scholarly journals Gastrointestinal Bleeding Secondary to Metastatic Duodenal Choriocarcinoma in a Patient with Concomitant Peptic Ulcer Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Ahmed Elfiky ◽  
Asmaa Mokhtar ◽  
Mira Alsheikh ◽  
Hassan Almoussawi ◽  
Stephen Mulrooney
Keyword(s):  
Gastrointestinal Bleeding ◽  
Chemotherapy Regimen ◽  
Push Enteroscopy ◽  
Ulcer Disease ◽  
Young Males ◽  
Antral Ulcer ◽  
Show Evidence ◽  
History Of ◽  
Tract Involvement

Testicular tumors are one of the most common solid tumors in young males. Choriocarcinoma usually presents as metastatic disease. Gastrointestinal tract involvement is rare. We report a case of a 40-year-old male presenting to our hospital with a three-day history of dyspnea on exertion and black stool after recent diagnosis of testicular choriocarcinoma. Urgent EGD performed revealed small clean-based fundal ulcer and an antral ulcer without the stigma of recent bleeding. Capsule endoscopy was performed and revealed a bleeding ill-defined mass in the proximal duodenum. A subsequent push enteroscopy showed an ulcerated bleeding mass in the third part of the duodenum that was treated with a hemospray with adequate hemostasis. Pathology was consistent with pure choriocarcinoma. The patient received a cisplatin-based chemotherapy regimen. The patient tolerated the chemotherapy regimen well and was discharged for outpatient follow-up. At the three-month follow-up, the patient did not show evidence of recurrent gastrointestinal bleeding.

Sporadic duodenal macrogastrinoma: a rare case report

2013 ◽  
Vol 19 (4) ◽  
pp. 395-402
Author(s):  
Dainius Šimčikas ◽  
Eligijus Poškus ◽  
Juozas Stanaitis ◽  
Ernesta Rinkevičiūtė ◽  
Algirdas Edvardas Tamošiūnas ◽  
...  
Keyword(s):  
Epigastric Pain ◽  
Somatostatin Receptor ◽  
Peptic Ulcers ◽  
Ulcer Disease ◽  
Biopsy Specimens ◽  
Receptor Scintigraphy ◽  
Rare Case Report ◽  
History Of ◽  
Upper Gi Endoscopy

Gastrinomas are rare neuroendocrine tumors characterized by the secretion of gastrin, which causes hyperchlorhydria, thereby producing the Zollinger-Ellison syndrome. In most cases this syndrome manifests as severe peptic ulcer disease. We are presenting an extremely rare clinical case of sporadic duodenal macrogastrinoma. The patient underwent investigation due to six-year history of epigastric pain, heartburn and episodic diarrhea. Endoscopy, endosonoscopy and histologic examination of biopsy specimens indicated the presence of duodenal gastrinoma with no signs of peptic ulcers. Pyloroduodenal segment including 3.5 cm macrogastrinoma was resected. This case is unique as duodenal gastrinomas are usually very small, up to 1 cm. During the follow up period we observed slowly decreasing hypergastrinemia. Somatostatin receptor scintigraphy, CT and upper GI endoscopy were performed to reveal the reasons, though did not find any abnormalities. 8 months of follow-up did not reveal any progression of the disease. The etiology of slowly decreasing hypergastrinemia remains unclear, controversial and is under investigation.

Adverse Dermatologic Reaction to Transdermal Nitroglycerin

1984 ◽  
Vol 18 (1) ◽  
pp. 69-70 ◽  
Author(s):  
Peter W. Letendre ◽  
Charles Barr ◽  
Kim Wilkens
Keyword(s):  
Transdermal Delivery ◽  
Obstructive Lung Disease ◽  
Chronic Obstructive Lung Disease ◽  
Chronic Obstructive ◽  
Adult Onset ◽  
Ulcer Disease ◽  
History Of ◽  
Adult Onset Diabetes ◽  
Transdermal Delivery System

The incidence of adverse effects from transdermal nitroglycerin systems is reported to be very low. A cutaneous reaction from Transderm-Nitro is described. The patient in this case was a 63-year-old male with a history of chronic obstructive lung disease, adult onset diabetes mellitus, peptic ulcer disease, congestive heart failure, and angina pectoris. Seven weeks after having used a Transderm-Nitro-5 patch daily, the patient was found to have two macular erythematous areas on his chest that corresponded to the exact sites of the nitroglycerin patch. Follow-up with the same patient, using a placebo Transderm-Nitro, elicited a reaction similar in appearance. The exact causative agent is unknown, but it is believed to be from the transdermal delivery system and not the nitroglycerin.

