Crohn’s disease manifested with massive colonic bleeding (review and a clinical case)

Massive gastrointestinal bleeding (GIB) is a rare complication of Crohn’s disease (CD). For the recent decades a number of medical and surgical methods to control the GIB have been introduced. However, the unified algorithm and approach to this subset of patients is still lacking, mostly due to the absence of adequately powered and wellconducted RCTs. Determining the optimal treatment approach to inflammatory bowel disease (IBD) in patients who develop a GIB is still a valid research target.

Crohn’s disease manifested with massive colonic bleeding (review and a clinical case)

Massive gastrointestinal bleeding (GIB) is a rare complication of Crohn’s disease (CD). For the recent decades a number of medical and surgical methods to control the GIB have been introduced. However, the unified algorithm and approach to this subset of patients is still lacking, mostly due to the absence of adequately powered and wellconducted RCTs. Determining the optimal treatment approach to inflammatory bowel disease (IBD) in patients who develop a GIB is still a valid research target.

New Trends and Advances in Non-Variceal Gastrointestinal Bleeding—Series II

The gastrointestinal tract is a long tubular structure wherein any point in the mucosa along its entire length could be the source of a hemorrhage. Upper (esophagel and gastroduodenal) and lower (jejunum, ileum, and colon) gastrointestinal bleeding are common. Gastroduodenal and colonic bleeding are more frequent than bleeding from the small bowel, but nowadays the entire gastrointestinal tract can be explored endoscopically and bleeding lesions can be locally treated successfully to stop or prevent further bleeding. The extensive use of antiplatelet and anticoagulants drugs in cardiovascular patients is, at least in part, the cause of the increasing number of patients suffering from gastrointestinal bleeding. Patients with these conditions are usually older and more fragile because of their comorbidities. The correct management of antithrombotic drugs in cases of gastrointestinal bleeding is essential for a successful outcome for patients. The influence of the microbiome in the pathogenesis of small bowel bleeding is an example of the new data that are emerging as potential therapeutic target for bleeding prevention. This text summarizes the latest research and advances in all forms of acute gastrointestinal bleeding (i.e., upper, small bowel and lower). Diagnosis is approached, and medical, endoscopic or antithrombotic management are discussed in the text in an accessible and comprehensible way.

Lower Gastrointestinal Bleeding

Bleeding from the lower part of the digestive system that appears as hematochezia (fresh blood, clot or cherry-coloured stool) or melena (dark-coloured tarry stool) is called lower gastrointestinal tract bleeding (lower GI bleeding) (or colonic bleeding). In the traditional definition, lower GI bleeding was generally classified as bleeding distal to the Treitz ligament (duodenojejunal junction) as the border. In the last decade, GI bleeding has adopted three categories in some recent publications: Upper, middle, and lower. According to this category, bleeding from a source between the Treitz ligament and the ileocecal valve is classified as middle GI bleeding, bleeding from the distal of the ileocecal valve is classified lower GI bleeding. Lower GI bleeding and hospitalization rates increase with ageing. Currently, physicians managing lower GI bleeding have many different diagnostics and therapeutic options ranging from colonoscopy and flexible sigmoidoscopy to radiographic interventions such as scintigraphy or angiography. Lower GI bleeding often stops spontaneously and less common than upper GI bleeding. Even though no modality has emerged as the gold standard in the treatment of lower GI bleeding, colonoscopy has several advantages and is generally considered as the preferred initial test in most of the cases.

PEUTZ–JEGHERS–TOURAINE' SYNDROME (CASE REPORT)

PEUTS-JEGHERS TOURINE SYNDROMENishanov F., Abdullajanov B., Bozorov N.,Nishanov М., Hamidov F., Mishenina E.Authoris present two clinical observations syndrome Peutz-Jeghers Touraine, wich is hereditary and appears periorifitsial lentiginosis multiple polyposis of the small intestine (jejunum mainly)and it complications such as intestinal obstruction invaginated which combines intra colonic bleeding. The authors concluded that abdominal surgery should know and remember about the syndromePeutz-Jeghers Touraine,in order to avoid diagnostic and tactical errors and promptly provide expert surgical treatment for the.Key words: syndrome, emergency surgery, perioficial lentinginosis, invagination intestinal obstruction. РезюмеСИНДРОМ ПЕЙТЦА-ЕГЕРСА-ТУРЕНАНішанов Ф., Абдуллажанов Б., Бозоров Н.,Нішанов М., Хамідов Ф., Мішеніна Е. Автори наводять два клінічних спостереження синдрому Пейтца-Егерса-Турена, який має спадковий характер і проявляється періоріфіціальним лентігінозом, множинним поліпозом тонкої кишки (переважно порожньої) і його ускладнень у вигляді інвагінаційної кишкової непрохідності, яка поєднується з внутрішньокишковою кровотечею. Автори роблять висновок,що абдомінальним хірургам слід знати і пам'ятати про синдром Пейтца - Егерса - Турена, що дозволить уникнути діагностичних і тактичних помилок і своєчасно надати кваліфіковану екстрену хірургічну допомогу.Ключові слова: синдром, екстрена хірургія, періоріфіціальнийлентігіноз, інвагінаційна кишкова непрохідність. РезюмеСИНДРОМ ПЕЙТЦА-ЕГЕРСА-ТУРЕНАНишанов Ф., Абдуллажанов Б., Бозоров Н., Нишанов М., Хамидов Ф., Мишенина Е.Авторы приводят два клинических наблюдения синдрома Пейтца-Егерса-Турена, который имеет наследственный характер и проявляется периорифициальным лентигинозом, множественным полипозом тонкой кишки (преимущественно тощей) и его осложнений в виде инвагинационной кишечной непроходимости, которая сочетается внутрикишечным кровотечением. Авторы заключают что, абдоминальным хирургам следует знать и помнить о синдроме Пейтца – Егерса - Турена, что позволит избежать диагностических и тактических ошибок и своевременно оказать квалифицированную экстренную хирургическую помощь. Ключевые слова: синдром, экстренная хирургия, периорифициальный лентигиноз, инвагинационной кишечной непроходимости.