Subject(s)
Angiodysplasia/diagnosis , Rectal Diseases/diagnosis , Rectum/blood supply , Sigmoidoscopy/methods , Adult , Angiodysplasia/complications , Angiodysplasia/therapy , Diagnosis, Differential , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/pathology , Gastrointestinal Hemorrhage/therapy , Humans , Male , Rectal Diseases/complications , Rectal Diseases/therapyABSTRACT
Nutrition assessments using anthropometric, visceral, and immunologic measurements were performed to determine the prevalence, characteristics, and clinical importance of nutrition disorders in patients with liver cirrhosis from alcohol or viral hepatitis. Severely malnourished patients, as determined by triceps skinfold thickness or midarm muscle circumference, had significantly poorer survival rates.
Subject(s)
Liver Cirrhosis/mortality , Nutritional Status , Anthropometry , Humans , Liver Cirrhosis/complications , Liver Cirrhosis/physiopathology , Muscle, Skeletal/pathology , Muscle, Skeletal/physiopathology , Nutrition Disorders/etiology , Nutrition Disorders/pathology , Nutrition Disorders/physiopathology , Predictive Value of Tests , Skinfold Thickness , Survival RateABSTRACT
The anticardiolipin or antiphospholipid antibody syndrome is characterized by an increased incidence of venous and arterial thromboses. This syndrome may occur in association with systemic lupus erythematosus or independently. Gastroenterological manifestations have included Budd-Chiari syndrome, hepatic infarction, esophageal necrosis with perforation, intestinal ischemia and infarction, pancreatitis, and colonic ulceration. We report a 39-yr-old man with antiphospholipid antibody syndrome complicated by adrenal insufficiency secondary to bilateral adrenal infarction who presented with severe epigastric pain. Endoscopic evaluation disclosed progressive gastric ulceration with necrosis in the distal body. Angiography revealed no vasculitis. Because of intractable pain despite intravenous anticoagulation and narcotic analgesia, the patient was taken to surgery, and an antrectomy with Billroth II gastrojejunostomy was performed. Histological examination revealed widespread vascular occlusive disease involving veins, small arteries, and arterioles present in all layers of the stomach and the perigastric fat consistent with the vasculopathy of the antiphospholipid antibody syndrome. Treatment with high intensity oral anticoagulation and corticosteroids resulted in clinical and endoscopic improvement. This case report extends the gastroenterological manifestations of the antiphospholipid antibody syndrome to include giant gastric ulceration and emphasizes the importance of anticoagulation in treatment.
Subject(s)
Antiphospholipid Syndrome/complications , Stomach Ulcer/etiology , Adult , Antiphospholipid Syndrome/diagnosis , Antiphospholipid Syndrome/pathology , Antiphospholipid Syndrome/surgery , Gastrostomy , Humans , Jejunostomy , Male , Microcirculation , Stomach/blood supply , Stomach/pathology , Stomach Ulcer/diagnosis , Stomach Ulcer/pathology , Stomach Ulcer/surgery , Thrombosis/complications , Thrombosis/diagnosis , Thrombosis/pathology , Thrombosis/surgeryABSTRACT
Primary aortoduodenal fistula is an uncommon cause of massive upper gastrointestinal hemorrhage; it is most commonly caused by the erosion of an abdominal aortic aneurysm into the third portion of the duodenum. This report describes a 73-yr-old man who developed uncontrollable hematemesis due to a primary aortoduodenal fistula in the fourth portion of the duodenum approximately 20 yr after radiotherapy and para-aortic lymph node dissection for seminoma. Surgical and postmortem examination revealed encasement of a normal-size aorta by dense fibrous tissue, ischemic necrosis of the aortic wall, and distinct chronic radiation changes of the duodenum. We propose that radiation may have played a significant role in the pathogenesis of the aortoduodenal fistula in this case. A history of radiotherapy may be relevant in the etiology of massive gastrointestinal bleeding and should prompt rapid attempts at visualization of the distal duodenum if the source of bleeding is unclear.
