Giant Solitary Gastric Peutz-Jeghers Polyp Mimicking a Malignant Gastric Tumor: the Largest Described in Literature

2014 ◽  
Vol 23 (3) ◽  
pp. 321-324 ◽  
Author(s):  
Sorinel Lunca ◽  
Vlad Porumb ◽  
Natalia Velenciuc ◽  
Dan Ferariu ◽  
Gabriel Dimofte
Keyword(s):  
Upper Gastrointestinal Bleeding ◽  
Rare Event ◽  
Gastric Tumor ◽  
Node Metastasis ◽  
Mucocutaneous Pigmentation ◽  
History Of ◽  
Peutz Jeghers Syndrome ◽  
Upper Gastrointestinal ◽  
Gastric Malignancy ◽  
Polypoid Tumor

A solitary Peutz-Jeghers polyp is defined as a unique polyp occurring without associated mucocutaneous pigmentation or a family history of Peutz-Jeghers syndrome. Gastric solitary localization is a rare event, with only eight reported cases to date. We report herein the case of a 43-year old woman who presented with upper gastrointestinal bleeding, severe anemia, weight loss and asthenia. Endoscopy revealed a giant polypoid tumor with signs of neoplastic invasion of the cardia, with pathological aspect suggesting a Peutz-Jeghers hamartomatous polyp. Computed tomography suggested a malignant gastric tumor and a total gastrectomy was performed. The pathological specimen showed a giant 150/70/50 mm polypoid tumor and immunochemistry established the final diagnostic of a Peutz-Jegers type polyp. This is the largest solitary Peutz-Jeghers gastric polyp reported until now, and the second one mimicking a gastric malignancy with lymph node metastasis.

scholarly journals Massive hemobilia caused by rupture of gastroduodenal artery pseudoaneurysm, a delayed complication of laparoscopic cholecystectomy: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Kurniawan Kurniawan ◽  
I Dewa Nyoman Wibawa ◽  
Gde Somayana ◽  
I Ketut Mariadi ◽  
I Made Mulyawan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gastrointestinal Bleeding ◽  
Abdominal Trauma ◽  
Upper Gastrointestinal Bleeding ◽  
Rare Complication ◽  
Gastroduodenal Artery ◽  
Time Interval ◽  
Artery Pseudoaneurysm ◽  
History Of ◽  
Upper Gastrointestinal

Abstract Background Hemobilia is a rare cause of upper gastrointestinal bleeding that originates from the biliary tract. It is infrequently considered in diagnosis, especially in the absence of abdominal trauma or history of hepatopancreatobiliary procedure, such as cholecystectomy, which can cause arterial pseudoaneurysm. Prompt diagnosis is crucial because its management strategy is distinct from other types of upper gastrointestinal bleeding. Here, we present a case of massive hemobilia caused by the rupture of a gastroduodenal artery pseudoaneurysm in a patient with a history of laparoscopic cholecystectomy 3 years prior to presentation. Case presentation A 44-year-old Indonesian female presented to the emergency department with complaint of hematemesis and melena accompanied by abdominal pain and icterus. History of an abdominal trauma was denied. However, she reported having undergone a laparoscopic cholecystectomy 3 years prior to presentation. On physical examination, we found anemic conjunctiva and icteric sclera. Nonvariceal bleeding was suspected, but esophagogastroduodenoscopy showed a blood clot at the ampulla of Vater. Angiography showed contrast extravasation from a gastroduodenal artery pseudoaneurysm. The patient underwent pseudoaneurysm ligation and excision surgery to stop the bleeding. After surgery, the patient’s vital signs were stable, and there was no sign of rebleeding. Conclusion Gastroduodenal artery pseudoaneurysm is a rare complication of laparoscopic cholecystectomy. The prolonged time interval, as compared with other postcholecystectomy hemobilia cases, resulted in hemobilia not being considered as an etiology of the gastrointestinal bleeding at presentation. Hemobilia should be considered as a possible etiology of gastrointestinal bleeding in patients with history of cholecystectomy, regardless of the time interval between the invasive procedure and onset of bleeding.

scholarly journals Schistosomiasis, Upper Gastrointestinal Bleeding, and Health Related Quality of Life Measurements in Rural Africa

2020 ◽  
Author(s):  
Christopher Kenneth Opio ◽  
Francis Kazibwe ◽  
Lalitha Rejani ◽  
Narcis B Kabatereine ◽  
Ponsiano Ocama
Keyword(s):  
Upper Gastrointestinal Bleeding ◽  
Female Gender ◽  
Health Related Quality ◽  
Disability Weights ◽  
Related Quality ◽  
Health Related ◽  
History Of ◽  
Upper Gastrointestinal ◽  
Eq Vas

