ABSTRACT
The paradigm for the diagnosis and management of gastric cancer is changing with advanced diagnostic and therapeutic interventions. Prior gastric surgery (20 years or more) is one of the risk factors for gastric cancer. Increased intragastric carcinogen formation is thought to contribute toward gastric cancer development in the remaining portion of the stomach. This case illustrates the importance of a thorough clinical and pathologic workup and highlights the advanced technique of single-balloon enteroscopy (SBE) and its role in managing patient's health.
ABSTRACT
Obscure gastrointestinal bleeding (GIB) in patients with continuous-flow left ventricular assist devices (CF-LVAD) is common. Capsule endoscopy (CE) can be used in the diagnosis of obscure GIB. Safety and outcomes of CE in patients with CF-LVAD are unknown. The aim is to define the safety and outcomes of CE in this population. Paitents with CF-LVAD undergoing CE at a single center between 2007 and 2014 were retrospectively reviewed. Thirty-four CE studies were performed. Positive CE occurred in 19 studies. No clinically significant cardiac events occurred. Medical intervention was the most common management strategy. Rebleeding after CE occurred in 10 patients. Patients with active bleeding or lesions such as arteriovenous malformations (AVM) incurred a higher risk of rebleeding, transfusion, and repeated endoscopy. CE is safe in patients with CF-LVAD. The risk of rebleeding was more common in patients with active bleeding or AVM lesions although this result did not reach statistical significance.
Subject(s)
Capsule Endoscopy , Gastrointestinal Hemorrhage/diagnosis , Heart-Assist Devices/adverse effects , Ventricular Function, Left , Aged , Arteriovenous Malformations/complications , Capsule Endoscopy/adverse effects , Female , Gastrointestinal Hemorrhage/etiology , Humans , Male , Middle Aged , Minnesota , Predictive Value of Tests , Prosthesis Design , Recurrence , Retrospective Studies , Risk FactorsABSTRACT
Primary aortoenteric fistula (PAEF) is a well-known but rare cause of gastrointestinal bleeding. The diagnosis can be difficult since the majority of patients do not have classical symptoms. "Herald bleed" is usually followed by a massive hemorrhage. Endoscopy and radiographic studies can assist in diagnosis. We present the case of 56-year-old male with PAEF who presented with obscure gastrointestinal bleeding. Endoscopic studies were unremarkable. Computed tomography (CT) in this stable but symptomatic patient helped in establishing diagnosis of PAEF. Patient underwent laparotomy with aortobifemoral graft placement. A high index of suspicion, early diagnosis and prompt appropriate surgical intervention are crucial for survival of these patients.
Subject(s)
Aortic Aneurysm, Abdominal/complications , Fistula/complications , Gastrointestinal Hemorrhage/etiology , Intestinal Fistula/complications , Jejunal Diseases/complications , Aortic Aneurysm, Abdominal/diagnostic imaging , Gastrointestinal Hemorrhage/diagnostic imaging , Humans , Laparotomy , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
We report a case of histoplasma panniculitis in a patient with rheumatoid arthritis treated with multiple immunosuppressive agents including infliximab. The patient presented with erythematous plaques involving the right upper anterior abdominal wall, the right flank and later extension to involve the left flank and the left axilla. The histopathologic examination of these lesions was consistent with lobular panniculitis and the cultures of these lesions and blood grew Histoplasma capsulatum. The clinical and histopathologic picture of histoplasma panniculitis and rheumatoid arthritis-associated panniculitis can be very similar, but the treatment is clearly different. Our case emphasizes the importance of considering rare manifestations of opportunistic infections in an era of widespread use of immunosuppressive medications in the field of rheumatology.
