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1.
BMC Surg ; 21(1): 71, 2021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33530973

RESUMO

BACKGROUND: Hemobilia due to rupture of hepatic artery pseudoaneurysm and recurrent hemorrhage caused by hepatic artery collateral circulation are both rare complications after liver trauma. There have been a number of separate reports of both complications, but no cases have been reported in which the two events occurred in the same patient. Here we report a recurrent hemorrhage in the bile duct due to hepatic artery pseudoaneurysm secondary to collateral circulation formation after hepatic artery ligation in a patient with liver trauma. CASE PRESENTATION: A 52-year-old male patient was admitted to our hospital for liver trauma (Grade IV according to the American Association for the Surgery of Trauma (AAST) grading system) with active bleeding after a traffic accident. Hepatic artery ligation was performed for hemostasis. Three months after the surgery, the patient was readmitted for melena and subsequent hematemesis. Selective angiography examination revealed the formation of collateral circulation between the superior mesenteric artery and right hepatic artery. Moreover, a ruptured hepatic artery pseudoaneurysm was observed and transcatheter arterial embolization (TAE) was performed for hemostasis at the same time. After the treatment, the patient recovered very well and had an uneventful prognosis until the last follow-up. CONCLUSION: For patients with hepatic trauma, the selection of the site of hepatic artery ligation and the diagnosis and treatment methods of postoperative biliary hemorrhage are crucial for the prognosis of the disease.


Assuntos
Falso Aneurisma , Aneurisma Roto , Hemobilia , Artéria Hepática , Ligadura/efeitos adversos , Fígado , Traumatismos Abdominais/complicações , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Aneurisma Roto/etiologia , Aneurisma Roto/terapia , Angiografia/métodos , Ductos Biliares/diagnóstico por imagem , Ductos Biliares/lesões , Circulação Colateral , Embolização Terapêutica , Hematemese/etiologia , Hematemese/terapia , Hemobilia/etiologia , Hemobilia/terapia , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/lesões , Artéria Hepática/cirurgia , Humanos , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Fígado/lesões , Masculino , Melena/etiologia , Melena/terapia , Pessoa de Meia-Idade , Recidiva , Circulação Esplâncnica
5.
Eur J Gastroenterol Hepatol ; 32(7): 797-803, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32175981

RESUMO

OBJECTIVES: 'Coffee ground' vomiting (CGV) has classically been considered a sign of upper gastrointestinal bleeding. There is a paucity of data concerning endoscopic findings and outcomes in patients presenting with CGV. The aim of this study was to analyze endoscopic yield and 30-day outcomes in CGV patients. METHODS: Analysis was performed over the period 1992-2005 and four groups were identified: CGV alone, hematemesis alone, melena alone, and hematemesis and melena. Endoscopic yield, requirement for blood transfusion, rebleeding, and mortality rate at 30 days were calculated and compared using logistic regression analysis. RESULTS: 6054 patients (mean age 61.3 years, 3538 male) were included in the study. The hematemesis group was younger compared with the other groups. Therefore, endoscopic yield was adjusted for age and sex. CGV was associated with a significantly lower risk of gastric ulcer, duodenal ulcer, varices, gastric cancer, esophageal cancer, and Mallory-Weiss tears compared with some or all of the other groups. CGV was associated with an increased risk of esophagitis and no source was found. CGV was associated with a lower rate of blood transfusion and rebleeding (all P < 0.0001) but 30-day mortality rates were similar. CGV was less likely to require endoscopic intervention compared with the other groups (all P < 0.001). CONCLUSIONS: CGV is associated with a lower endoscopic yield, requirement for blood transfusion, rebleeding rate, and potential for intervention compared to those with hematemesis, melena or both. Mortality rates are similar suggesting a nonbleeding cause and therefore questions the role of endoscopy in CGV.


