scholarly journals Aorto-digestive fistula: a rare cause of gastrointestinal bleeding

2021 ◽  
Vol 25 (4) ◽  
pp. 23
Author(s):  
D. V. Belov ◽  
D. V. Garbuzenko ◽  
S. I. Andrievskikh ◽  
S. S. Anufrieva
Keyword(s):  
Gastrointestinal Bleeding ◽  
Conflict Of Interest ◽  
Aortic Aneurysms ◽  
Treatment Modalities ◽  
Risk Of Death ◽  
Aortic Replacement ◽  
Pubmed Database ◽  
Russian Science Citation Index ◽  
Massive Gastrointestinal Bleeding ◽  
Digestive Fistula

<p>Aorto-digestive fistulas are a rare but extremely dangerous cause of massive gastrointestinal bleeding with a high risk of death. The aim of the review was to examine the modern principles of aorto-digestive fistula diagnosis and optimal treatment modalities.</p><p>Scientific publications and their reference lists were searched on PubMed database, Google Scholar and Russian Science Citation Index. Articles relevant to the topic, published over the past 25 years (1996-2021), were included and they were searched and categorised using the following key words: ‘gastrointestinal bleeding’, ‘aorto-digestive fistulas’, ‘diagnosis’ and ‘treatment’. Inclusion criteria were limited to gastrointestinal bleeding associated with aorto-digestive fistulas.</p><p>Patients with aortic aneurysms or those who have undergone prosthetics should have increased alertness regarding the formation of aorto-digestive fistulas. With a presence of gastrointestinal bleeding and exclusion of other sources based on multispiral computed tomography data with intravenous bolus contrast enhancement, this will allow for quick verification of the diagnosis and also enable timely medical measures to be taken. In an emergency situation, to achieve rapid hemostasis in unstable patients, endovascular aortic replacement is most justified. Open reconstruction of the aorta in situ with simultaneous elimination of the hollow organ defect and sanitation of fistula-associated foci of infection should be considered as a radical intervention for aorto-digestive fistulas.</p><p>Received 19 May 2021. Revised 7 July 2021. Accepted 9 July 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Contribution of the authors:</strong> The authors contributed equally to this article.</p>

scholarly journals Diagnostic And Therapeutic Approaches For Non-Variceal Upper Gastrointestinal Bleeding

2021 ◽  
Vol 38 (SI-1) ◽  
pp. 11-16
Author(s):  
Talat AYYILDIZ ◽  
Mustafa DUYGULU
Keyword(s):  
Blood Cell ◽  
Gastrointestinal Bleeding ◽  
Red Blood Cell ◽  
Upper Gastrointestinal Bleeding ◽  
Treatment Modalities ◽  
Severe Bleeding ◽  
Risk Of Death ◽  
Acid Suppression Therapy ◽  
Radiological Procedures ◽  
Upper Gastrointestinal

Upper gastrointestinal bleeding (UGIB) is a common, life-threatening medical condition. Non-variceal causes account for more than 90% of bleeding episodes. Peptic ulcer disease is the most frequent cause of non-variceal UGIB. Patients present with hematemesis and/or melena but hematochezia might be present in patients with severe bleeding. Despite advances in diagnostic and therapeutic methods, mortality remains high in the elderly and patients with comorbidities. Endoscopy is the primary procedure that should be performed to identify the etiology of UGIB and for treatment purposes following adequate resuscitation of patients. Early endoscopy (within the first 24 hours) has considerably improved the clinical outcomes. A number of scoring systems are being used in patients with UGIB to identify the risk of complications, rebleeding risk, the need for interventional procedures and the risk of death. The most commonly used scoring tools are the Rockall score, Glasgow-Blatchford score and AIMS65 score. Primary treatment modalities include adequate resuscitation, intravenous fluid support, transfusion of red blood cell suspension, acid suppression therapy and administration of prokinetic agents. In general, angiography, computed tomography, technetium-99m-labeled red blood cell scintigraphy and capsule endoscopy may be used in patients whose bleeding cannot be detected endoscopically. Interventional radiological procedures should be initially performed for hemorrhages that cannot be stopped endoscopically and surgical options should be considered when interventional radiological procedures are out of reach or unsuccessful.

scholarly journals Surgical approach to recurrent secondary aortoenteric fistulas: A case report

2021 ◽  
Vol 29 (3) ◽  
pp. 399-403
Author(s):  
Elbrus Zarbaliyev ◽  
Oğuz Konukoğlu ◽  
Mehmet Çağlıkülekçi ◽  
Denyan Mansuroğlu ◽  
Serap Baş ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Clinical Symptoms ◽  
Occult Blood ◽  
Aortic Aneurysms ◽  
Fecal Occult Blood ◽  
Aortic Graft ◽  
Abdominal Aortic ◽  
Short Period ◽  
Massive Gastrointestinal Bleeding ◽  
Aortoenteric Fistulas

