scholarly journals Hemorragia digestiva alta y divertículo duodenal. Reporte de un caso

2020 ◽  
Vol 50 (2) ◽  
Author(s):  
Juan Jerónimo Solé ◽  
Hernán Figgini ◽  
Leonela Aloy ◽  
Otto Ritondale ◽  
Hugo Daniel Ruiz
Keyword(s):  
Upper Gastrointestinal Bleeding ◽  
Hemodynamic Instability ◽  
Duodenal Diverticulum ◽  
Duodenal Wall ◽  
Digestive Endoscopy ◽  
Hemodynamic Stability ◽  
Hemorragia Digestiva ◽  
Radiological Control ◽  
Mechanical Suture ◽  
Upper Gastrointestinal

Bleeding duodenal diverticulum is an infrequent pathology in need of emergency treatment due to its high mortality. We present the clinical case of a 72-year-old patient with multiple comorbidities, who was admitted with upper gastrointestinal bleeding, abdominal pain and hemodynamic instability. Once hemodynamic stability was achieved, upper digestive endoscopy was performed, showing duodenal diverticulum in the upper knee with bleeding in the fundus, performing hemostatic control. CT was requested: at the level of the upper duodenal knee, wide base diverticulum. Surgery was scheduled for the high risk of new bleeding. In surgery, cholecystectomy and diverticulectomy were performed laparoscopically with mechanical suture. Anatomopathological report: duodenal wall with parietal thinning of the duodenum, suggestive of diverticulum by pulsion. The discharge was granted with radiological control on the 3rd postoperative day. The aim of this case is to show the importance of endoscopic resolution of urgency and subsequent laparoscopic management in a patient with important risk factors, evidencing the short hospital stay without postoperative complications.

scholarly journals In-Hospital Nonvariceal Upper Gastrointestinal Bleeding following Cardiac Surgery: Patient Characteristics, Endoscopic Lesions and Prognosis

Ulcers ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Marcos Amorim ◽  
Alan N. Barkun ◽  
Martin Larocque ◽  
Karl Herba ◽  
Benoit DeVarennes ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Patient Characteristics ◽  
Hemodynamic Instability ◽  
Predictors Of Outcome ◽  
Surgery Patient ◽  
Endoscopic Characteristics ◽  
Upper Gastrointestinal

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.

scholarly journals Long-acting Release Octreotide for Pediatric Upper Gastrointestinal Bleeding

2020 ◽  
Vol 91 (2) ◽  
pp. 251
Author(s):  
I. Malla ◽  
S. López ◽  
L. Busquet ◽  
J. Lipsich ◽  
S. Sierre ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Hemorragia Digestiva ◽  
Long Acting ◽  
Upper Gastrointestinal

Introducción: La hemorragia digestiva por hipertensión portal, sin alternativa de tratamiento endoscópico o quirúrgico por localizaciones ectópicas, no identificadas del sitio de sangrado o características anatómicas, constituye un desafío terapéutico en Pediatría. El tratamiento habitual incluye la infusión de octreótido endovenoso. En los últimos años, la presentación de octreótido de liberación prolongada (OCT-LAR) para administración mensual intramuscular, resulta una alternativa terapéutica atractiva.Objetivo: Reportar el caso de un lactante con hemorragia digestiva por hipertensión portal que recibió tratamiento exitoso con OCT-LAR.Caso Clínico: Paciente de 8 meses de vida, con malformación de vena porta extrahepática y episodios reiterados de sangrados digestivos con requerimientos transfusionales e infusiones de octréotido, sin posibilidad de tratamiento endoscópico o quirúrgico. Indicamos OCT-LAR intramuscular mensualmente. Después de diez meses de iniciado el tratamiento, el paciente no repitió sangrados digestivos y no presentó efectos adversos relacionados a la medicación.Conclusión: Consideramos que el reporte de este caso puede resultar de utilidad al presentar una nueva alternativa para el tratamiento de pacientes pediátricos con sangrado digestivo por hipertensión portal sin posibilidades terapéuticas convencionales.

scholarly journals National Survey Regarding the Timing of Endoscopic Procedures during the Covid-19 Pandemic

2020 ◽  
Author(s):  
José Daniel Marroquín-Reyes ◽  
Sergio Zepeda-Gómez ◽  
Alejandra Tepox-Padrón ◽  
Mariana Quintanar-Martínez ◽  
Omar Edel Trujillo-Benavides ◽  
...  
Keyword(s):  
Response Rate ◽  
Upper Gastrointestinal Bleeding ◽  
Nationwide Survey ◽  
Hemodynamic Instability ◽  
Severe Anaemia ◽  
Benign Disease ◽  
Endoscopic Procedures ◽  
Electronic Survey ◽  
Clinical Scenarios ◽  
Upper Gastrointestinal

Abstract Background: During the COVID-19 pandemic, several questions have arisen about which endoscopic procedures (EPs) must be performed and which ones can be postponed. The aim of this study was to conduct a nationwide survey regarding the appropriate timing of EPs during the COVID-19 pandemic. Methods: This prospective study was performed through a nationwide electronic survey. The survey consisted of 15 questions divided into three sections. The first evaluated the agreement for EPs classified as “time sensitive” and “not time sensitive”. Two other sections assessed “high-priority” and “low-priority” scenarios. Agreement was considered when >75% of respondents answered a question in the same direction. Results: The response rate was 27.2% (214/784). Among the respondents, agreement for the need to perform EP in <72 hours was only reached for variceal bleeding (93.4%). Dysphagia with alarm symptoms was the scenario in which the highest percentage of physicians (95.9%) agreed that an EP needed to be performed within a month. Less than 30% of endoscopists would perform an EP within the first 72 hours for patients with mild cholangitis, non-variceal upper gastrointestinal bleeding without hemodynamic instability, or severe anaemia without overt bleeding. In time-sensitive clinical scenarios suggestive of benign disease, none of the scenarios reached agreement in any sense. Among the time-sensitive clinical scenarios suggestive of malignancy, >90% of the surveyed respondents considered that EP could not be postponed for >8 weeks. Conclusions: There was no consensus among endoscopists about the timing of EPs in patients with pathologies considered time sensitive or in those with high-priority pathologies. Agreement was only reached in five (17%) of the evaluated clinical scenarios.

scholarly journals Rare cause of upper gastrointestinal bleeding

2020 ◽  
Vol 43 (6) ◽  
pp. 394-395
Author(s):  
JM Arroyo Argüelles ◽  
A de Vicente Ortega ◽  
S Romero Moreno ◽  
L Frutos Muñoz ◽  
M Tercero Lozano
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Hemorragia Digestiva ◽  
Upper Gastrointestinal

Resumen Presentamos el caso de un varón que ingresa por hemorragia digestiva alta secundaria a un leiomiosarcoma retroperitoneal que infiltra duodeno.

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