scholarly journals Esophageal Dieulafoy Lesion: A Rare and Potentially Fatal Entity

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Eoghan P Burke
Keyword(s):  
Emergency Department ◽  
Large Volume ◽  
Gastrointestinal Endoscopy ◽  
Upper Gastrointestinal Endoscopy ◽  
Initial Resuscitation ◽  
Submucosal Vessel ◽  
Dieulafoy Lesion ◽  
Upper Gastrointestinal

A 35-year-old gentleman presented acutely to the emergency department with large volume haematemesis and melena. Following adequate initial resuscitation, the patient underwent emergency upper gastrointestinal endoscopy which revealed a dilated tortuous submucosal vessel which was actively bleeding at the midpoint of the esophagus. This was consistent with a Dieulafoy lesion. However, its position in the midpoint of the esophagus is rare. Our patient recovered well following intervention.

scholarly journals The Hole in the Stomach

2008 ◽  
Vol 2008 ◽  
pp. 1-2
Author(s):  
Hans Bödeker ◽  
Steffen Leinung ◽  
Henning Wittenburg ◽  
Julia Fischer ◽  
Ingolf Schiefke ◽  
...  
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Diaphragmatic Hernia ◽  
Gastrointestinal Endoscopy ◽  
Gastric Fundus ◽  
Upper Gastrointestinal Endoscopy ◽  
Chest Discomfort ◽  
Partial Necrosis ◽  
Upper Abdominal ◽  
Upper Gastrointestinal

A 57 year old woman was presented to the emergency department with upper abdominal pain and left sided chest discomfort. No cardiac or pulmonary cause could be determined and the patient underwent upper gastrointestinal endoscopy. Inversion of the scope to the fundus and subsequent fluoroscopy revealed a diaphragmatic hernia with a large herniation of the gastric fundus. Immediate laparotomy showed a 3 cm orifice of the diaphragm. The orifice was widened and a partial necrosis of the incarcerated fundus was resected. The patient recovered fully and was discharged 12 days after laparotomy.

scholarly journals Endoscopic Insufflation–Induced Gastric Barotrauma during Percutaneous Endoscopic Gastrostomy: A Report of Three Patients and Review of Literature

2021 ◽  
Vol 12 (02) ◽  
pp. 103-106
Author(s):  
Avnish Kumar Seth ◽  
Rinkesh Kumar Bansal
Keyword(s):  
Percutaneous Endoscopic Gastrostomy ◽  
Gastrointestinal Endoscopy ◽  
Gastroesophageal Junction ◽  
Upper Gastrointestinal Endoscopy ◽  
Proximal Stomach ◽  
Endoscopic Gastrostomy ◽  
Lesser Curvature ◽  
Upper Gastrointestinal ◽  
New Onset

Abstract Background We report three patients with endoscopic insufflation–induced gastric barotrauma (EIGB) during upper gastrointestinal endoscopy (UGIE) for percutaneous endoscopic gastrostomy (PEG). A definition and classification of EIGB is proposed. Materials and Methods Records of patients undergoing UGIE over 7 years (April 2013–March 2020) were reviewed. Patients who developed new onset of bleeding or petechial spots in proximal stomach, in an area previously documented to be normal during the same endoscopic procedure, were studied. Results New onset of bleeding or petechial spots in proximal stomach occurred in 3/286 (0.1%) patients undergoing PEG and in none of the 19,323 other UGIE procedures during the study period. All patients were men with median age 76 years (range 68–80 years), with no coagulopathy. Aspirin and apixaban were discontinued 1 week and 3 days prior to the procedure. Fresh blood was noted in the stomach at a median of 275 seconds (range 130–340) seconds after commencement of endoscopy. At retroflexion, multiple linear mucosal breaks of up to 3 cm, with oozing of blood, were noted in the proximal stomach along the lesser curvature, close to the gastroesophageal junction in two patients. In the third patient, multiple petechial spots were noticed in the fundus. The plan for PEG was abandoned and the stomach deflated by endoscopic suction. There was no subsequent hematemesis, melena, or drop in hemoglobin. One week later, repeat UGIE in the first two patients revealed multiple healing linear ulcers of 1 to 3 cm in the lesser curvature and PEG was performed. Conclusion Overinsufflation over a short duration during UGIE may lead to EIGB. Early detection is key and in the absence gastric perforation, patients can be managed conservatively.

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