Assuntos
Café , Úlcera Gástrica , Endoscopia Gastrointestinal , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Hematemese/diagnóstico , Hematemese/epidemiologia , Hematemese/etiologia , Humanos , Masculino , Melena/epidemiologia , Melena/etiologia , Melena/terapia , Pessoa de Meia-Idade
6.
Eur J Gastroenterol Hepatol ; 31(11): 1334-1341, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31524777

RESUMO

OBJECTIVES: Patients with acute upper gastrointestinal bleeding (AUGIB) often manifest as hematemesis and melena. Theoretically, hematemesis will carry worse outcomes of AUGIB. However, there is little real-world evidence. We aimed to compare the outcomes of hematemesis versus no hematemesis as a clinical manifestation of AUGIB at admission in cirrhotic patients. METHODS: All cirrhotic patients with AUGIB who were consecutively admitted to our hospital from January 2010 to June 2014 were considered in this retrospective study. Patients were divided into hematemesis with or without melena and melena alone without hematemesis at admission. A 1:1 propensity score matching analysis was performed. Subgroup analyses were performed based on systemic hemodynamics (stable and unstable) and Child-Pugh class (A and B+C). Sensitivity analyses were conducted in patients with moderate and severe esophageal varices confirmed on endoscopy. Primary outcomes included five-day rebleeding and in-hospital death. RESULTS: Overall, 793 patients were included. Patients with hematemesis at admission had significantly higher five-day rebleeding rate (17.4 versus 10.1%, P = 0.004) and in-hospital mortality (7.9 versus 2.4%, P = 0.001) than those without hematemesis. In the propensity score matching analyses, 358 patients were included with similar Child-Pugh score (P = 0.227) and MELD score (P = 0.881) between the two groups; five-day rebleeding rate (19.0 versus 10.6%, P = 0.026) and in-hospital mortality (8.4 versus 2.8%, P = 0.021) remained significantly higher in patients with hematemesis. In the subgroup and sensitivity analyses, the statistical results were also similar. CONCLUSIONS: Hematemesis at admission indicates worse outcomes of cirrhotic patients with AUGIB, which is useful for the risk stratification of AUGIB.


Assuntos
Varizes Esofágicas e Gástricas/fisiopatologia , Hematemese/fisiopatologia , Cirrose Hepática/fisiopatologia , Melena/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue , Causas de Morte , Criança , Doença Hepática Terminal/mortalidade , Endoscopia Gastrointestinal , Varizes Esofágicas e Gástricas/etiologia , Feminino , Fármacos Gastrointestinais/uso terapêutico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/fisiopatologia , Hemorragia Gastrointestinal/terapia , Hematemese/etiologia , Hematemese/terapia , Encefalopatia Hepática/mortalidade , Hormônios/uso terapêutico , Mortalidade Hospitalar , Humanos , Cirrose Hepática/complicações , Falência Hepática/mortalidade , Masculino , Melena/etiologia , Melena/terapia , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/mortalidade , Octreotida/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Recidiva , Índice de Gravidade de Doença , Somatostatina/uso terapêutico , Adulto Jovem
8.
J Dermatol ; 46(1): 73-75, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30474867

RESUMO

Generalized pustular psoriasis (GPP) is a systemic inflammatory disease that presents with erythema and sterile pustules, pathologically characterized by Kogoj's spongiform pustules. GPP is sometimes accompanied by mucosal involvement, and the most common lesion is on the tongue. IL36RN mutation was found to contribute to the pathogenesis of GPP especially in patients who develop GPP without a past medical history of psoriasis vulgaris. The association of IL36RN mutation with mucosal involvement in GPP is controversial. We herein report a 60-year-old male GPP patient with no past history of plaque psoriasis presenting with not only severe skin lesions and arthritis but also severe mucosal involvements of pharyngeal and gastrointestinal lesions, which led to gastrointestinal bleeding. Our case did not have any mutation in the IL36RN gene. We should be aware that severe GPP can cause gastrointestinal bleeding. The relevancy of IL36RN mutation with mucosal involvement in GPP remains to be elucidated.


