Monomorphic Epitheliotropic Intestinal T Cell Lymphoma With Lower Gastrointestinal Hemorrhage: A Case Report and Literature Review

Enteropathy-associated T cell lymphoma(EATL) is a kind of malignant lymphoma with strong invasiveness. Due to poor effect of conventional symptomatic treatment, the prognosis is not as good as other T-cell lymphomas. A 63-year-old man was admitted to our hospital due to hematochezia. No definite cause was found by electronic gastroscopy and electronic colonoscopy. After symptomatic treatment, the patient's condition did not show significant remission. However, he refused further examination and was discharged. Two months later, the man was admitted to our hospital again due to hematochezia. The site of the lesion was found by capsule endoscopy and small intestinal endoscopy, and the nature of the lesion was confirmed by immunohistochemistry. The patient received chemotherapy and autologous stem cell transplantation after a definite diagnosis. No recurrence or metastasis has been found in an 18-months follow-up after treatment.

Incidental massive lower gastrointestinal hemorrhage caused by a rectal Dieulafoy’s lesion

A Dieulafoy’s lesion is a rare cause of massive gastrointestinal (GI) bleeding. It represents an abnormally dilated submucosal artery that erodes the overlying epithelium in the absence of a primary ulcer. These lesions are usually located in the stomach, nevertheless, they have been found in all areas of the GI tract, including the oesophagus, duodenum and colon. Bleeding episodes are often self-limited, although bleeding can be recurrent and profuse. The case describes a 50-year-old woman who developed haemorrhagic shock secondary to a rectal Dieulafoy’s lesion and discusses the diagnostic and therapeutic approaches.

Computed Tomographic Evaluation of Colonic Diverticulum Complications

Cases of diverticulosis of the colon continue to increase, especially in Western countries. In these countries, two-thirds of the population older than 70 years of age are considered to experience this disease. Medical and surgical treatment for diverticulosis is begun actually for the complications of diverticulitis and lower gastrointestinal hemorrhage. The first evaluation of complicated diverticular disease is based on patient history, physical examination, and laboratory data. But all these exams and data can be inaccurate and are often questionable in the diagnoses of many features of the disease. To describe the position, severity, and presence of complications of a detected diverticulum is crucial to its appropriate treatment. The greater part of the patients have the mild disease and can be successfully cured medically. Only a small number of patients admit with acute diverticulitis and need urgent surgical intervention. Determining these patients early is crucial to morbidity and mortality reduction. Radiologic examination is important for exact evaluation of the extent of the course of the disease over the last three decades. This article aims to chart the place of the computed tomography (CT) imaging procedure in the assessment of acute complicated diverticular disease.

Severe Acute Colonic Diverticular Bleeding: The Efficacy of Rapid Bowel Preparation With 1 L Polyethylene Glycol Ascorbate Solution and Direct Endoscopic Hemoclipping for Successful Hemostasis

Colonic diverticular bleeding is an established cause of painless acute lower gastrointestinal hemorrhage. Colonoscopy, performed within 24 hours of presentation, is the usual initial diagnostic procedure in such patients. In order to improve the diagnostic and therapeutic yield of urgent colonoscopy, adequate colon cleansing is required in patients with signs and symptoms of ongoing bleeding. We hereby delineate the importance of rapid bowel preparation with a very-low-volume novel 1 L polyethylene glycol ascorbate solution in the setting of acute severe colonic diverticular bleeding. The 1-L regimen may demonstrate similar efficacy to that of traditional higher volume preparations and it can substantially reduce the time for bowel preparation. Therefore, it can be considered for bowel purge when colonoscopy has to be rapidly planned in critical patients. This article further illustrates that the endoscopic technique using epinephrine followed by direct hemoclipping may be added to the armamentarium for acute colonic diverticular hemorrhage as the first treatment, especially in elderly patients with multiple comorbid conditions. While ample evidence surrounding the efficacy of the clipping method persists in the literature, rapid bowel preparation with 1 L polyethylene glycol ascorbate solution’s imperativeness to achieve hemostasis with direct hemoclipping remains elusive.