A hard-to-reach bleeding lesion

2021 ◽  
Vol 70 (1) ◽  
Author(s):  
Karnes
Keyword(s):  
Bleeding Lesion

scholarly journals Hemostasis of an actively bleeding lesion at the ileocecal valve by low-pressure endoscopy using the gel immersion technique

VideoGIE ◽  
2021 ◽  
Vol 6 (4) ◽  
pp. 184-186
Author(s):  
Keitaro Yano ◽  
Tomonori Yano ◽  
Manabu Nagayama ◽  
Alan Kawarai Lefor ◽  
Hironori Yamamoto
Keyword(s):  
Ileocecal Valve ◽  
Low Pressure ◽  
Bleeding Lesion ◽  
Immersion Technique

Surface applicator high-dose-rate fractionated brachytherapy for conservative definitive management of extramammilary Paget’s disease of the penis, scrotum, and mons pubis.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 333-333
Author(s):  
Phillip M. Devlin
Keyword(s):  
Dose Rate ◽  
Treatment Plan ◽  
High Dose Rate ◽  
High Dose ◽  
Deep Tissue ◽  
Bleeding Lesion ◽  
Set Up ◽  
Electron Photon ◽  
Optimized Treatment ◽  
Geographic Miss

333 Background: This case is of a 70 yo Asian male who had suffered for many years from a painful eroding, oozing, bleeding lesion that started on the mons and over time had spread the full length of the penis and onto the anterior scrotum. A surface mold applicator fractionated computer-optimized high-dose rate (HDR) brachytherapy to 50Gy given in 2 Gy/day 5 days/week for 5 weeks. Methods: For the mons and the anterior scrotum a flat plate of aquaplast was molded with an aperture through which to pass the penis. For the penis a soft wrap, make of two layers of 5mm superflab was created with 15 truguide catheters embedded between. The wrapped penis was then supported with towels and tapes. Using radio-opaque dummy markers a CT was generated and an optimized treatment plan using Oncentra Brachytherapy. Because of the need for daily setups and the intrinsically elastic nature of the penis and scrotum, effort was made to keep the dwell times even so as to minimize any effect from day to day variation in set up. The prescription isodose line was manually adjusted so that where possible there was sparing of deep tissue of the urethra, bladder and testes. When QA was approved the patient began with daily treatments and successfully completed 25 without a treatment break. Results: Sustained local control was observed. Discussion: Surface mold applicator brachytherapy provides the most conformal of radiation therapy to complex superficial targets. For these targets it compares most favorably with all external beam approaches including electron, photon, IMRT and proton therapy. Conclusions: This modality optimally treated these lesions. The depth of the dose can be modulated. The treatment plan can be adapted to deal with swelling late in the course of therapy. The chance of a geographic miss of therapy is low because of the direct application to the affected area.

scholarly journals Analysis of Non-Small Bowel Lesions Detected by Capsule Endoscopy in Patients with Potential Small Bowel Bleeding

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Fatma Ebru Akin ◽  
Oyku Tayfur Yurekli ◽  
Aylin Demirezer Bolat ◽  
Mustafa Tahtacı ◽  
Huseyin Koseoglu ◽  
...  
Keyword(s):  
Small Bowel ◽  
Capsule Endoscopy ◽  
Video Capsule Endoscopy ◽  
Gi Bleeding ◽  
Gastric Lesions ◽  
Male Ratio ◽  
Bleeding Lesion ◽  
Anastomotic Bleeding ◽  
Bowel Segments ◽  
Small Bowel Bleeding

