scholarly journals Hemosuccus Pancreaticus: A Rare Bleeding Pseudoaneurysm of the Inferior Pancreaticoduodenal Artery Treated with Embolization

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Luke L. Wang ◽  
Zachary M. Bauman
Keyword(s):  
Gastrointestinal Bleeding ◽  
Medical Therapy ◽  
Pancreaticoduodenal Artery ◽  
Hemosuccus Pancreaticus ◽  
Less Invasive ◽  
Invasive Angiography ◽  
Life Threatening

Hemosuccus pancreaticus is a very rare cause of gastrointestinal bleeding and can be life-threatening if not managed appropriately. Still thought to be a surgical problem, advances in medical therapy now afford these patients the opportunity to undergo less-invasive angiography techniques to manage this illness when it occurs. Here, we present a case of hemosuccus pancreaticus safely managed with liquid N-butyl-2-cyanoacrylate embolization.

A Review on the Use of Reversal Agents of Direct Oral Anticogulant Drugs in Case of Gastrointestinal Bleeding

2020 ◽  
Vol 15 ◽  
Author(s):  
Veronica Ojetti ◽  
Angela Saviano ◽  
Mattia Brigida ◽  
Luisa Saviano ◽  
Alessio Migneco ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Major Bleeding ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Medical Emergency ◽  
Management Approach ◽  
Emergency Setting ◽  
Reversal Agents ◽  
Life Threatening ◽  
Andexanet Alfa

Background : Major bleeding is a life-threatening condition and a medical emergency with high mortality risk. It is often the complication of anticoagulant’s intake. Anticoagulants are commonly used for the prevention and the treatment of thrombotic events. The standard therapy with vitamin K antagonist (warfarin) has been frequently replaced by direct oral anticoagulants (DOACs). The latter agents (rivaroxaban, apixaban, edoxaban, dabigatran, betrixaban) showed a better efficacy and safety compared to standard warfarin treatment and they are recommended for the reduction of ischemic stroke. Literature data reported a high risk of gastrointestinal bleeding with DOACs, in particular with dabigatran and rivaroxaban. In case of life-threatening gastrointestinal bleeding, these patients could benefit from the use of reversal agents. Methods: We performed an electronic search on PUBMED of the literature concerning reversal agents for DOACs and gastrointestinal bleeding in the Emergency Department from 2004 to 2020. AIM: This review summarizes the current evidences about three reversal agents idarucizumab, andexanet alfa and ciraparantag, and the use of the first two in the emergency setting in patients with an active major bleeding or who need urgent surgery to offer physicians indications for a better management approach in order to increase patient’s safety. Conclusion: Although these agents have been marketed for five years (idarucizumab) and two years (andexanet alfa) respectively, and despite guidelines considering antidotes as first-line agents in treating life-threatening hemorrhage when available, these antidotes seem to gain access very slowly in the clinical practice. Cost, logistical aspects and need for plasma level determination of DOAC for an accurate therapeutic use probably have an impact on this phenomenon.. An expert multidisciplinary bleeding team should be established so as to implement international guidelines based on local resources and organization.

scholarly journals A case with massive hemobilia long-term after internal drainage surgery for congenital biliary dilation

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Shunryo Minezaki ◽  
Takeyuki Misawa ◽  
Makoto Watanabe ◽  
Hideki Takahashi ◽  
Takashi Koenuma ◽  
...  
Keyword(s):  
Bile Duct ◽  
Gastrointestinal Bleeding ◽  
Pathological Condition ◽  
Extrahepatic Bile Duct ◽  
Pathological Examination ◽  
Emergency Setting ◽  
Internal Drainage ◽  
Bile Duct Resection ◽  
Extrahepatic Bile Duct Resection ◽  
Life Threatening

Abstract Background Currently, there is an unwavering consensus that the standard surgery for congenital biliary dilation (CBD) is extrahepatic bile duct resection and choledochojejunostomy. However, decades prior, choledochocyst–gastrointestinal anastomosis without extrahepatic bile duct resection (internal drainage surgery, IDS) was preferred for CBD because of its simplicity. Currently, there is almost no chance of a surgeon encountering a patient who has undergone old-fashioned IDS, which has been completely obsolete due to the risk of carcinogenesis from the remaining bile duct. Moreover, the pathological condition long after IDS is unclear. Herein, we report a case of life-threatening bile duct bleeding as well as carcinoma of the bile duct 62 years after IDS in a patient with CBD. Case presentation An 82-year-old Japanese woman with hemorrhagic shock due to gastrointestinal bleeding was transferred to our hospital. She had a medical history of unspecified surgery for CBD at the age of 20. Based on imaging findings and an understanding of the historical transition of the surgical procedure for CBD, the cause of gastrointestinal bleeding was determined to be rupture of the pseudoaneurysm of the dilated bile duct that remained after IDS. Hemostasis was successfully performed by transcatheter arterial embolization (TAE) in an emergency setting. Then, elective surgery for extrahepatic bile duct resection and choledochojejunostomy was performed to prevent rebleeding. Pathological examination revealed severely and chronically inflamed mucosa of the bile duct. Additionally, cholangiocarcinoma (Tis, N0, M0, pStage 0) was incidentally revealed. Conclusion It has been indicated that not only carcinogenesis, but also a risk of life-threatening bleeding exists due to long-lasting chronic inflammation to the remnant bile duct after IDS for CBD. Additionally, both knowledge of which CBD operation was performed, and an accurate clinical history are important for the diagnosis of hemobilia.

