Periesophageal Pseudoaneurysms: Rare Cause of Refractory Bleeding Treated with Transarterial Embolization

A 43-year-old female with history of systemic lupus erythematosus, prior cytomegalovirus esophagitis treated with ganciclovir, and long segment Barrett’s esophagus (Prague class C8 M9) with high grade dysplasia treated with radiofrequency ablation presented to the hospital with hematemesis. An upper gastrointestinal endoscopy showed multiple esophageal ulcers with active arterial spurting which could not be controlled with endoscopic interventions including placement of hemostatic clips. An emergent angiogram demonstrated actively bleeding saccular dilations (pseudoaneurysms) in the esophageal branches of the lower thoracic aorta as well as left gastric artery for which gelfoam and coil embolization was initially successful. Due to recurrence of massive bleeding, she subsequently underwent emergent esophagectomy and bipolar exclusion. Pathology demonstrated submucosal hemorrhage, esophagitis with dysplastic Barrett’s mucosa, and an ulcer containing cytomegaloviral inclusions. We report the first case of arterial bleeding from periesophageal pseudoaneurysms as well as use of angiographic embolization for arterial bleeding in the esophagus.

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Tocilizumab for massive refractory pleural effusion in an adolescent with systemic lupus erythematosus

Pediatric Rheumatology ◽

10.1186/s12969-021-00635-w ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Arianna De Matteis ◽

Emanuela Sacco ◽

Camilla Celani ◽

Andrea Uva ◽

Virginia Messia ◽

...

Keyword(s):

Pleural Effusion ◽

Lupus Erythematosus ◽

High Dose ◽

Common Symptom ◽

Systemic Lupus ◽

Malar Rash ◽

Case Presentation ◽

Double Stranded Dna ◽

First Case ◽

History Of

Abstract Background Pleural effusion in systemic lupus erythematous (SLE) is a common symptom, and recent studies demonstrated that IL-6 has a pivotal role in its pathogenesis. Case presentation We report a case of a 15 years old Caucasian boy with a history of persistent pleural effusion without lung involvement or fever. Microbiological and neoplastic aetiologies were previously excluded. Based on the presence of pleuritis, malar rash, reduction of C3 and C4 levels and positivity of antinuclear antibody (ANA) and anti-double stranded DNA (dsDNA), the diagnosis of juvenile SLE (JSLE) was performed. Treatment with high dose of intravenous glucocorticoids and mycophenolate mofetil was started with partial improvement of pleural effusion. Based on this and on adults SLE cases with serositis previously reported, therapy with intravenous tocilizumab (800 mg every two weeks) was started with prompt recovery of pleural effusion. Conclusion To the best of our knowledge, this is the first case of JSLE pleuritis successfully treated with tocilizumab.

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Pulmonary Hemosiderosis in Children with Bronchopulmonary Dysplasia

Case Reports in Pediatrics ◽

10.1155/2014/876195 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3

Author(s):

David Kurahara ◽

Marina Morie ◽

Maya Yamane ◽

Sarah Lam ◽

Wallace Matthews ◽

...

Keyword(s):

Bronchopulmonary Dysplasia ◽

Lupus Erythematosus ◽

High Frequency ◽

Pulmonary Hemorrhage ◽

High Frequency Ventilation ◽

First Case ◽

Pulmonary Hemosiderosis ◽

Life Saving ◽

Frequency Ventilation ◽

History Of

We describe a possible association between pulmonary hemosiderosis (PH) and a history of bronchopulmonary dysplasia (BPD). Both patients were born at 28-week gestation and presented with PH at ages 22 months and 6 years, respectively. Both initially presented with cough and tachypnea, and bronchoalveolar lavage showed evidence of hemosiderin-laden macrophages. Initial hemoglobin levels were < 4 g/dL and chest radiographs showed diffuse infiltrates that cleared dramatically within days after initiation of intravenous corticosteroids. In the first case, frank pulmonary blood was observed upon initial intubation, prompting the need for high frequency ventilation, immediate corticosteroids, and antibiotics. The mechanical ventilation wean was made possible by the addition of mycophenolate mofetil (MMF) and hydroxychloroquine. Slow tapering off of medications was accomplished over 6 years. These cases represent a possible correlation between prematurity-associated BPD and PH. We present a review of the literature regarding this possible association. In addition, MMF proved to be life-saving in one of the PH cases, as it has been in pulmonary hemorrhage related to systemic lupus erythematosus. Further studies are warranted to investigate the possible association between PH and prematurity-related BPD, as well as the use of MMF in the treatment of PH.

