divertículos esofágicos: a propósito de un caso / Upper gastrointestinal bleeding by esophageal diverticulums: a purpose of a case

Se describe el caso de hemorragía digestiva superior por divertículos en el tercio medio del esófago en un paciente masculino con antecedentes de dispepsia de 8 años de evolución, tratado con analgésico no esteroideo por presentar patología urinaria, consulta por episodio de hematemesis y melena líquida cediendo con terapéutica endoscópica e insuflación de balón gástrico (sonda de Sengstaken-Blakemore). Podemos concluir que el manejo médico fue una alternativa de tratamiento en este paciente con inestabilidad hemodinámica y patología asociada que aumentaban la morbi-mortalidad

Gastric tuberculosis presenting with hematemesis.

The stomach is rarely involved by tuberculosis. We report a patient with gastric tuberculosis who presented with exsanguinating hematemesis.

Enfermedad ulcerosa péptica en pacientes cirróticos / Peptic ulcer disease in cirrhotic patients

Este estudio se llevó a cabo en el Servicio de Gastroenterología de Hospital Nacional "Daniel Alcides Carrión" Callao-Perú, entre Junio de 1993 y Mayo de 1994, para determinar la incidencia, así como las caracteristicas clínicas y endocópicas de la enfermedad ulcerosa péptica en pacientes cirróticos. 24 de los 46 (52.17 por ciento) pacientes cirróticos hospitalizados en dicho lapso, tuvieron enfermedad ulcerosa péptica. La relación masculino femenino fue 1:1. La edad promedio fue 63.54 años, con un rango de 44 a 90. Se halló asociación estadística (p<0.5) entre la severidad de la hepatopatía, determinada por la clasificación Child Pugh y la presencia de úlcera gástrica. En cuanto a la sintomatología, 54.16 por ciento presentaron hematemesis y/o melena y 37.5 por ciento fueron sintomáticos. 6 de los pacientes tuvieron 2 o más úlceras, presentando la serie total 35 úlceras, que oscilaron entre 0.4 y 1.2 cm. La localización más frecuente fue antro gástrico (60 por ciento), segudo de bulbo duodenal (20 por ciento). Concluímos que, la enfermedad ulcerosa péptica en nuestros pacientes cirróticos es más frecuente que lo reportado por la literatura internacional (5-32 por ciento). La severidad de la hepatopatía se asoció a úlcera gástrica

Diagnostic upper GI endoscopy for hemetemesis in children: experience from a pediatric gastroenterology centre in north India.

Upper GI endoscopies were done in 236 children (upto 12 years of age) presenting with history of hemetemesis. Varices were the commonest lesions (in 39.41%) followed by esophagitis (23.73%). Gastritis, gastric ulcer, duodenal ulcer and oesophageal ulcers were identified in 7.20%, 1.27%, 0.42% and 0.42% cases respectively. Cause of bleeding could not be ascertained in 27.54% cases. No significant premedication or procedure related complications were observed. Upper GI endoscopy is thus a safe and useful mode of investigation in cases of hemetemesis in children.

Hemorragia digestiva / Gastrointestinal hemorrhage

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.

Upper gastrointestinal endoscopy in children.

Diagnostic and therapeutic upper gastrointestinal endoscopy was carried out among 200 children. The procedure proved useful in detecting causes of various upper gastrointestinal problems especially hematemesis and dysphagia. It was also helpful in early detection of esophageal varices in children with suspected portal hypertension. Duodenal biopsies could be obtained in all children being investigated for chronic diarrhea and proved helpful in diagnosing three cases of celiac disease. Fiberoptic endoscopy has a large role to play in pediatric practice and is largely a safe procedure.