Secondary Metastatic Gastric Melanoma

Gastrointestinal melanomas are commonly metastatic from a cutaneous origin. They cause significant cancer related mortality. A 47- year - old male patient presented with severe pallor and prostration due to profuse upper GI bleeding. He was urgently managed with fluid and blood transfusion. Endoscopy revealed gastric mass and CT showed gastric neoplasm with abdominal lymphadenopathy but endoscopic biopsy revealed inflammatory lesion. He had history of malignant melanoma of right third toe three years back which was managed with surgery and chemotherapy. Exploratory laparotomy was done and biopsy was taken from gastric lesion as well as enlarged lymph nodes. Histopathology revealed melanoma from both specimens. Prognosis is bad. Counseling and collaboration with different relevant disciplines are essential. Management is directed to symptom relieve as well as lengthening survival. J Bangladesh Coll Phys Surg 2021; 39(1): 68-75

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Prevention of recurrent idiopathic gastroduodenal ulcer bleeding: a double-blind, randomised trial

Gut ◽

10.1136/gutjnl-2019-318715 ◽

2019 ◽

Vol 69 (4) ◽

pp. 652-657 ◽

Cited By ~ 1

Author(s):

Grace L H Wong ◽

Louis H S Lau ◽

Jessica Y L Ching ◽

Yee-Kit Tse ◽

Rachel H Y Ling ◽

...

Keyword(s):

Duodenal Ulcer ◽

Randomised Trial ◽

Ulcer Bleeding ◽

Recurrent Ulcer ◽

Gi Bleeding ◽

Double Blind ◽

Upper Gi Bleeding ◽

Upper Gi ◽

History Of ◽

Bleeding Ulcers

ObjectivePatients with a history of Helicobacter pylori-negative idiopathic bleeding ulcers have a considerable risk of recurrent ulcer complications. We hypothesised that a proton pump inhibitor (lansoprazole) is superior to a histamine 2 receptor antagonist (famotidine) for the prevention of recurrent ulcer bleeding in such patients.DesignIn this industry-independent, double-blind, randomised trial, we recruited patients with a history of idiopathic bleeding ulcers. After ulcer healing, we randomly assigned (1:1) patients to receive oral lansoprazole 30 mg or famotidine 40 mg daily for 24 months. The primary endpoint was recurrent upper GI bleeding within 24 months, analysed in the intention-to-treat population as determined by an independent adjudication committee.ResultsBetween 2010 and 2018, we enrolled 228 patients (114 patients in each study group). Recurrent upper GI bleeding occurred in one patient receiving lansoprazole (duodenal ulcer) and three receiving famotidine (two gastric ulcers and one duodenal ulcer). The cumulative incidence of recurrent upper GI bleeding in 24 months was 0.88% (95% CI 0.08% to 4.37%) in the lansoprazole arm and 2.63% (95% CI 0.71% to 6.91%) in the famotidine arm (p=0.313; crude HR 0.33, 95% CI 0.03 to 3.16, p=0.336). None of the patients who rebled used aspirin, non-steroidal anti-inflammatory drugs or other antithrombotic drugs.ConclusionThis 2-year, double-blind randomised trial showed that among patients with a history of H. pylori-negative idiopathic ulcer bleeding, recurrent bleeding rates were comparable between users of lansoprazole and famotidine, although a small difference in efficacy cannot be excluded.Trial registration numberNCT01180179; Results.

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Hemorrhagic Gastritis and Duodenitis Following Celiac Plexus Neurolysis

January 2018 - Pain Physician ◽

10.36076/ppj.2011/14/1001 ◽

2009 ◽

Vol 6;12 (6;12) ◽

pp. 1001-1003

Author(s):

Scott Pello

Keyword(s):

Pancreatic Cancer ◽

Abdominal Pain ◽

Celiac Plexus ◽

Celiac Plexus Block ◽

Upper Endoscopy ◽

Gi Bleeding ◽

Upper Gi ◽

History Of ◽

Upper Abdominal ◽

Plexus Block

Introduction: Neurolytic celiac plexus block is a well established intervention to palliate pain, and it potentially improves quality of life in patients suffering from an upper abdominal malignancy, specifically pancreatic cancer. Methods: We describe a 61-year-old female with a history of pancreatic cancer, unexplained transfusion dependent anemia with a normal recent upper endoscopy, and abdominal pain, who had previously undergone gastrojejunostomy and a Roux-en-Y hepaticojejunostomy as well as chemotherapy and radiation therapy. She suffered from intractable abdominal pain and elected to undergo palliative celiac plexus neurolysis. Results: The patient initially appeared to tolerate celiac plexus block well, however, 45 minutes after the procedure, the patient had bright red blood per rectum followed by bloody diarrhea. Her abdomen was soft and non-tender with minimal distention and positive bowel sounds. The patient’s hemoglobin decreased to 7.5 g/dl from 9.0 g/dl, and she received a blood transfusion. Upper endoscopy and enteroscopy demonstrated diffuse hemorrhagic gastritis and duodenitis. The bleeding was controlled and the patient remained hemodynamically stable. Ultimately, the patient did well and was discharged home. Discussion: We report a case of a patient with known history of gastritis and duodenitis, who developed severe upper GI bleeding immediately following the celiac plexus neurolysis. There are no published reports documenting similar cases. It is difficult to offer a precise physiologic explanation for this complication. However, we speculate that inhibition of sympathetic tone from the celiac plexus neurolysis caused increased blood flow to the GI system, and this resulted in active bleeding from previously indolent hemorrhagic gastritis and duodenitis. Conclusion: It may be beneficial for patients with a history of gastritis, duodenitis or GI bleeding to undergo a careful upper GI evaluation prior to celiac plexus neurolysis. Key words: Case report, pancreatic cancer, celiac plexus neurolysis, anemia, hemorrhagic gastritis and doudenitis, sympathetic block

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Gossypiboma - A Diagnostic Dilemma

International Journal of Health Sciences and Research ◽

10.52403/ijhsr.20210551 ◽

2021 ◽

Vol 11 (5) ◽

pp. 329-332

Author(s):

Faaizah Shaikh ◽

Sujoy Mani ◽

Abhay Gursale

Keyword(s):

Abdominal Pain ◽

Foreign Body ◽

Exploratory Laparotomy ◽

Diagnostic Challenge ◽

Diagnostic Dilemma ◽

Surgical Sponge ◽

Retained Foreign Body ◽

History Of ◽

Gastric Mass ◽

Vague Abdominal Pain

A surgical sponge is the most common type of retained foreign body (RFB) also known as a gossypiboma (gossypium = cotton, boma = concealment). It is mostly asymptomatic but can lead to a host of symptoms in the patient ranging from pain in the abdomen to anorexia and weight loss. It poses a diagnostic challenge not just for the surgeon but also the radiologist as it can mimic an intraabdominal mass. Here we present a case of a 58 yrs old male who presented with dysphagia and abdominal pain on and off who was radiologically diagnosed as a case of gastric mass and subsequently underwent exploratory laparotomy where it was proven to be a gossypiboma. The case attempts to highlight the importance of keeping gossypiboma as a differential diagnosis for patients with vague abdominal pain and history of a surgery in the past. Key words: gossypiboma, sponge, abdominal pain, computed tomography, foreign body.

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