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Palliation with Oesophageal Metal Stent of Pseudoachalasia from Gastric Carcinoma at the Cardia: A Case Report

Diagnostic and Therapeutic Endoscopy ◽

10.1155/2009/791627 ◽

2009 ◽

Vol 2009 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Salvatore Maria Antonio Campo ◽

Roberto Lorenzetti ◽

Marina de Matthaeis ◽

Cesare Hassan ◽

Angelo Zullo ◽

...

Keyword(s):

Old Age ◽

Iron Deficiency Anaemia ◽

Gastrointestinal Endoscopy ◽

Barium Swallow ◽

Upper Gastrointestinal Endoscopy ◽

Metal Stent ◽

History Of ◽

Upper Gastrointestinal ◽

Progressive Dysphagia

We present an 82-year-old woman with a 3-month history of progressive dysphagia and a normal initial upper gastrointestinal endoscopy. The diagnosis of pseudoachalasia was suspected by oesophageal manometric and barium swallow studies, and confirmed by biopsies revealing an intestinal type carcinoma of the stomach at a repeated endoscopy. In view of the history of heart disease, diabetes, and old age, this patient was treated by a partially covered Ultraflex self-expanding metal stent (Boston Scientific, Natick, MA, USA) placed into the oesophageal body with no direct complications and obtaining the relief from dysphagia. During the 11-month follow-up she was treated for an iron deficiency anaemia due to reflux oesophagitis with ulcerations in the oesophageal body and died from myocardial infarction. According to the localization of the cancer, the old age, and the presence of comorbidities, we should recommend the insertion of a partially covered self-expanding metal stent as a reasonable palliative treatment in selected subjects with pseudoachalasia.

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Intramucosal esophageal dissection after esophagogastroduodenoscopy: two case reports

International Journal of Case Reports ◽

10.28933/ijcr-2020-11-1505 ◽

2021 ◽

pp. 198

Author(s):

Keyword(s):

Ct Scan ◽

Subcutaneous Emphysema ◽

Case Reports ◽

Upper Gastrointestinal Endoscopy ◽

Conservative Approach ◽

First Case ◽

Esophageal Dissection ◽

Dental Arcade ◽

Sharp Foreign Body ◽

Upper Gastrointestinal

Introduction: Intramucosal esophageal dissection (IED) is an uncommon disorder, described as the separation of the mucosa and/or submucosa from deeper muscular layers due to abrupt increase in intraesophageal pressure. Case presentation: The first case il that of a 52 – years old female patient who underwent an esophagogastroduodenoscopy for control. After the procedure an extensive subcutaneous emphysema of the neck and a massive pneumomediastinum occurred. The patient was successfully treated with a conservative approach. The second case is that of a 43-years old male patient affected by Down’s Syndrome, who underwent an esopagogastroduodenoscopy because of persisting dysphagia. The endoscopic showed the presence of a serrated stricture at 20 centimeters from dental arcade. After the procedure he fell dysphagia. A neck-chest TC-SCAN showed superior and posterior pneumomediastinum and subcutaneous emphysema, without signs of mediastinitis. The patient was successfully treated with conservative approach. After a few days, a new chest CT-SCAN showed the presence of an anomalous right subclavian artery arising from the descending part of the aortic arch, causing dysphagia lusoria. Discussion: The causes of IED include iatrogenic instrumentation, hemostatic applications, mucosal injuries from ingestion of sharp foreign body, or spontaneous. A fluoroscopic upper gastrointestinal series or upper gastrointestinal endoscopy has been widely used to diagnose IED. CT and magnetic resonance are useful for differential diagnosis. In the absence of signs of mediastinitis management is conservative. Conclusion: CT SCAN should be the first exam to perform in the suspicion of IED. The first line treatment should be conservative. In case of the onset of complications and in patients who are refractory to conservative management, endoscopic or surgical treatment are indicated.

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A rare cause of abdominal pain with fever

BMJ Case Reports ◽

10.1136/bcr-2018-228401 ◽

2019 ◽

Vol 12 (3) ◽

pp. e228401

Author(s):

Diana Martins Oliveira ◽

Catarina Correia ◽

Flávia Cunha ◽

Patrícia Dias

Keyword(s):