Abstract Introduction Health related quality of life (HRQOL) measurements, which include disability weights, are important endpoints of health care delivery. These measurements are scarce for patients with upper gastrointestinal bleeding (UGIB) in rural sub-Saharan Africa (SSA) where schistosomiasis is endemic. Methods and materials In 2014, we studied HRQOL measurements among patients with UGIB in SSA where schistosomiasis is endemic. Participants included adult inpatients and outpatients with a history of UGIB at a primary health facility. We measured HRQOL using the EuroQoL 5-dimension (EQ-VAS/EQ5D) instrument and derived disability weights from EQ-VAS and EQ5D measurements. We profiled each participant’s medical history, physical examination, laboratory tests, imaging, and endoscopy findings. These were summarized through descriptive and inferential statistics.Results We studied 107 participants with a median age of 45 years. All participants experienced ≥1 lifetime episode of UGIB, 60% were females, while 22% had acute severe UGIB requiring admission, 98% hepatic schistosomiasis, 90% splenomegaly, 80% had esophageal varices, and 20% had peptic ulcers. Most (80%) had ever received praziquantel for schistosomiasis. No participant had ever had an endoscopy for UGIB or received propranolol for prevention of recurrent variceal UGIB. Measures of the 5 dimensions of health revealed a large proportion of participants had problems related to self-care (76%), anxiety/depression (88%), and pain/discomfort (89%). Few participants had problems with mobility(37%). The mean/median EQ-VAS derived disability weights and EQ5D derived disability weights were 0.38/0.30 and 0.38/0.34, respectively. Participants with ascites, acute UGIB, and severe anemia were found to have the highest EQ-VAS and EQ5D median disability weights. At linear regression age, female gender, ascites, and acute UGIB predicted EQ-VAS derived disability weights [F(4,100)=9.35, p<0.0000,R-squared =0.27] and EQ5D derived disability weights [F(4,100)=23.24, p<0.0000, R-squared =0.44]. Within these models, all four factors were significantly predicted higher disability weights, P-value <0.05. Conclusions In our study, older age, female gender, those with ascites or acute UGIB had the highest disability weights, and the greatest probability of having higher disability weights among patients with a history of UGIB where schistosomiasis is endemic. These findings are unique and improve the definitions of different health states among patients with UGIB and schistosomiasis.

Variceal Bleeding is Leading Cause of Upper GI Bleed: A Study from Northern Part of Pakistan

2021 ◽  
Vol 15 (7) ◽  
pp. 1837-1839
Author(s):  
Tanveer Ahmed ◽  
Mustafa Kamal ◽  
Ramish Riaz ◽  
Mashhood Ali
Keyword(s):  
Hepatitis C ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Age Group ◽  
Gastrointestinal Bleed ◽  
Upper Gi ◽  
Variceal Bleed ◽  
History Of ◽  
Gi Bleed ◽  
Upper Gastrointestinal

Background: Upper gastrointestinal bleeding (UGIB) is a leading cause of hospitalization in medical emergencies around the world, with a high death and morbidity rate. In all cases of upper gastrointestinal bleeding, endoscopy is the primary diagnostic tool. Key management of depends on diagnosing the exact cause of disease. Methodology: This descriptive study was carried out at Gastroenterology Department, PIMS, Islamabad from January 2019 to December 2019. All patients having history of upper gastrointestinal bleed were included in the study. Patients unfit for endoscopy i.e. with perforation, peritonitis, comatose needing intubation and those unwilling to undergo the procedure were excluded. Total 490 patients fulfilled the criterion. The cause of GI bleed was noted upon endoscopy. Data was noted on set performa and further statistical analysis was performed via SPSS v 26. Results: Among 490 patients, 298 (61%) were males while 192 (39%) were females. Most common age group presenting with upper GI bleed belongs to old age group i.e. had age above 60 years (n=235, 47.9%) followed by 40 to 59 years (n=174, 35.5%).Most common cause of upper GI bleed was found to be variceal bleed (n=292, 59.5%), followed by ulcer bleed (n=88, 18.0%) and stomach cancer (n=28, 6%). In 82 (17%) cases no reason for gastrointestinal bleed could be found out. Chi-square test showed Variceal bleed to be the most significant reason (χ2=65.2, P-Value<0.001) of Upper GI bleed. Conclusion: Variceal bleed is the most significant cause of upper GI bleed in our study population. This trend can be attributed to increased prevalence of hepatitis C in Pakistan. Special attention to the patient’s symptoms especially with history of HCV can help in early diagnosis and timely management. Keywords: Variceal Bleed, Upper GI Bleed, Endoscopy, Ulcer, Hepatitis C.