Assuntos
Fármacos Dermatológicos/uso terapêutico , Úlcera Duodenal/etiologia , Doenças do Esôfago/etiologia , Melena/etiologia , Psoríase/complicações , Anticorpos Monoclonais Humanizados/uso terapêutico , Biópsia , Úlcera Duodenal/diagnóstico por imagem , Úlcera Duodenal/patologia , Endoscopia do Sistema Digestório , Transfusão de Eritrócitos , Doenças do Esôfago/diagnóstico por imagem , Doenças do Esôfago/patologia , Mucosa Esofágica/diagnóstico por imagem , Mucosa Esofágica/patologia , Humanos , Interleucinas/genética , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/patologia , Masculino , Melena/diagnóstico por imagem , Melena/patologia , Melena/terapia , Pessoa de Meia-Idade , Mutação , Psoríase/tratamento farmacológico , Psoríase/genética , Psoríase/patologia , Pele/patologia , Resultado do Tratamento
10.
Am J Gastroenterol ; 113(3): 358-366, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29380820

RESUMO

OBJECTIVES: Numerous reviews indicate bloody hematemesis signifies more severe bleeding than coffee-grounds hematemesis. We assessed severity and outcomes related to bleeding symptoms in a prospective study. METHODS: Consecutive patients presenting with hematemesis or melena were categorized as bloody emesis (N=1209), coffee-grounds emesis without bloody emesis (N=701), or melena without hematemesis (N=1069). We assessed bleeding severity (pulse, blood pressure) and predictors of outcome (hemoglobin, risk stratification scores) at presentation, and outcomes of bleeding episodes. The primary outcome was a composite of transfusion, intervention, or mortality. RESULTS: Bloody and coffee-grounds emesis were similar in pulse ≥100 beats/min (35 vs. 37%), systolic blood pressure ≤100 mm Hg (12 vs. 12%), and hemoglobin ≤100 g/l (25 vs. 27%). Risk stratification scores were lower with bloody emesis. The composite end point was 34.7 vs. 38.2% for bloody vs. coffee-grounds emesis; mortality was 6.6 vs. 9.3%. Hemostatic intervention was more common (19.4 vs. 14.4%) with bloody emesis (due to a higher frequency of varices necessitating endoscopic therapy), as was rebleeding (7.8 vs. 4.5%). Outcomes were worse with hematemesis plus melena vs. isolated hematemesis for bloody (composite: 62.4 vs. 25.6%; hemostatic intervention: 36.5 vs. 13.8%) and coffee-grounds emesis (composite: 59.1 vs. 27.1%; hemostatic intervention: 26.4 vs. 8.1%). CONCLUSIONS: Bloody emesis is not associated with more severe bleeding episodes at presentation or higher mortality than coffee-grounds emesis, but is associated with modestly higher rates of hemostatic intervention and rebleeding. Outcomes with hematemesis are worsened with concurrent melena. The presence of bloody emesis plus melena potentially could be considered in decisions regarding timing of endoscopy.


Assuntos
Hematemese/fisiopatologia , Melena/fisiopatologia , Trato Gastrointestinal Superior , Idoso , Preservação de Sangue , Transfusão de Sangue/estatística & dados numéricos , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/cirurgia , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/fisiopatologia , Hemorragia Gastrointestinal/terapia , Frequência Cardíaca , Hematemese/etiologia , Hematemese/mortalidade , Hematemese/terapia , Hemoglobinas/metabolismo , Hemostase Endoscópica/estatística & dados numéricos , Humanos , Masculino , Melena/etiologia , Melena/mortalidade , Melena/terapia , Pessoa de Meia-Idade , Mortalidade , Estudos Prospectivos , Recidiva , Medição de Risco , Índice de Gravidade de Doença
12.
Gastrointest Endosc ; 86(6): 1028-1037, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28396275