The increasing number of abdominal aortic grafts due to abdominal aortic aneurysms has caused secondary aortoenteric fistulas to be seen more frequently as a cause of gastrointestinal bleeding. High index of suspicion plays a significant role in the diagnosis in patients having clinical symptoms ranging from fecal occult blood to massive gastrointestinal bleeding, accompanied by hemorrhagic shock. A 65-year-old male patient developed two secondary aortoenteric fistulas consecutively. The first one was aortic graft-jejunal and the second one was aortic graft-duodenal in a short period. Secondary aortoenteric fistula developed after aortobifemoral bypass. The patient underwent graft revision and jejunal repair. He was reoperated three months later due to the newly developed aortic graft-duodenal fistula. The duodenal defect was closed, and an extra-anatomic aortoiliac bypass was performed to avoid graft-related enteric fistula. The patient was discharged uneventfully and was free from any complication at nine months after surgery.

Uncommon cause of massive gastrointestinal bleeding

2005 ◽  
Vol 43 (05) ◽  
Author(s):  
K Rábai ◽  
M Bartha ◽  
F Ender ◽  
I Szántó ◽  
B Nádas ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Massive Gastrointestinal Bleeding

Epigenetic Profiling Identifies Novel Genes for Ascending Aortic Aneurysm Formation with Bicuspid Aortic Valves

2015 ◽  
Vol 18 (4) ◽  
pp. 134 ◽  
Author(s):  
Asad A Shah
Keyword(s):  
Gene Expression ◽  
Aortic Aneurysm ◽  
Methylation Status ◽  
Aortic Aneurysms ◽  
Aortic Valves ◽  
Ascending Aortic Aneurysm ◽  
Novel Genes ◽  
Aneurysm Formation ◽  
Aortic Replacement ◽  
Bicuspid Aortic Valves

<p><strong>Background:  </strong>Bicuspid aortic valves predispose to ascending aortic aneurysms, but the mechanisms underlying this aortopathy remain incompletely characterized.  We sought to identify epigenetic pathways predisposing to aneurysm formation in bicuspid patients.</p><p><strong>Methods:  </strong>Ascending aortic aneurysm tissue samples were collected at the time of aortic replacement in subjects with bicuspid and trileaflet aortic valves.  Genome-wide DNA methylation status was determined on DNA from tissue using the Illumina 450K methylation chip, and gene expression was profiled on the same samples using Illumina Whole-Genome DASL arrays.  Gene methylation and expression were compared between bicuspid and trileaflet individuals using an unadjusted Wilcoxon rank sum test.  </p><p><strong>Results:  </strong>Twenty-seven probes in 9 genes showed significant differential methylation and expression (P&lt;5.5x10<sup>-4</sup>).  The top gene was protein tyrosine phosphatase, non-receptor type 22 (<em>PTPN22</em>), which was hypermethylated (delta beta range: +15.4 to +16.0%) and underexpressed (log 2 gene expression intensity: bicuspid 5.1 vs. trileaflet 7.9, P=2x10<sup>-5</sup>) in bicuspid patients, as compared to tricuspid patients.  Numerous genes involved in cardiovascular development were also differentially methylated, but not differentially expressed, including <em>ACTA2</em> (4 probes, delta beta range:  -10.0 to -22.9%), which when mutated causes the syndrome of familial thoracic aortic aneurysms and dissections</p><p><strong>Conclusions:  </strong>Using an integrated, unbiased genomic approach, we have identified novel genes associated with ascending aortic aneurysms in patients with bicuspid aortic valves, modulated through epigenetic mechanisms.  The top gene was <em>PTPN22</em>, which is involved in T-cell receptor signaling and associated with various immune disorders.  These differences highlight novel potential mechanisms of aneurysm development in the bicuspid population.</p>

scholarly journals A 60-year-old woman with asymptomatic total thoracic–abdominal aortic aneurysm

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jianying Deng ◽  
Wei Liu
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Effective Treatment ◽  
Clinical Symptoms ◽  
Aortic Aneurysms ◽  
Case Presentation ◽  
Second Stage ◽  
Aortic Replacement ◽  
Abdominal Aortic ◽  
Thoracoabdominal Aortic Replacement

Abstract Introduction Total thoracic–abdominal aortic aneurysm is a rare disease in cardiovascular surgery, with high surgical risk and high mortality. Surgery is considered the most effective treatment for total aortic aneurysms. Case presentation Our group admitted a 60-year-old female patients with asymptomatic complex total thoracic–abdominal aortic aneurysm, and successfully performed two-staged surgery, namely Bentall + Sun’s operation in the first-stage and thoracoabdominal aortic replacement in the second-stage. The results of the surgery were satisfactory. Conclusions Patients with total thoracic–abdominal aortic aneurysm may not have typical clinical symptoms and require a careful and comprehensive physical examination and related auxiliary examinations by clinicians. Staged repair of total thoracic–abdominal aortic aneurysms is still a safe and effective treatment.