(A155) Acute Myocardial Infarction with Upper Gastrointestinal Bleeding

2011 ◽  
Vol 26 (S1) ◽  
pp. s44-s44
Author(s):  
S. Tandon ◽  
P. Bordoloi ◽  
T. Kole
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Inferior Wall ◽  
Upper Gi ◽  
Coffee Ground ◽  
History Of ◽  
Gi Bleed ◽  
Upper Gastrointestinal

ObjectiveTo report a rare case of Acute Myocardial Infarction (AMI) along with Upper Gastrointestinal bleeding (UGIB).Presentation and InterventionA 58 year old male with history of black coloured stools was admitted in ER for chest pain and coffee ground emesis. ECG showed an acute inferior wall MI. After doing the necessary interventions, patient was inserted with a nasogastric tube and started on medications in the Emergency for UGIB followed by immediate endoscopy. Endoscopy confirmed presence of multiple superficial Ulcers in the stomach along with Esophagitis.ConclusionWe support Esophagogastroduodenoscopy (EGD) prior to cardiac catheterisation in patients with AMI associated with overt Upper GI Bleed. This results in fewer complications as compared with direct catheterization

VKORC1-1639 G>A Polymorphism and the Risk of Non-Variceal Upper Gastrointestinal Bleeding

2017 ◽  
Vol 26 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Ioana Groza ◽  
Dana Matei ◽  
Marcel Tanţău ◽  
Adrian P Trifa ◽  
Sorin Crişan ◽  
...  
Keyword(s):  
Risk Factor ◽  
Alcohol Consumption ◽  
Vitamin K ◽  
Low Dose ◽  
Upper Gastrointestinal Bleeding ◽  
Aspirin Therapy ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
History Of ◽  
Upper Gastrointestinal

Background & Aims: The mutations in the gene that encodes vitamin K epoxide reductase (VKOR) enzyme are responsible for low levels of vitamin K. The purpose of this study was to evaluate whether the presence of the VKORC1 -1639 G> A polymorphism is a risk factor for non-variceal upper gastrointestinal bleeding (UGIB) in patients without concomitant therapy with vitamin K antagonists.Methods: This case-control study comprised 163 consecutive patients diagnosed with UGIB and 178 controls, in whom the diagnosis of UGIB was excluded. The following data were recorded: age, gender, alcohol consumption, smoking, history of UGIB, nonsteroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin consumption. Genetic analysis included genotyping for the VKORC1 -1639 G>A polymorphism.Results: History of UGIB (OR 3.463, CI95% 1.463-8.198, p=0.005), smoking (OR 2.498, CI95% 1.358-4.597, p=0.003), alcohol consumption (OR 3.283, CI95% 1.796-6.000, p<0.001), use of NSAIDs (OR 4.542, CI95% 2.502-8.247, p<0.001) or of low-dose aspirin (OR 2.390, CI95% 1.326-4.310), and the VKORC1 -1639 G> A AA genotype (OR 1.364, CI95% 0.998-1.863, p=0.05) were associated with an increased risk of UGIB. The risk of UGIB was analyzed in patients with genotype AA who used aspirin or NSAIDs. The genotype AA has not kept its status of independent risk factor (p=0.3). In subjects with NSAIDs/aspirin therapy and genotype AA there was a two times higher chance of UGIB compared to those under NSAIDs/aspirin therapy alone (OR 7.6 vs. 3.6, p<0.001).Conclusion: Patients with non-variceal UGIB caused by the use of NSAIDs or low-dose aspirin are more frequent carriers of the VKORC1 -1639 G>A AA genotype, as compared to those without UGIB.

Isolated, Idiopathic Splenic Vein Thrombosis, Presenting with Massive Lower GI Bleeding.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4131-4131
Author(s):  
Aref Agheli ◽  
Alka Arora ◽  
Maged Khalil ◽  
Seema Naik ◽  
Theresa Dumlao ◽  
...  
Keyword(s):  
Case Report ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Splenic Vein ◽  
Lower Gastrointestinal Bleeding ◽  
Splenic Vein Thrombosis ◽  
Vein Thrombosis ◽  
History Of ◽  
Venous Phase ◽  
Upper Gastrointestinal

