scholarly journals Multiple Duodenal Diverticula: A Rare Cause of Massive Upper Gastrointestinal Bleeding and Hemodynamic Instability

2015 ◽  
Vol 6 (10) ◽  
pp. 444-446
Author(s):  
Nneoma Okoronkwo ◽  
Sami Samiullah ◽  
Gustavo Churrango ◽  
Weizheng Wang
Ulcers ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Marcos Amorim ◽  
Alan N. Barkun ◽  
Martin Larocque ◽  
Karl Herba ◽  
Benoit DeVarennes ◽  
...  

Background. Nonvariceal upper gastrointestinal bleeding (NVUGIB) can occur following cardiac surgery, with sparse contemporary data on patient characteristics and predictors of outcome in this setting. Aim. To describe the clinical and endoscopic characteristics of patients with NVUGIB following cardiac surgery and characterize predictors of outcome. Methods. Retrospective review of 131 consecutive patients with NVUGIB following cardiac surgery from 2002 to 2005. Demographic characteristics, therapeutic management, and predictors of outcomes were determined. Results. 69.5% were male, mean age: 68.8 ± 10.2 yrs, mean Parsonnet score: 24.6 ± 14.2. Commonest symptoms included melena (59.4%) or coffee ground emesis (25.8%). In-hospital medications included ASA (88.5%), heparin (95.4%, low molecular weight 6.9%), coumadin (48.1%), clopidogrel (22.9%), and NSAIDS (42%). Initial hemodynamic instability was noted in 47.1%. Associated laboratory results included hematocrit 26 ± 6, platelets 243 ± 133 109/L, INR 1.7 ± 1.6, and PTT 53.3 ± 35.6 s. Endoscopic evaluation (122 patients) yielded ulcers (85.5%) with high-risk lesions in 45.5%. Ulcers were located principally in the stomach (22.5%) or duodenum (45.9%). Many patients had more than one lesion, including esophagitis (28.7%) or erosions (26.8%). 48.8% received endoscopic therapy. Mean lengths of intensive care unit and overall stays were 10.4 ± 18.4 and 39.4 ± 46.9 days, respectively. Overall mortality was 19.1%. Only mechanical ventilation under 48 hours predicted mortality (O.R = 0.11; 95% CI = 0.04−0.34). Conclusions. This contemporary cohort of consecutive patients with NVUGIB following cardiac surgery bled most often from ulcers or esophagitis; many had multiple lesions. ICU and total hospital stays as well as mortality were significant. Mechanical ventilation for under 48 hours was associated with improved survival.


2017 ◽  
Author(s):  
Chasen A Croft ◽  
Frederick Moore

Acute upper gastrointestinal bleeding (UGIB) is a common and potentially life-threatening emergency. Despite significant advances in intensive care resuscitation, medical treatment of gastric acid hypersecretion, and progress in endoscopic and surgical management, mortality from upper gastrointestinal hemorrhage has remained steady over the past four decades. One of the major challenges of managing UGIB involves identifying patients who are at high risk for rebleeding and death and who require admission to the intensive care unit. Regardless of the cause, initial evaluation of patients with UGIB is based on the degree of hemodynamic instability and the presumed rate of bleeding. Those patients with evidence of active bleeding and hemodynamic instability require aggressive resuscitation and hospitalization. Although diagnostic imaging may be useful in identifying the source of bleeding, endoscopy remains the “gold standard” diagnostic and therapeutic modality. Recent advances in transcatheter angiographic embolization have made this modality an attractive alternative to surgical intervention in patients who fail endoscopic management. However, in the hemodynamically unstable patient, surgical intervention is often necessary. In this review, we describe the most common causes of acute UGIB and detail the initial workup and management of each cause.  This review contains 6 figures, 3 tables, and 71 references. Key words: acute upper gastrointestinal bleeding, angiographic embolization, Billroth, Dieulafoy, esophagogastroduodenoscopy, peptic ulcer disease, scintigraphy, varices


2008 ◽  
Vol 74 (1) ◽  
pp. 27-28
Author(s):  
Jaime Ruiz-Tovar ◽  
Renato SÁInz ◽  
Alfonso Sanjuanbenito ◽  
Enrique MartÍNez Molina

Most duodenal diverticula are asymptomatic, incidentally discovered at endoscopy or barium studies. Upper gastrointestinal bleeding has been described, but it is an infrequent complication. We describe the 14th case reported in the literature of massive upper gastrointestinal bleeding originating from a duodenal diverticulum.


2011 ◽  
Vol 49 (05) ◽  
Author(s):  
E Schafer ◽  
K Rusznyák ◽  
Z Visnyei ◽  
K Dunkel ◽  
B Tolmácsi ◽  
...  

2013 ◽  
Vol 51 (05) ◽  
Author(s):  
E Schafer ◽  
T Szamosi ◽  
K Rusznyák ◽  
M Varsányi ◽  
F Zsigmond ◽  
...  

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