Aneurysm of a. gastroduodenalis as a source of gastric hemorrhage

Aneurysm of a. gastroduodenalis as a source of gastric hemorrhage

Injectable Self-Healing Adhesive pH-Responsive Hydrogels Accelerate Gastric Hemostasis and Wound Healing

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are well-established therapeutics for gastrointestinal neoplasias, but complications after EMR/ESD, including bleeding and perforation, result in additional treatment morbidity and even threaten the lives of patients. Thus, designing biomaterials to treat gastric bleeding and wound healing after endoscopic treatment is highly desired and remains a challenge. Herein, a series of injectable pH-responsive self-healing adhesive hydrogels based on acryloyl-6-aminocaproic acid (AA) and AA-g-N-hydroxysuccinimide (AA-NHS) were developed, and their great potential as endoscopic sprayable bioadhesive materials to efficiently stop hemorrhage and promote the wound healing process was further demonstrated in a swine gastric hemorrhage/wound model. The hydrogels showed a suitable gelation time, an autonomous and efficient self-healing capacity, hemostatic properties, and good biocompatibility. With the introduction of AA-NHS as a micro-cross-linker, the hydrogels exhibited enhanced adhesive strength. A swine gastric hemorrhage in vivo model demonstrated that the hydrogels showed good hemostatic performance by stopping acute arterial bleeding and preventing delayed bleeding. A gastric wound model indicated that the hydrogels showed excellent treatment effects with significantly enhanced wound healing with type I collagen deposition, α-SMA expression, and blood vessel formation. These injectable self-healing adhesive hydrogels exhibited great potential to treat gastric wounds after endoscopic treatment.

Anesthesia for an emergency gastrorrhagia operation in a patient suspected with COVID-19: a case report

BackgroundThe spread of the Coronavirus Disease 2019 (COVID-19) in China since December 2019 was very grave. According to Chinese govenment's guidelines, patients can be divided into confirmed cases and suspected cases. The protective measures for both are the same.Case summaryWe report a case of an emergency gastrorrhagia operation for a patient suspected to have contracted COVID-19. A 54-year-old man with massive gastric hemorrhage was scheduled for an emergency operation for exploratory hemostasis. COVID-19 infection, however, could not be ruled out, and the patient was treated as a suspected case. All the protective measures were based on patients infected or suspected to be infected with COVID-19. Before the operation, we carried out a series of protective measures, such as preparing the operating room and wearing personal protective gear. We increased the dose of neuromuscular blocking agents during the induction of anesthesia to prevent the splashing of secretions by coughing. The operation went smoothly, and the patient was transferred to an intensive care unit (ICU) in the isolation ward for extubation. Seven days later, the patient was ruled out for COVID-19 infection. ConclusionThe patient recovered successfully from the massive gastric hemorrhage, and the medical staff were not infected.

A Degrading Potassium Tablet Mimicking Active Gastric Bleeding in a Computer Tomographic Investigation

A 54-year-old male patient was admitted to the hospital due to symptoms caused by an intramural hematoma of the descending aorta. In a contrast media-enhanced computed tomography scan performed five days after admission to evaluate dynamics of the hematoma, a hyperdense lesion was seen in the stomach. A suspicion of gastric hemorrhage was raised at the first evaluation. Because the patient’s clinical condition and hemoglobin levels were stable, gastroscopy to rule out an aorto-gastric fistula or another type of bleeding was not undertaken. In the secondary evaluation of the history and images, it became clear that the hyperdense lesion mimicking bleeding in the stomach must have been caused by a degrading potassium tablet ingested by the patient five hours before the investigation.