Ovoid palatal patch: a clue to anti-TIF1γ dermatomyositis

2020 ◽  
Vol 13 (4) ◽  
pp. e234111
Author(s):  
Ellen Franciosi ◽  
Kaitlin Blankenship ◽  
Laura Houk ◽  
Mehdi Rashighi
Keyword(s):  
Lupus Erythematosus ◽  
Cutaneous Lupus Erythematosus ◽  
Oral Exam ◽  
Increased Risk ◽  
Show Evidence ◽  
Risk Of Malignancy ◽  
History Of ◽  
Scalp Biopsy ◽  
Prompt Diagnosis

An 80-year-old woman presented with a several-year history of progressive hair loss and scalp pruritus. No other rashes or muscle weakness were noted on examination. Scalp biopsy showed interface dermatitis, dense perivascular and periadnexal lymphocytic infiltrate, mucin and scarring alopecia. Laboratory analysis did not show evidence of myositis. The patient was started on hydroxychloroquine for possible cutaneous lupus erythematosus. On follow-up, she presented with a new violaceous rash on the superior eyelids and a well-defined oval patch on the mid-hard palate suspicious for dermatomyositis. Myositis-specific autoantibodies revealed presence of anti-transcriptional intermediary factor-1γ (anti-TIF1γ) in the serum. Anti-TIF1γ autoantibody-positive dermatomyositis is a newly recognised subtype of dermatomyositis that is highly associated with amyopathic disease and has an increased risk of malignancy, making prompt diagnosis crucial. This case highlights the utility of a thorough oral exam in patients suspected to have connective tissue disease as the distinctive ovoid palatal patch is nearly pathognomonic for anti-TIF1γ dermatomyositis.

scholarly journals An Insidious Gastrointestinal Bleeding from Secondary Aortoduodenal Fistula Leading to Septic Shock

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Ahmad Khan ◽  
Ejaz Ahmad ◽  
Saad Javaid ◽  
Mohamed Riad Sankari
Keyword(s):  
Septic Shock ◽  
Gastrointestinal Bleeding ◽  
Abdominal Aortic Aneurysm Repair ◽  
Aortoduodenal Fistula ◽  
Diagnostic Challenge ◽  
Push Enteroscopy ◽  
Abdominal Aortic ◽  
History Of ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

Insidious gastrointestinal bleeding from a secondary aortic fistula poses a significant diagnostic challenge. Failure to recognize it early on can lead to devastating outcomes. We describe a case of insidious gastrointestinal bleeding from a secondary aortic fistula in an elderly woman who presented with recurrent admissions for melanotic stools and eventually developed septic shock. Esophagogastroduodenoscopy did not reveal any obvious source of bleeding. The patient eventually had push endoscopy that revealed infected graft and a secondary aortoduodenal fistula. One should proceed with push enteroscopy in occult bleeding if the patient has a history of abdominal aortic aneurysm repair.

scholarly journals Randomized Controlled Trial Comparing Outcomes of Video Capsule Endoscopy with Push Enteroscopy in Obscure Gastrointestinal Bleeding

2015 ◽  
Vol 29 (2) ◽  
pp. 85-90 ◽  
Author(s):  
Dev S Segarajasingam ◽  
Stephen C Hanley ◽  
Alan N Barkun ◽  
Kevin A Waschke ◽  
Pascal Burtin ◽  
...  
Keyword(s):  
Small Bowel ◽  
Gastrointestinal Bleeding ◽  
Resource Utilization ◽  
Capsule Endoscopy ◽  
Diagnostic Yield ◽  
Video Capsule Endoscopy ◽  
Health Resource ◽  
Health Resource Utilization ◽  
Push Enteroscopy

