Small bowel bleeding treated successfully with transcatheter arterial embolization with imipenem/cilastatin.

BACKGROUND: Small bowel bleeding is an uncommon cause of lower gastrointestinal bleeding, which may require different management. CASE PRESENTATION: A 37-year-old man presenting with hematochezia was promptly diagnosed with small bowel bleeding by computed tomography angiography. Transcatheter arterial embolization was carried out because the patient's hemodynamic status deteriorated. Hemostasis was achieved by embolization with imipenem/cilastatin, although superselective embolization failed. Capsule endoscopy revealed multiple ulcers and erosions. Drug-induced small bowel injury was suspected to be the cause of small bowel bleeding. CONCLUSION: Computed tomography angiography can facilitate the management of lower gastrointestinal bleeding. Considering transcatheter arterial embolization and choosing an optimal embolic agent depending on the situation are important in the management of hemodynamically unstable patients.

Aortic Thrombosis in a Patient With Malignant Disease: A Literature Review and Case Presentation.

INTRODUCTION:: Aortic mural thrombosis associated with a malignant disease is rare, and whether anticoagulation therapy or surgical treatment is the more definitive primary treatment remains uncertain. This study aims to determine the best treatment strategy for aortic thrombosis in a patient with a malignant disease. METHODS:: We reviewed medical literature using the PubMed database and present a case of aortic thrombosis due to a hypercoagulable state related to sigmoid colon adenocarcinoma. RESULTS:: Of the 18 patients from 14 articles included in this study, 13 received simple anticoagulation as a primary treatment (anticoagulation group), while 5 underwent surgical treatment (surgical treatment group). Recurrence or exacerbation of embolism was found in 2 (15.4%) of the 13 patients and in 1 (20.0%) of the 5 patients ( P = 1.0). Major complications were observed in 1 (7.7%) of the patients in the anticoagulation group and in 1 (20.0%) of the 5 patients in the surgical treatment group ( P = .49). No significant differences between the groups were found. CONCLUSIONS:: A simple anticoagulation therapy may be as effective as surgical treatment in patients with aortic thrombosis associated with malignancy.

Laparoscopic relief of reduction en masse followed by elective preperitoneal inguinal hernia repair with Modified Kugel™ Patch.

INTRODUCTION: Reduction en masse is a rare complication of inguinal hernia. This condition is defined as the displacement of a strangulated hernia mass into the preperitoneal space. CASE PRESENTATION: A 62-year-old man presented with severe abdominal pain after a forcible reduction of an incarcerated right inguinal hernia. Abdominal computed tomography (CT) scan suggested strangulated bowel. Emergency exploratory laparoscopy was performed and the incarcerated bowel was successfully released. Elective preperitoneal inguinal hernia repair using the Modified Kugel™ Patch was performed under laparoscopic guidance. The patient made an uneventful recovery. DISCUSSION: Reduction en masse should be considered when abdominal pain persists after a difficult reduction of inguinal hernia. Laparoscopic guidance led to the definitive repair of the inguinal hernia with reduction en masse. CONCLUSION: Laparoscopic relief can be an efficient therapeutic option for the management of this condition. In addition, Modified Kugel™ Patch repair with ligation of the hernia sac could be a reasonable treatment.

Delayed intestinal stenosis of nonocclusive mesenteric ischemia after autologous blood collection: A case report.

INTRODUCTION: Nonocclusive mesenteric ischemia (NOMI) has been reported to be associated with high mortality. Early diagnosis of NOMI and prompt restoration of the intestinal blood flow is necessary in order to achieve a favorable outcome. PRESENTATION OF CASE: We present the case of a patient who developed NOMI after autologous blood collection and was treated by selective infusion of the superior mesenteric artery with papaverine, intestinal decompression using a long intestinal tube, the administration of antibiotics, and fluid replacement. Although this non-surgical management was successful, 8 weeks after the ischemic event, segmental bowel resection was necessary because of repeated intestinal obstruction caused by bowel stricture. DISCUSSION: Autologous blood collection might be a risk factor of NOMI. In addition, the possibility of delayed intestinal stenosis remains, even if bowel necrosis and surgical resection were avoided with non-surgical management including vasodilator therapy. CONCLUSION: Rapid diagnosis and intervention are essential to minimize intestinal ischemia.