Hemangioma gástrico como causa de hemorragia digestiva alta / Gastric hemangioma as a cause of upper gastrointestinal bleeding

El hemangioma gástrico como causa de hemorragia digestiva alta (HDA) es un evento clínico raro. Presentamos el caso de un varón de 83 años con historia de dolor abdominal, intolerancia oral y melena con pérdida de peso de 8 Kg. En la endoscopía digestiva alta muestra una lesión elevada en antro gástrico con úlcera y vaso visible en su parte superior el cual recibe terapia endoscópica, en la tomografía abdominal se observa una tumoración dependiente de pared gástrica de contornos definidos captadora de contraste. Por persistencia HDA con descompensación hemodinámica ingresa a laparotomía exploratoria encontrándose una tumoración vascularizada que en el estudio histopatológico se concluye como hemangioma cavernoso gástrico.

Gastric hemangioma as a cause of upper gastrointestinal bleeding (UGIB) is a rare event. We present the case of an 83 years old male with a history of abdominal pain, vomiting and melena, along with an 8 Kg weight loss. The upper gastrointestinal endoscopy showed an elevated, ulcerated lesion in the gastric antrum with a visible vessel, for which he receives endoscopic therapy. In the abdominal computed tomography, a contrast enhancing, well-circumscribed mass attached to the gastric wall is observed. Due to the persistence of the UGIB, the patient suffers hemodynamic decompensation and undergoes exploratory laparotomy, where a vascularized mass is found. The pathology report informs a gastric cavernous hemangioma

[Use of propofol administered by nurse for the sedation during coloscopies in a national hospital in Lima - Peru]. / Uso de Propofol administrado por enfermera para la sedación durante colonoscopias en un Hospital Nacional Lima - Perú

INTRODUCTION: Propofol is becoming a widely used drug in patient sedation for patients that undergo endoscopic procedures. There are no reports on the use of propofol in public hospitals in Peru. OBJECTIVE: To describe our experience in propofol use in colonoscopies performed at Hospital Nacional Cayetano Heredia administered by a dedicated nurse with clinical and pulse oximetry monitorization in procedures performed by gastroenterologists and in-training residents of gastroenterology. MATERIAL AND METHODS: An observational and prospective study was performed at the Gastroenterology unit of Hospital Nacional Cayetano Heredia from Lima, Peru from January 2007 to April 2008. Patients were chosen on arrival to get an appointment for colonoscopy provided they did not have any exclusion criteria. Midazolam and meperidine IV premedication was administered prior to attack dose administration of propofol followed by boluses administered according to the nurse and physician assessment of the patient's pulse oximetry, ventilation, sedation and tolerance to the procedure. RESULTS: 163 colonoscopies were performed. Medium dose of propofol was 89.51mg (range 30mg - 220mg). 5,5% of patients had oxygen saturation less than 90% during the procedure but none required mask ventilation. There were no other complications. Procedure was performed by a gastroenterologist and by an in-training resident of gastroenterology. The same and only nurse was in charge of sedation in every procedure. Sedation degree achieved by patients in SAS scale (sedation agitation scale) was 3 (Sedated) in 66,26% and 4 (Calm and cooperative) in 29,45%. No patient had scales 1 (unarousable), 6 (very agitated) or 7 (dangerous agitation). CONCLUSION: Propofol sedation can be safely administered by a trained nurse with only pulse oximetry and clinical monitorization in colonoscopies performed by gastroenterologist as well as in-training residents of gastroenterology, being a very comfortable procedure both for patients and endoscopists.