Massive bleeding from Dieulafoy's lesion of the small intestine in a child--therapy for the bleeding from gastrointestinal tract out of endoscopic observation.

Dieulafoy's lesion is recognized as a submucosal artery associated with a minute mucosal defect and a rare cause of severe gastrointestinal hemorrhage. Especially, that of distal jejunum or ileum is extraordinarily rare. It is very difficult to detect the lesion in these parts. We experienced massive bleeding from Dieulafoy's lesion of the distal jejunum in a 12-year-old girl. Preoperative angiography and intraoperative palpation detected the point of bleeding. She was rescued by partial jejunectomy. Compiled reports suggested that careful palpation was useful for detection of the location of the bleeding point, which was enhanced as vascular dilatation by the angiogram, during the operation comparatively.

Influence of exogenous fat emulsion on pulmonary gas exchange after major surgery.

The use of fat emulsion in total parenteral nutrition (TPN) is closely related to changes in respiratory function. The aim of this study was to evaluate the influence of exogenous fat emulsion on pulmonary gas exchange in the early period after major surgery. Total parenteral nutrition was administered to 18 patients for 6 days after esophagectomy for carcinoma. Half of the patients received glucose (glucose group), and the other half received glucose and fat (fat group). The fat emulsion was continuously infused for 24 hours over 6 days. Glucose utilization was significantly higher in the glucose group than in the fat group. Fat utilization was significantly higher in the fat group than in the glucose group. Carbon dioxide (CO2) production and respiratory quotient were significantly decreased in the fat group compared to the glucose group. There were no differences in the pulmonary vascular resistance index or alveolar-arterial difference in oxygen tension between the two groups. Although exogenous fat emulsion utilized as energy substrate decreases CO2 production after major surgery, it does not clinically influence the pulmonary hemodynamics or diffusion capacity.