Gastrointestinal Endoscopy ◽

Acute Cholangitis ◽

Magnetic Resonance Cholangiopancreatography ◽

Upper Gastrointestinal Endoscopy ◽

Laboratory Findings ◽

Reactive Protein ◽

Elevated Liver Enzymes ◽

History Of ◽

Lemmel’S Syndrome ◽

Upper Gastrointestinal

An 89-year-old man presented to the emergency department with a 1-month history of upper right quadrant pain, worsened in the last 3 days and accompanied by fever and chills. On physical examination, he had scleral icterus and right upper quadrant tenderness. Laboratory findings showed hyperbilirubinemia, elevated liver enzymes and C reactive protein. The patient was admitted, suspecting of an acute cholangitis and started on antibiotics. An upper gastrointestinal endoscopy revealed the presence of a juxtapapillary diverticulum in the second portion of the duodenum, which was confirmed by a magnetic resonance cholangiopancreatography, along with upstream biliary tract ectasia. The imaging findings allowed us to diagnose a Lemmel’s syndrome. Due to potential surgical risk, we decided for a conservative approach. The patient had a favourable course and was discharged home.

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Upper Gastrointestinal Endoscopy Detection of Synchronous Multiple Primary Cancers in Esophagus and Stomach: Single Center Experience from China

Gastroenterology Research and Practice ◽

10.1155/2012/432367 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Rui Wang ◽

Mo-Jin Wang ◽

Jin-Lin Yang ◽

Cheng-Wei Tang

Keyword(s):

Squamous Cell ◽

Endoscopic Examination ◽

Clinicopathological Features ◽

Multiple Primary Cancers ◽

Upper Gastrointestinal Endoscopy ◽

Simultaneous Exposure ◽

Single Center Experience ◽

Multiple Primary ◽

History Of ◽

Upper Gastrointestinal

The present study was undertaken to clarify the prevalence and clinicopathological features of synchronous multiple primary cancers (SMPCs) under upper gastrointestinal endoscopic examination. We enrolled 45,032 consecutive patients who underwent upper gastrointestinal endoscopic examination for digestive disease from January 2006 to December 2007 in our hospital and analyzed the clinicopathological features of SMPCs in esophagus and stomach. SMPCs are defined as two or over two different cancerous lesions developing in the same or other organs within 6 months. SMPCs were identified in 46 patients (0.1%). The gender ratio was 5.6 : 1 (male/female) and the mean age was 59.4 years. Synchronous esophageal and gastric cancers were the most frequent, being seen in 32 patients (0.07%). The most common histological types of SMPCs were squamous cell carcinoma in esophagus and adenocarcinoma in stomach, respectively. There were 27 (59%) SMPCs patients who had the history of simultaneous exposure to tobacco smoking and alcohol drinking. Additionally, 32 (78%) esophageal squamous cell cancers were associated with tobacco use. And 23 adenocarcinomas of the stomach were associated withHelicobacter pyloriinfection.

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Hepatic Rupture Induced by Spontaneous Intrahepatic Hematoma

Case Reports in Surgery ◽

10.1155/2018/2026846 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

Jin-bao Zhou ◽

Wei-bo Chen ◽

Feng Zhu

Keyword(s):

Lupus Erythematosus ◽

Vena Cava ◽

Caudate Lobe ◽

Posterior Lobe ◽

Hepatic Rupture ◽

Arterial Bleeding ◽

Daily Dose ◽

History Of ◽

Upper Abdominal ◽

The Right

The etiology of hepatic rupture is usually secondary to trauma, and hepatic rupture induced by spontaneous intrahepatic hematoma is clinically rare. We describe here a 61-year-old female patient who was transferred to our hospital with hepatic rupture induced by spontaneous intrahepatic hematoma. The patient had no history of trauma and had a history of systemic lupus erythematosus for five years, taking a daily dose of 5 mg prednisone for treatment. The patients experienced durative blunt acute right upper abdominal pain one day after satiation, which aggravated in two hours, accompanied by dizziness and sweating. Preoperative diagnosis was rupture of the liver mass. Laparotomy revealed 2500 mL fluid consisting of a mixture of blood and clot in the peritoneal cavity. A 3.5 cm × 2.5 cm rupture was discovered on the hepatic caudate lobe near the vena cava with active arterial bleeding, and a 5 × 6 cm hematoma was reached on the right posterior lobe of the liver. Abdominal computed tomography (CT) and laparotomy revealed spontaneous rupture of intrahepatic hematoma with hemorrhagic shock. The patient was successfully managed by suturing the rupture of the hepatic caudate lobe and clearing part of the hematoma. The postoperative course was uneventful, and the patient was discharged after two weeks of hospitalization.

