[Lower gastrointestinal bleeding; a case report]

A 40-year-old woman was referred to our health center with a bulky rectorrhagia. The patient was treated with meropenem and vancomycin for an enterococcal meningitis one week earlier. A colonoscopy was performed at a different center, which was unsuccessful due to high blood volume in the colon and poor vision. The patient underwent angiography of the superior and inferior mesenteric arteries and the rectum artery, but the origin of the bleeding was not known. A polypoid mass with ulcer and bleeding from the site was seen in repeated colonoscopy of the left colon reagion. Due to the severity of the bleeding, the patient was transferred to the operating room and a large uterine mass that had transmitted to the lobes of the sigmoid colon was observed. Due to the diagnosis of uterine tumor, hysterectomy and oophorectomy were performed, and the descending colon was removed as a colostomy from the abdominal wall. In the pathological examination, diffuse endometriosis was found, which had involved the left ovary, the left fallopian tube, and both parametrium and sigmoid to the submucosal layer. On the 26th day, the patient was discharged with a good general condition and full vigilance

Oncological emergencies--management guidelines for clinicians.

The authors in the present article have given a brief outline of oncological emergencies and discussed the management guidelines from clinical stand point.

Fibreoptic colonoscopic study of diabetic patients with lower gastro-intestinal disturbances

Fifteen patients with long standing diabetes mellitus with clinical manifestations of autonomic neuropathy and 10 without autoncmic neuropathy. All of them were complaining of lower gastrointestinal symptoms. Patients with parasitic infestation were excluded. Barium enema and fibreoptic colonoscopic examination with biopsies taken for histopathology and histochemical study were done. Results revealed constipation in 80%, diabetic diarrhea in 60%, irregular bowel habit in 40% and faecal incontinence in 20% of patients with autonomic disturbances radiological results showed spastic descending colon with loss of haustration in 30% of cases. Endoscopically, the lumen of descending colon was narrow and spastic in 50% who complained of constipation and irregular bowel habit. Oilated in 10% who had diabetic diarrhea. Hyperaemic mucosa and increased vascular pattern in 80%. Mainly in patients with diarrhea while erosion and bleeding on touch occurred only in 10% of cases. Fine granulations of mucosa up to the sigmoid were found in 30%. The histopathological pattern of nonspecific colitis. Congestion, different degree of cellular infiltrations - in 60% and superficial ulceration in 10%. Histochemical study showed increased activity of acid phosphatase enzyme in patients with erosions and hyperaemic congested mucosa. There was an observed relation between the degree of autonomic disturbances and the severity but not the duration of gastrointestinal symptoms, this may be attributed to disturbed colonic motor functions and susceptibility of diabetics to infection