scholarly journals Massive Life-threatening Gastrointestinal Bleeding and Shock in a Patient with Angiodysplasia

2006 ◽  
Vol 39 (8) ◽  
pp. 1414-1417 ◽  
Author(s):  
Yukihiro Itabashi ◽  
Toshiaki Baba ◽  
Satoru Kato ◽  
Mutsuo Sasaki
Keyword(s):  
Gastrointestinal Bleeding ◽  
Life Threatening

scholarly journals Dieulafoy Lesion of Ileum: A Case Report

2020 ◽  
Vol 3 (1) ◽  
pp. 64-66
Author(s):  
Prakash Poudel ◽  
Ramesh Dhakwa
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Gastrointestinal Bleeding ◽  
Gastrointestinal Haemorrhage ◽  
Definitive Diagnosis ◽  
Gi Bleeding ◽  
Mucosal Defect ◽  
Life Threatening ◽  
High Index Of Suspicion ◽  
Dieulafoy Lesion

Dieulafoy lesion is a rare cause of massive GI bleeding. It’s an abnormal sub-mucosal artery protruding from a minute mucosal defect (≤3 mm). A 31 yearold male presented with complaints of hematochezia. Preliminary investigations failed to locate the exact source of bleed. Enteroscopy suggested distal ileal bleed. At laparotomy, an ulcerated nodular lesion, approximately 0.5 cm was identified in distal ileum. 30 cm of ileum along with mesentery was resected. Histology revealed it to be Dieulafoy lesion. Dieulafoy lesion is uncommon but one of the causes of obscure gastrointestinal bleeding that could result in treacherous and life-threatening gastrointestinal haemorrhage. This lesion is difficult to identify and high index of suspicion is required to make diagnosis. Hence, it should be considered in the differential diagnosis of active GI bleeding. The definitive diagnosis is based only on histopathology.

scholarly journals Life-Threatening Extrarenal Manifestations in an Infant with Atypical Hemolytic Uremic Syndrome Caused by a Complement 3-Gene Mutation

2019 ◽  
Vol 44 (5) ◽  
pp. 1300-1305
Author(s):  
Sa Ra Han ◽  
Myung Hyun Cho ◽  
Jin Soo Moon ◽  
Il Soo Ha ◽  
Hae Il Cheong ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Hemolytic Uremic Syndrome ◽  
Gene Mutation ◽  
Hemolytic Anemia ◽  
Atypical Hemolytic Uremic Syndrome ◽  
Pulmonary Hemorrhage ◽  
Microangiopathic Hemolytic Anemia ◽  
Life Threatening ◽  
Uremic Syndrome ◽  
Extrarenal Manifestations

Background: Atypical hemolytic uremic syndrome (aHUS) is a rare, life-threatening disease characterized by microangiopathic hemolytic anemia, thrombocytopenia, and renal impairment caused by uncontrolled activation of the complement system. About 20% of patients show extrarenal manifestations, with central nervous system involvement being the most frequent. We described the clinical course and management of aHUS in an infant, that was caused by a complement 3 (C3) gene mutation with severe extrarenal manifestations. Case Presentation: A 4-month-old girl visited our hospital for jaundice and petechiae. Laboratory tests revealed microangiopathic hemolytic anemia, thrombocytopenia, and hyperazotemia. She was diagnosed with aHUS with a C3 p.E1160K mutation. Daily fresh-frozen plasma (FFP) therapy was administered; however, she experienced the severe extrarenal manifestations of pulmonary hemorrhage and gastrointestinal bleeding. With aggressive treatment, supportive care, and daily FFP transfusion, the patient recovered and was discharged after 72 days of hospital stay, on a regular FFP transfusion. Four months after diagnosis, she was switched to eculizumab treatment. Twenty months have passed since then and she has been relapse-free until now. Conclusion: aHUS is rare but has a devastating course if not properly treated. Severe extrarenal manifestations, such as pulmonary hemorrhage and gastrointestinal bleeding, can develop in aHUS caused by a C3 mutation. In our case, long-term management with eculizumab resulted in relapse-free survival.

Gastric Mucormycosis as a Cause of Life-Threatening Upper Gastrointestinal Bleeding in a Trauma Patient

2010 ◽  
Vol 76 (7) ◽  
pp. 76-77 ◽  
Author(s):  
Chad B. Johnson ◽  
Mentor Ahmeti ◽  
Alan H. Tyroch ◽  
Marc J. Zuckerman ◽  
M. Nawar Hakim
Keyword(s):  
Gastrointestinal Bleeding ◽  
Trauma Patient ◽  
Upper Gastrointestinal Bleeding ◽  
Life Threatening ◽  
Upper Gastrointestinal
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