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Medication Bezoar Causing acute Gastric Outlet Obstruction: A Case Report

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v33i3.28063 ◽

2016 ◽

Vol 33 (3) ◽

pp. 177-180 ◽

Cited By ~ 1

Author(s):

Md Abdul Mazid

Keyword(s):

Gastric Outlet Obstruction ◽

Epigastric Pain ◽

Outlet Obstruction ◽

Uneventful Recovery ◽

Upper Gastrointestinal Endoscopy ◽

Abdominal Ultrasonography ◽

Life Threatening ◽

History Of ◽

Upper Gastrointestinal ◽

Made In

Medication bezoars are rare and are composed of medications and/or medication vehicles. Rarely, medication bezoars can cause serious problems due to complications such as perforation, obstruction, haemorrhage. A 60 years old woman presented with 10 days history of epigastric pain, weakness and postprandial non-bilious vomiting. Her abdominal ultrasonography showed strong post acoustic shadow noted within 1st part of duodenum possibly foreign body. Upper gastrointestinal endoscopy was performed and a bezoar of tablet of aluminum hydroxide was extracted. The patient had uneventful recovery. Acute gastric outlet obstruction is relatively uncommon and mostly due to foreign bodies related to food impaction, with meat being the most frequent culprit. The diagnostic approach to acute gastric outlet obstruction is similar to other cause of GOO. However, therapeutic options differ for each patient. The diagnosis should be made in prompt time to prevent life threatening complications due obstruction and/or effect of medication forming bezoar.J Bangladesh Coll Phys Surg 2015; 33(3): 177-180

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High-grade spheno-orbital meningioma in patients with systemic lupus erythematosus: Two case reports and literature review

Surgical Neurology International ◽

10.25259/sni_583_2020 ◽

2020 ◽

Vol 11 ◽

pp. 367

Author(s):

Sarah Bin Abdulqader ◽

Nasser Almujaiwel ◽

Wafa Alshakweer ◽

Gmaan Alzhrani

Keyword(s):

Systemic Lupus Erythematosus ◽

Female Patient ◽

Lupus Erythematosus ◽

World Health ◽

Histopathological Diagnosis ◽

High Grade ◽

Systemic Lupus ◽

Who Grade ◽

First Case ◽

History Of

Background: Spheno-orbital meningiomas (SOMs) are often benign. The association of meningioma and systemic lupus erythematosus (SLE) is rarely discussed in the literature. Here, we report two patients with high-grade, SOMs with a prolonged history of SLE and review the literature. Case Description: The first case is a 52-year-old female patient with a 15-year history of SLE diagnosis who was referred to our center with a 1-year history of proptosis and excessive tearing of the left eye. This patient was operated for the left SOM with histopathological diagnosis of the World Health Organization (WHO) Grade III rhabdoid meningioma. The second case is a 36-year-old female patient with a 12-year history of SLE diagnosis who presented to our clinic with a 5-year-history of progressive right eye proptosis and occasional headaches. She was operated for the right SOM with histopathological diagnosis of the WHO Grade II chordoid meningioma. Conclusion: Rhabdoid and chordoid SOMs are uncommon and no previous report discussed their occurrence in patients with SLE. The association of high-grade meningiomas and SLE deserves further exploration.

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Fatal bleeding in a 1.5-year-old child with aortoesophageal fistula: case report and review of the literature

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care ◽

10.17816/psaic956 ◽

2021 ◽

Vol 11 (2) ◽

pp. 177-184

Author(s):

Saidkhassan M. Bataev ◽

Zaurbek Z. Magomedov ◽

Dmitriy V. Kibalnic ◽

Anastasia I. Lello ◽

Andrey S. Akatiev

Keyword(s):

Massive Bleeding ◽

Aortoesophageal Fistula ◽

Review Of The Literature ◽

Treatment Results ◽

Esophageal Lumen ◽

Fatal Bleeding ◽

Uncommon Disease ◽

History Of ◽

The Moment ◽

Upper Gastrointestinal

Aortoesophageal fistula in children is a very uncommon disease, which in most cases leads to death during the first days from the moment it occurs. Its high mortality is due to the lack of knowledge among doctors about the similarity of the disease in children and the lack of experience treating it. This paper presents the case history of a 1.5-year-old child who was admitted with bleeding from the upper gastrointestinal tract and died 36 hours after admission due to continued massive bleeding at the diagnostic measure stages. An autopsy revealed an aortic aneurysm with a diameter of 1.5 cm, which penetrated the esophageal lumen and formed an aortoesophageal fistula. This article analyzes the treatment results of 17 cases of successfully treating children with aortoesophageal fistula, which we found in the literature. It describes the leading causes and mechanisms of the development of this pathology in children. Also, the article describes the diagnostic and treatment methods for children with aortoesophageal fistula.

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