Gastrointestinal (GI) bleeding cases in whom source cannot be identified after conventional upper and lower GI endoscopy are defined as potential small bowel bleeding. We aimed to search for lesions in the reach of conventional endoscopy in patients to whom video capsule endoscopy (VCE) had been applied for potential small bowel bleeding. 114 patients who had VCE evaluation for potential small bowel bleeding between January 2009 and August 2015 were retrospectively evaluated. Mean age of the patients was 55 ± 17 years. Female/male ratio is 39/75. In 58 patients (50.9%) bleeding lesion could be determined. Among these 58 patients 8 patients’ lesions were in the reach of conventional endoscopes. Overall these 8 patients comprised 7% of patients in whom VCE was performed for potential small bowel bleeding. Among these 8 patients 5 had colonic lesions (4 angiodysplasia, 1 ulcerated polypoid cecal lesion), 2 had gastric lesions (1 GAVE, 1 anastomotic bleeding), and 1 patient had a bleeding lesion in the duodenal bulbus. Although capsule endoscopy is usually performed for potential small bowel bleeding gastroenterologists should always keep in mind that these patients may be suffering from bleeding from non-small bowel segments and should carefully review images captured from non-small bowel areas.

scholarly journals Airway management in patient with continuous bleeding lesion of the trachea: a case report

2015 ◽  
Vol 68 (4) ◽  
pp. 407
Author(s):  
Kyu Nam Kim ◽  
Hee Jong Lee ◽  
Hoon Il Choi ◽  
Dong Won Kim
Keyword(s):  
Case Report ◽  
Airway Management ◽  
Bleeding Lesion ◽  
Continuous Bleeding

scholarly journals Acute upper gastrointestinal nonvariceal bleeding: How to determine low risk patients for rebleeding and mortality after endoscopic sclerotherapy?

2007 ◽  
Vol 54 (1) ◽  
pp. 107-114
Author(s):  
S. Djuranovic ◽  
M. Spuran ◽  
N.S. Mijalkovic ◽  
D. Stanisavljevic ◽  
M. Ugljesic ◽  
...  
Keyword(s):  
Low Risk ◽  
Endoscopic Sclerotherapy ◽  
First Line ◽  
Risk Levels ◽  
Risk Of Death ◽  
Bleeding Lesion ◽  
Risk Patients ◽  
Initial Hospitalization ◽  
Upper Gastrointestinal

Introduction: Successful endoscopic sclero-therapy is effective in securing hemostasis for bleeding lesions and remains the first line and only needed therapy for most of the patients (pts), but bleeding reoccurs in 10% to 30% pts, and 4% to 14% of the pts die after acute nonvariceal upper gastrointestinal bleeding (UGIB). The need for hospitalization and its duration for all the bleeding pts is still a controversial question. AIM: To create the simple scoring system able to determine low risk pts for rebleeding and mortality by establishing the relative importance of risk factors for rebleeding and mortality after successful endoscopic sclerotherapy of acute nonvariceal UGIB. Patients and methods: Prospective study included 315 pts who where admitted to hospital because of acute nonvariceal UGIB. All of them underwent gastroscopy with successful sclerotherapy within 12 hours after the admission. We investigated the episode of rebleeding and death during the initial hospitalization, and analyzed the following parameters: age, gender, drug intake, shock, bleeding stigmata, location of bleeding lesion and comorbidity. Results: Rebleeding occurred in 53 pts (16.8%) and was determined by shock, bleeding stigmata and comorbidity. Eleven pts (3.5%) died and shock, rebleeding and comorbidity were all independent, statistically significant predictors of pts? mortality. The numerical scores for determination of pts with different risk levels for rebleeding and mortality have been developed using the significant predictors of rebleeding and death. The score values for rebleeding ranged from 3 to 9 and pts with values <4 had low risk of rebleeding. We identified 59 pts (18,7% of all) with score for rebleeding <4. Score values for mortality risk ranged from 3 to 8 and the values <5 revealed negligible risk of death. In our group we found 290 pts (92,1% of all) with low mortality score values. Conclusion: Following the successful initial endoscopic sclerotherapy, these scores can help to identify pts with low risk of rebleeding and negligible risk of death, so they can be treated as outpatients.

scholarly journals Fast Medical Image Auto-segmentation for Bleeding Gastric Tissue Detection based on Deep DuS-KFCM Clustering