Abstract Isolated, also called idiopathic, splenic vein thrombosis (SVT) is a very rare clinical condition, which usually results in left-sided portal hypertension and isolated fundal varices. This syndrome is a rare cause of mostly upper, gastrointestinal bleeding. There are only a few hundreds of cases reported in the literature. Colonic varices are even much rarer, 0.07% post mortem autopsies, and 0.2% in a prospective large endoscopic trials. Pancreatic disorders, including malignancies are the most common underlying causes for SVT. Congenital aneurysm of the splenic vein is one of the theoretical explanations of the Isolated, Idiopathic SVT. Case report: A 53 year old Caucasian female with history of hypertension, and no history of smoking or alcohol abuse, presented with chronic lower gastrointestinal bleeding. Upper endoscopy and flexible colonoscopy revealed perigastric varices without any source of acute bleeding. A bleeding scan demonstrated marked splenomegaly and source of bleeding from left colon. Mesenteric angiogram during venous phase showed splenic vein thrombosis and extensive perigastric varices. In addition, a single large left colonic varix from the lower pole of the spleen was identified as the source of bleeding. The patient was treated with splenic artery embolization with coils, followed by splenectomy, without any major complication. Coagulation studies 8 weeks after the procedure did not show any hypercoagulable state. Conclusion: The Isolated, Idiopathic SVT, itself is a very rare syndrome. Our center has reported four cases of SVT, secondary to medical conditions, such as; pancreatic malignancy, MRSA sepsis, and multi-organ failure. Upper gastrointestinal bleeding has been more frequently reported than lower bleeding. Interestingly, in our case report, a single colonic varix secondary to SVT was proved to be the cause of chronic lower gastrointestinal bleeding. SVT should be suspected in any patient with a triad of gastric varices, splenomegaly, and normal liver function tests, who presents with gastrointestinal bleeding secondary to left sided or so called “sinistral” portal hypertension. Mesenteric angiography with venous phase is the gold standard for the diagnosis of SVT, as endoscopic studies may not be diagnostic of this syndrome. Splenectomy is the only and definitive procedure of choice in the patients with isolated SVT, followed by post splenectomy vaccination.

P1953Risk of upper gastrointestinal bleeding following myocardial infarction: a novel prediction model for assessing appropriateness of proton pump inhibition therapy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T S G Sehested ◽  
P Blanche ◽  
P W Hansen ◽  
M G Charlot ◽  
C Torp-Pedersen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Gastrointestinal Bleeding ◽  
Prediction Model ◽  
Proton Pump ◽  
Upper Gastrointestinal Bleeding ◽  
Oral Anticoagulants ◽  
Increased Risk ◽  
History Of ◽  
One Year ◽  
Upper Gastrointestinal

Abstract Background Upper gastrointestinal bleeding following myocardial infarction continues to be a severe complication associated with increased mortality; however, bleeding events might be avoided by appropriate therapy with proton pump inhibitors. Purpose To develop and validate a prediction model aimed at identifying patients at increased risk of upper gastrointestinal bleeding following myocardial infarction. Methods Based on multiple nationwide Danish registers, all patients initiating dual antiplatelet or anticoagulant therapy in combination with antiplatelet following myocardial infarction between 2003 and 2016 were identified. Primary outcome of interest was one-year risk of upper gastrointestinal bleeding. A derivation cohort including all patients between 2003 and 2013 was selected, whereas patients identified between 2014 and 2016 was employed for internal validation. Multiple logistic regression was used to predict person specific risks based on age, history of gastrointestinal bleeding or peptic ulcer, anaemia or gastrointestinal cancer, use of nonsteroidal anti-inflammatory drugs, oral anticoagulants, selective serotonin reuptake inhibitors or loop diuretics. We compared our model with the European Society of Cardiology (ESC) guideline recommendation on gastrointestinal bleeding risk assessment. Results A total of 61 543 patients with myocardial infarction were identified for the study. In the total cohort, the median age was 68 years (IQR: 58–77), 85.0% (52 334) underwent coronary angiography, 2.6% (1 608) had a history of gastrointestinal bleeding and 7.1% (4 354) used oral anticoagulants. The average one-year risk of upper gastrointestinal bleeding was 1.04% (95% CI: 0.95–1.14%), and mean predicted risk of the model was 1.04% (IQR: 0.64–1.26%). The discriminative ability of the model evaluated by area under the curve was 74.2% (95% CI: 66.9–78.6%) in the validation cohort. The proposed risk model demonstrated improved sensitivity and specificity at the specific threshold of the ESC risk schemes (Figure 1). Results remain principally unchanged regardless of inclusion or exclusion of patients initiating proton pump inhibitors at baseline. Furthermore, using cross-validation for the model evaluation produced similar discrimination results. Figure 1 Conclusion Based on nationwide registers a novel prediction model aimed at identifying patients at increased risk of upper gastrointestinal bleeding was developed and validated; the model observed moderate discrimination in the validation cohort providing possible benefit for clinicians in terms of communicating absolute risk to the patients and determining the appropriateness of initiating preventive therapy. Acknowledgement/Funding The Danish Heart Foundation

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