RESUMO

BACKGROUND AND AIMS: We performed a prospective multi-national study of patients presenting to the emergency department with upper GI bleeding (UGIB) and assessed the relationship of time to presentation after onset of UGIB symptoms with patient characteristics and outcomes. METHODS: Consecutive patients presenting with overt UGIB (red-blood emesis, coffee-ground emesis, and/or melena) from March 2014 to March 2015 at 6 hospitals were included. Multiple predefined patient characteristics and outcomes were collected. Rapid presentation was defined as ≤6 hours. RESULTS: Among 2944 patients, 1068 (36%) presented within 6 hours and 576 (20%) beyond 48 hours. Significant independent factors associated with presentation ≤6 hours versus >6 hours on logistic regression included melena (odds ratio [OR], 0.22; 95% CI, 0.18-0.28), hemoglobin ≤80 g/L (OR, 0.47; 95% CI, 0.36-0.61), altered mental status (OR, 2.06; 95% CI, 1.55-2.73), albumin ≤30 g/L (OR, 1.43; 95% CI, 1.14-1.78), and red-blood emesis (OR, 1.29; 95% CI, 1.06-1.59). Patients presenting ≤6 hours versus >6 hours required transfusion less often (286 [27%] vs 791 [42%]; difference, -15%; 95% CI, -19% to -12%) because of a smaller proportion with low hemoglobin levels, but were similar with regard to hemostatic intervention (189 [18%] vs 371 [20%]), 30-day mortality (80 [7%] vs 121 [6%]), and hospital days (5.0 ± 0.2 vs 5.0 ± 0.2). CONCLUSIONS: Patients with melena alone delay their presentation to the hospital. A delayed presentation is associated with a decreased hemoglobin level and increases the likelihood of transfusion. Other outcomes are similar with rapid versus delayed presentation. Time to presentation should not be used as an indicator for poor outcome. Patients with delayed presentation should be managed with the same degree of care as those with rapid presentation.


Assuntos
Duodenopatias/sangue , Doenças do Esôfago/sangue , Hematemese/sangue , Melena/sangue , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gastropatias/sangue , Idoso , Transfusão de Sangue/estatística & dados numéricos , Confusão/etiologia , Duodenopatias/mortalidade , Duodenopatias/terapia , Doenças do Esôfago/mortalidade , Doenças do Esôfago/terapia , Feminino , Escala de Coma de Glasgow , Hematemese/mortalidade , Hematemese/terapia , Hemoglobinas/metabolismo , Hemostase Endoscópica/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Letargia/etiologia , Masculino , Melena/mortalidade , Melena/terapia , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Albumina Sérica/metabolismo , Gastropatias/mortalidade , Gastropatias/terapia , Estupor/etiologia , Tempo para o Tratamento
13.
World J Gastroenterol ; 23(10): 1920-1924, 2017 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-28348499

RESUMO

Gastrointestinal stromal tumors (GISTs) represent the most common mesenchymal tumors of the alimentary tract. These tumors may have different clinical and biological behaviors. Malignant forms usually spread via a hematogenous route, and lymph node metastases rarely occur. Herein, we report a patient with a jejunal GIST who developed supraclavicular lymph node metastasis. We conclude that lymphatic diffusion via the mediastinal lymphatic station to the supraclavicular lymph nodes can be a potential metastatic route for GISTs.


Assuntos
Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/patologia , Melena/etiologia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/patologia , Antineoplásicos/administração & dosagem , Antineoplásicos/uso terapêutico , Biópsia por Agulha , Quimioterapia Adjuvante , Transfusão de Eritrócitos , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/terapia , Humanos , Mesilato de Imatinib/administração & dosagem , Mesilato de Imatinib/uso terapêutico , Jejuno/patologia , Jejuno/cirurgia , Linfonodos/patologia , Metástase Linfática , Masculino , Melena/terapia , Pessoa de Meia-Idade , Esvaziamento Cervical , Gradação de Tumores , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/terapia , Ultrassonografia
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