Blue rubber bleb nevus syndrome: A rare cause of chronic gastro intestinal bleed in children

Blue rubber bleb nevus syndrome (BRBNS) is a rare congenital disorder presenting with multifocal venous malformations of the skin, soft tissues, and gastrointestinal (GI) tract. Here, we report a case of a 10-year-old girl who presented with recurrent lower GI bleeding and abdominal pain requiring repeated blood transfusion for 2 years. A contrast computed tomography showed multiple cavernous haemangiomas in the liver, oesophagogastroduodenoscopy and colonoscopy showed multiple hemangiomas from esophagus to large bowel. Her molecular pathology confirmed BRBNS. She underwent endoscopic argon plasma coagulation with uneventful recovery. In spite of a wide range of therapeutic options for the management of BRBNS described in the literature, the efficacy of those available therapies, including surgical excision, is not well established.

Causes and Management of Lower Gastro-Intestinal Bleeding

Gastrointestinal (GI) bleeding from the colon is a communal reason for hospitalization and is being more frequent in older patients. Gastrointestinal bleeding is known as any bleeding that takes place in the GIT from mouth to anus. Lower GI bleeding is defined as bleeding distal to the ligament of Treitz. Lower GI bleed is typically presented as hematochezia which is the passing of bright red blood clots or burgundy stools through the rectum. The causes of lower GI bleeding are changing over the past several decades from diverticulosis (which is the protrusion of the colon wall at the site of penetrating vessels), infectious colitis, ischemic colitis, angiodysplasia, inflammatory bowel disease, colon cancer, hemorrhoids, anal fissures, rectal varices, dieulafoy lesion, radiation-induced damage following cancer treatment to post-surgical. Management of lower GI bleeding is done through assessing the severity of symptoms and the condition of the overall case.

EP.FRI.464 Application of the Oakland score to a real world lower GI bleeding patient population

Aims Lower GI bleeding (LGIB) is a significant burden on healthcare resources with an estimated 21120 UK annual admissions. The Oakland score was developed in 2017 and allows patients to be triaged based on clinical and laboratory parameters to predict safe discharge; an Oakland score <8 predicts safe discharge with a 98.4% sensitivity. We aim to describe our experience at applying this scoring system to our practice. Methods This retrospective single centre study included 25 consecutive emergency LGIB referrals to a busy district general hospital. Oakland score was retrospectively calculated from case notes and clinical outcomes followed up. Results The average age of the patient group was 72.8 years, 56% were male. 64% of our patients were referred from ED with the remainder from GP. Mean Oakland score was 16.68. 40% of patients were on anti-platelets or a DOAC. The average length of stay was 2.56 days. 76% of these patients did not receive a blood transfusion and 73% did not undergo any imaging or endoscopy while an inpatient. Only 5 of the patients were sent home directly from the surgical assessment unit. Conclusions Our preliminary real world experience suggests that routine use of the Oakland score will allow for safe rationalisation of inpatient services. Further prospective data collection is required to validate this approach. Our data represents only patients admitted to hospital, therefore the low-scoring patient population is not represented; these patients will be included in prospective analysis.

A RETROSPECTIVE COHORT STUDY ON THE RISK FACTORS OF GASTROINTESTINAL BLEEDING IN ACUTE ISCHEMIC STROKE PATIENTS WITH ATRIAL FIBRILLATION

Introduction. Gastrointestinal (GI) bleeding is a serious complication of stroke causing high morbidity. Atrial fibrillation is associated with both ischemic stroke and GI bleeding due to usage of anticoagulant. The aim of this study is to determine the risk factors of GI bleeding in ischemic stroke patients with atrial fibrillation. Material and methods. All ischemic stroke patients with atrial fibrillation from January 2017 to December 2018 were extracted from our hospital-based stroke registry. We extracted demographical characteristic, subtypes of stroke, and medication history. Results. We found 96 ischemic stroke patients with AF were included in the study. Dyslipidemia (RR: 0.2; 95%CI: 0.043-0.939; p = 0.049) and antihyperlipidemic drugs (RR: 0.183; 95%CI: 0.039-0.857; p = 0.022) was associated with lower GI bleeding risk. There were no significant association between other risk factors and GI bleeding incidence Conclusion. Our research shows that dyslipidemia and history of antihyperlipidemic drugs are associated with lower GI bleeding risk in ischemic stroke patients with AF.

Blue Rubber Bleb Nevus Syndrome because of 12 Years of Iron Deficiency Anemia in a Patient by Double Balloon Enteroscopy; A Case Report and Review of Literature

Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder comprised of venous malformation mostly involving the skin and gastrointestinal (GI) tract but can also involve other visceral organs. The most predominant site of GI tract involvement is the small bowel. In patients with GI lesions, treatment depends on the severity of bleeding, and extent of involvement. Conservative therapy with iron supplementation and blood transfusion is appropriate in cases with mild bleeding but in severe cases endoscopic and surgical interventions would be beneficial. Also, medical therapy with sirolimus significantly reduces bleeding. A 20-year-old woman was referred to our hospital after transfusion of six units of packed cell because of several episodes of lower GI bleeding within the past three months in the form of melena and a single episode of hematochezia. Her last hemoglobin level before admission was 10mg/dl. She underwent various unsuccessful investigations since she was eight years old to find the origin of refractory iron deficiency anemia. In upper endoscopy, five bleeding polypoid lesions were discovered in the jejunum. Lesions were excised by snare polypectomy. Over a six-month follow-up period, no signs of lower GI bleeding were noted and the patient had a normal hemoglobin level.

Idiopathic Colonic Varix: Presenting as Lower GI Bleeding in an Elderly Male

not available Bangladesh Crit Care J March 2021; 9(1): 62-64