2021 ◽  
Author(s):  
Xian Xian Liu ◽  
Gloria Li ◽  
Wei Luo ◽  
Juntao Gao ◽  
Simon Fong
Keyword(s):  
Image Segmentation ◽  
Spatial Information ◽  
Diagnostic System ◽  
Lesion Detection ◽  
Experimental Results ◽  
Gastric Bleeding ◽  
Bleeding Lesion ◽  
Adjacent Structures ◽  
Benchmark Datasets ◽  
Occurrence Matrix

Detection and classification of gastric bleeding tissues are one of the challenging tasks in endoscopy image analysis. Lesion detection plays an important role in gastric cancer (GC) diagnosis and follow-up. Manual segmentation of endoscopy images is a very time-consuming task and subject to intra- and inter-rater variability. Accurate GB segmentation in abdominal sequences is an essential and crucial task for surgical planning and navigation in gastric lesion ablation. However, GB segmentation in endoscope is a substantially challenging work because the intensity values of gastric blood are similar to those of adjacent structures. Objective: In this paper the idea is to combine two parts: Neural Network and Fuzzy Logic--Hybrid Neuro-Fuzzy system. The objective of this manuscript is to provide an efficient way to segment the gastric bleeding lesion area. This work focuses on design and development of an automated diagnostic system using gastric bleeding cancer endoscopy images. Methods: In this paper, a coarse-to-fine method was applied to segment gastric bleeding lesion from endoscopy images, which consists of two stages including rough segmentation and refined segmentation. The rough segmentation is based on a kernel fuzzy C-means algorithm with spatial information (SKFCM) algorithm combined with spatial gray level co-occurrence matrix (GLCM) and the refined segmentation is implemented with deeplabv3+ (backbone with resnet50) algorithm to improve the overall accuracy. Results: Experimental results for gastric bleeding segmentation show that the method provides an accuracy of 87.9476% with specificity of 96.3343% and performs better than other related methods. Conclusions: The performance of the method was evaluated using two benchmark datasets: The GB Segmentation and the healthy datasets. Then use the gastric red spots (GRS) dataset to do the final test to verify weak bleeding symptoms. Our method achieves high accuracy in gastric bleeding lesion segmentation. The work describes an innovative way of using GLCM based textural features to extract underlying information in gastric bleeding cancer imagery. Modified deep DuS-KFCM endoscopy image segmentation method based on GLCM feature, The experimental results shown to be effective in image segmentation and has good performance of resisting noise, segmentation effect more ideal.

Management of complicated tumor response (CTR) to tyrosine kinase inhibitors (TKI) in gastrointestinal stromal tumor (GIST) patients (pts) with locally advanced/metastatic disease

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e21512-e21512
Author(s):  
P. Coco ◽  
E. Fumagalli ◽  
C. Morosi ◽  
A. Messina ◽  
R. Bertulli ◽  
...  
Keyword(s):  
Supportive Care ◽  
Kinase Inhibitors ◽  
Bowel Perforation ◽  
Locally Advanced ◽  
Second Line ◽  
Second Line Therapy ◽  
Bleeding Lesion ◽  
Line Therapy ◽  
Treatment Start ◽  
Life Threatening