scholarly journals Diagnostic and therapeutic treatment modalities for acute lower gastrointestinal bleeding: a systematic review

2017 ◽  
Vol 05 (10) ◽  
pp. E959-E973 ◽  
Author(s):  
Kathryn Oakland ◽  
Jennifer Isherwood ◽  
Conor Lahiff ◽  
Petra Goldsmith ◽  
Michael Desborough ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Flexible Sigmoidoscopy ◽  
Meta Analysis ◽  
Computed Tomographic Angiography ◽  
Lower Gastrointestinal Bleeding ◽  
Treatment Modalities ◽  
Computed Tomographic ◽  
Meta Analyses ◽  
Tomographic Angiography ◽  
Risk Ratios

Abstract Background and study aims Investigations for lower gastrointestinal bleeding (LGIB) include flexible sigmoidoscopy, colonoscopy, computed tomographic angiography (CTA), and angiography. All may be used to direct endoscopic, radiological or surgical treatment, although their optimal use is unknown. The aims of this study were to determine the diagnostic and therapeutic yields of endoscopy, CTA, and angiography for managing LGIB, and their influence on rebleeding, transfusion, and hospital stay. Patients and methods A systematic search of MEDLINE, PubMed, EMBASE, and CENTRAL was undertaken to identify randomized controlled trials (RCTs) and nonrandomized studies of intervention (NRSIs) published between 2000 and 12 November 2015 in patients hospitalized with LGIB. Separate meta-analyses were conducted, presented as pooled odds (ORs) or risk ratios (RR) with 95 % confidence intervals (CIs). Results Two RCTs and 13 NRSIs were included, none of which examined flexible sigmoidoscopy, or compared endotherapy with embolization, or investigated the timing of CTA or angiography. Two NRSIs (57 – 223 participants) comparing colonoscopy and CTA were of insufficient quality for synthesis but showed no difference in diagnostic yields between the two interventions. One RCT and 4 NRSIs (779 participants) compared early colonoscopy (< 24 hours) with colonoscopy performed later; meta-analysis of the NRSIs demonstrated higher diagnostic and therapeutic yields with early colonoscopy (OR 1.86, 95 %CI 1.12 to 2.86, P = 0.004 and OR 3.08, 95 %CI 1.93 to 4.90, P < 0.001, respectively) and reduced length of stay (mean difference 2.64 days, 95 %CI 1.54 to 3.73), but no difference in transfusion or rebleeding. Conclusions In LGIB there is a paucity of high-quality evidence, although the limited studies on the timing of colonoscopy suggest increased rates of diagnosis and therapy with early colonoscopy.

scholarly journals ATRT-26. META-ANALYSIS OF TREATMENT MODALITIES IN METASTATIC ATYPICAL TERATOID/RHABDOID TUMORS IN CHILDREN

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii281-iii281
Author(s):  
Reena M Underiner ◽  
Mostafa Eltobgy ◽  
Joseph R Stanek ◽  
Jonathan L Finlay ◽  
Mohamed S AbdelBaki
Keyword(s):  
Surgical Resection ◽  
Meta Analysis ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Substantial Effect ◽  
Treatment Modalities ◽  
Risk Of Death ◽  
Atypical Teratoid ◽  
Atypical Teratoid Rhabdoid Tumors ◽  
Rhabdoid Tumors

Abstract BACKGROUND Metastatic atypical teratoid/rhabdoid tumors (AT/RT) are aggressive central nervous system tumors that present during infancy and are associated with dismal outcomes. Patients receive multimodal treatment including surgical resection, systemic chemotherapy and one or more of intrathecal chemotherapy (IT), marrow-ablative chemotherapy with autologous hematopoietic cell rescue (AuHCR) and radiation therapy (XRT). While data regarding treatment modalities for AT/RT patients exist, no comprehensive data have been published regarding the metastatic patient population. METHODS We performed a meta-analysis of 1,578 articles published through September 2018, including 44 studies with a total of 123 subjects. Additionally, seven patients were incorporated through chart review of patients treated at Nationwide Children’s Hospital. RESULTS Analysis of 130 patients revealed a 3-year overall survival (OS) of 25%. Age at diagnosis had a significant impact on survival (p=0.0355); 3-year OS for infants &lt; 18 months was 21%; 18–36 months was 26%; and &gt; 36 months was 36%. Location of the primary tumor, metastatic stage and extent of surgical resection did not have significant impact on OS. On univariate analysis, XRT (p&lt;0.0001), IT (p=0.01) and AuHCR (p&lt;0.0001) were found to significantly improve survival. The most substantial effect was noted in patients who received AuHCR (3-year OS of 60% versus 9% in those who did not). On multivariable analysis XRT (p=0.0006), IT (p=0.0124) and AuHCR (p&lt;0.0001) were independently associated with reduced risk of death.

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