BACKGROUND: Optimal management of obscure gastrointestinal bleeding (OGIB) remains unclear.OBJECTIVE: To evaluate diagnostic yields and downstream clinical outcomes comparing video capsule endoscopy (VCE) with push enteroscopy (PE).METHODS: Patients with OGIB and negative esophagogastroduodenoscopies and colonoscopies were randomly assigned to VCE or PE and followed for 12 months. End points included diagnostic yield, acute or chronic bleeding, health resource utilization and crossovers.RESULTS: Data from 79 patients were analyzed (VCE n=40; PE n=39; 82.3% overt OGIB). VCE had greater diagnostic yield (72.5% versus 48.7%; P<0.05), especially in the distal small bowel (58% versus 13%; P<0.01). More VCE-identified lesions were rated possible or certain causes of bleeding (79.3% versus 35.0%; P<0.05). During follow-up, there were no differences in the rates of ongoing bleeding (acute [40.0% versus 38.5%; P not significant], chronic [32.5% versus 45.6%; P not significant]), nor in health resource utilization. Fewer VCE-first patients crossed over due to ongoing bleeding (22.5% versus 48.7%; P<0.05).CONCLUSIONS: A VCE-first approach had a significant diagnostic advantage over PE-first in patients with OGIB, especially with regard to detecting small bowel lesions, affecting clinical certainty and subsequent further small bowel investigations, with no subsequent differences in bleeding or resource utilization outcomes in follow-up. These findings question the clinical relevance of many of the discovered endoscopic lesions or the ability to treat most of these effectively over time. Improved prognostication of both patient characteristics and endoscopic lesion appearance with regard to bleeding behaviour, coupled with the impact of therapeutic deep enteroscopy, is now required using adapted, high-quality study methodologies.

scholarly journals Endoscopic profile and clinical outcome of patients presenting with upper gastrointestinal bleeding

2020 ◽  
Vol 7 (9) ◽  
pp. 1355
Author(s):  
Ashish Kumar ◽  
Umang Kasturi ◽  
Amritpal Singh ◽  
Dharamjit Kaur
Keyword(s):  
Peptic Ulcer ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Clinical Outcome ◽  
Gastrointestinal Bleeding ◽  
Peptic Ulcer Disease ◽  
Upper Gastrointestinal Bleeding ◽  
Ulcer Disease ◽  
History Of ◽  
Upper Gastrointestinal

Background: Acute upper gastrointestinal bleeding is a common medical emergency with significant mortality. The aim of the present study is to study endoscopic profile and clinical outcome of patients presenting with upper gastrointestinal bleeding in this region. Methods: This prospective observational study carried out on 100 patients admitted with upper gastrointestinal bleeding. All patients included in study underwent upper gastrointestinal endoscopy after initial evaluation and stabilization.  Status of study group patients was noted at discharge. Patients were telephonically contacted at day 15 and were asked about rebleed, readmission for gastrointestinal bleed or death of the patient.Results: The mean age of patients was 48.98 ±14.50 years with male to female ratio of 2.57:1. The most common lesions causing UGI bleed were related to portal hypertension (esophageal and gastric varices) and were seen in 67% of patients. Non portal hypertensive lesions causing UGI bleed (peptic and other lesions) were seen in 46% patients. Twenty six percent patients had combination of lesions while endoscopy was normal in 3% patients. Rebleeding within 15 days was seen in 11 patients out of whom 3 died during same admission. Out of other 8 patients with rebleed, readmission was seen in 6 patients while 2 patients had minor bleed. We found no correlation of mortality and rebleed with factors like age, history of liver disease, diabetes, NSAIDs use, peptic ulcer disease and presence of cirrhosis. However the correlation between rebleed and death was found to be statistically significant.Conclusions: Portal hypertension is the most common cause of upper gastrointestinal bleeding in this region. There is strong correlation between rebleeding and death. However there is no correlation between age, history of liver disease, diabetes, NSAIDs use, peptic ulcer disease and presence of cirrhosis with rebleed or mortality.

Natural history of helicobacter pylori infection from infancy to adulthood: A 21-year follow-up cohort study

2001 ◽  
Vol 120 (5) ◽  
pp. A128-A128 ◽  
Author(s):  
H MALATY ◽  
D GRAHAM ◽  
A ELKASABANY ◽  
S REDDY ◽  
S SRINIVASAN ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Cohort Study ◽  
Natural History ◽  
Helicobacter Pylori Infection ◽  
History Of
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