e21512 Background: Bleeding, perforation, and infection may complicate TKI therapy in GIST. Their incidence and best management are not completely known yet. Methods: Between May 2001 and December 2008, 278 pts were treated with imatinib or sunitinib, respectively, as first or second line therapy. Pts experienced bleeding, perforation and colliquation with superimposed infection were recorded and reviewed. Results: CTR occurred in 24 pts (9%) after a median time of 241 days from treatment start (8–2090 days). In 5 pts the complication took place after increasing the dose. Before complication, according to RECIST criteria, a partial response (PR) and a stable response (SD) were respectively documented in 16 and 8 pts . Radiologically assessed bleeding in closed lesions was seen in 13 pts (5%). All but one were treated conservatively with supportive care and blood transfusions. The other pt required surgical resection of his peritoneal bleeding lesion. Nine pts (3%) developed colliquation with bacterical superinfection: 5 were treated with antibiotics, 4 had their lesions drained. Two pts underwent emergency surgery due to perforation with a superimposed infection. In 21 out of 24 pts the event resolved without sequelae. Three pts died: 2 developed massive haemorrhage, 1 had a bowel perforation. After stopping treatment for a median interval of 10 days (2–63), all but one restarted treatment at the previous dose. No further complications were seen after the first event. Eight pts are still on treatment with a SD, 2 pts switched to a second line therapy due to progressive disease (PD), 11 died due to PD. Conclusions: Bleeding, perforation and colliquation with superimposed infection may occur at different time intervals from treatment start. Even if supportive care and medical therapy are successful in most of cases, pts should be carefully monitored because these complications can be life-threatening. Surgery should be considered in case of failure of conservative treatment. Reintroduction of the therapy at the same dose is feasible and well tolerated. [Table: see text]

Bleeding Lesion of the Small Bowel: an Extensive Update Leaving No Stone Unturned

2018 ◽  
Vol 20 (2) ◽  
Author(s):  
Cedric Van de Bruaene ◽  
Pieter Hindryckx ◽  
Laurens Van de Bruaene ◽  
Danny De Looze
Keyword(s):  
Small Bowel ◽  
Bleeding Lesion

scholarly journals Recurrent massive bleeding from a small intestinal arteriovenous malformation after surgery for biliary atresia in an infant: a case report and literature review

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Wataru Kudo ◽  
Katsunori Kouchi ◽  
Ayako Takenouchi ◽  
Aki Matsuoka ◽  
Kiyoaki Yabe ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Frozen Section ◽  
Massive Bleeding ◽  
Roux Limb ◽  
Intraoperative Endoscopy ◽  
Bleeding Lesion ◽  
Contrast Enhanced ◽  
Frozen Section Analysis ◽  
Small Intestinal ◽  
Section Analysis

Abstract Background Small intestinal arteriovenous malformation (AVM) can cause bleeding. Most small intestinal AVMs occur during adulthood, rarely in infancy. We report a case of an infant with hemorrhage due to small intestinal AVM early and recurrently after Kasai portoenterostomy (PE) for biliary atresia (BA). Case presentation A 51-day-old male infant was admitted to our institution for obstructive jaundice. Laparotomic cholangiography revealed BA (IIIb1μ), and Kasai PE was performed at 60 days of age. On postoperative day 17, he developed massive melena and severe anemia. Contrast-enhanced computed tomography (CT) revealed that the jejunum around the PE site was strongly enhanced with enhancing nodules in the arterial phase, and a wide area of the Roux limb wall was slightly enhanced in the venous phase. As melena continued, emergency laparotomy was performed. There were no abnormal macroscopic findings at the PE site except for a clot in the Roux limb 5 cm away from the PE site, and the Roux limb was resected 5 cm. On further investigation, a red spot was detected on the jejunal serosa 30 cm away from the Roux-en-Y anastomosis site. PE and wedge resection for the red spot were performed. Histopathologically, both specimens indicated AVM. He was jaundice-free 65 days after the first surgery. However, at 7 months of age, he developed massive melena again. Contrast-enhanced CT and upper gastrointestinal endoscopy revealed no bleeding lesions. Hemorrhagic scintigraphy showed a slight accumulation at the hepatic hilum prompting an emergency surgery. Intraoperative endoscopy detected a bleeding lesion at the PE site, and the Roux limb was resected (approximately 6 cm). Intraoperative frozen section analysis of the stump of the resected jejunum revealed no abnormal vessels. PE was performed, and permanent section analysis revealed an AVM in the resected jejunum. The postoperative course was uneventful without re-bleeding. Conclusions We experienced a case of recurrent massive bleeding from small intestinal AVM in an infant after surgery for BA. Intraoperative endoscopy and frozen section analysis helped identify the bleeding lesion and perform a complete resection of the small intestinal AVM, even after surgery, in the infant.

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