ABSTRACT
PURPOSE: This article reports a patient with acute intra-abdominal hemorrhage secondary to a rare vascular disease, segmental arterial mediolysis METHODS: The patient was a 56-year-old female who presented with severe acute abdominal pain. An abdominal and pelvic computed tomogram demonstrated suggestion of an intra-abdominal hemorrhage. Visceral angiography illustrated aneurysms in the branches of the inferior mesenteric artery. The patient underwent a left hemicolectomy with resection of the diseased artery. RESULTS: The angiographic and histologic findings were consistent with a diagnosis of segmental arterial mediolysis involving only the inferior mesenteric artery. CONCLUSIONS: This is the first known reported case of intra-abdominal hemorrhage related to segmental arterial mediolysis requiring emergent hemicolectomy.
Subject(s)
Abdomen/blood supply , Hemorrhage/etiology , Mesenteric Artery, Inferior/pathology , Tunica Media/pathology , Vascular Diseases/complications , Female , Hemorrhage/diagnosis , Hemorrhage/therapy , Humans , Middle Aged , Vascular Diseases/diagnosis , Vascular Diseases/therapyABSTRACT
BACKGROUND: N-butyl cyanoacrylate injection has been shown to be effective and safe for the endoscopic treatment of gastric varices. N-butyl cyanoacrylate is not available in the United States, but use of a similar agent, 2-octyl cyanoacrylate, recently was approved for skin closure. This pilot study prospectively evaluated the efficacy and safety of 2-octyl cyanoacrylate injection for treatment of gastric fundal varices. METHODS: Twenty-five patients with large gastric fundal varices with either stigmata of recent hemorrhage, a history of bleeding, or high-risk varices underwent intravariceal injection of undiluted 2-octyl cyanoacrylate. The end points for this study were cessation of active bleeding, successful obliteration of visible varices, and prevention of bleeding. RESULTS: Within 2 weeks of treatment, 52% of patients had a history of significant variceal bleeding, and 12% had active gastric variceal bleeding at the time of injection. The rate of immediate hemostasis was 100%. Gastric variceal bleeding recurred in 4% of patients (mean follow-up 11 months). The overall mortality rate was 12%; the bleeding-related mortality rate was 4%. CONCLUSIONS: Injection of 2-octyl cyanoacrylate appears to be efficacious and safe for both prevention and control of gastric variceal hemorrhage. Larger studies are required to further establish the use of 2-octyl cyanoacrylate for treatment of gastric fundal varices.
Subject(s)
Cyanoacrylates/administration & dosage , Embolization, Therapeutic/methods , Esophageal and Gastric Varices/therapy , Sclerotherapy/methods , Tissue Adhesives/administration & dosage , Aged , Aged, 80 and over , Endoscopy, Gastrointestinal , Esophageal and Gastric Varices/diagnosis , Female , Gastric Fundus , Humans , Male , Middle Aged , Pilot Projects , Prospective StudiesABSTRACT
BACKGROUND & AIMS: Toxic mushroom poisoning leads to a variety of clinical outcomes ranging from self-limited gastrointestinal symptoms to fulminant hepatic failure requiring orthotopic liver transplantation. We reviewed the outcomes of patients with severe acute hepatitis secondary to mushroom poisoning, treated with contemporary modalities. METHODS: We retrospectively reviewed patients admitted to our institution over a 5-year period with elevated transaminase levels (>1000 IU/L) attributed to recent mushroom ingestion. The patients' clinical course, laboratory data, and treatment regimen were recorded and analyzed. RESULTS: Eight patients who presented with severe hepatitis after mushroom ingestion qualified for analysis. The mean peak serum levels were: aspartate transaminase 5488 IU/L, alanine transaminase 7618 IU/L, and total bilirubin 10.5 mg/dL. The mean peak prothrombin time was 31 seconds. One patient developed acute renal failure requiring hemodialysis. Three patients developed encephalopathy ranging from grade I to III. All 8 patients survived without significant morbidity or need for liver transplantation. Subgroup analysis revealed that older patients spent more days in the intensive care unit and subsequently had longer hospital stays. The older group also had a trend toward more severe laboratory abnormalities. CONCLUSIONS: Patients with severe hepatitis from mushroom poisoning are thought to have a poor prognosis and frequently need liver transplantation for survival. We suggest that with early and aggressive multidisciplinary care, such patients have improved outcomes and may avoid liver transplantation.
