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Etiological Analysis of 419 Cases of Digestive Tract Hemorrhage  [PDF]
Shibao Song, Dong Wang, Chuanxin Zou
Yangtze Medicine (YM) , 2018, DOI: 10.4236/ym.2018.23019
Abstract: Aim: To study common cause of digestive tract hemorrhage and the relationship between etiology and age. Methods: Retrospective analysis about the data of 419 cases of digestive tract hemorrhage in digestive internal medicine from January 2016 to January 2018 in Jingzhou Central Hospital. Results: 419 cases of digestive tract hemorrhage include 305 cases of hemorrhage in upper digestive tract and 114 cases of hemorrhage in lower digestive tract. The first 5 causes of upper digestive tract hemorrhage in middle-aged and young group were: duodenal bulb ulcer, gastric ulcer, esophageal and stomach bottom varices bleeding in cirrhosis of schistosomiasis, compound ulcer, esophageal and stomach bottom varices bleeding in hepatitis B cirrhosis. The first 5 causes of upper digestive tract hemorrhage in elderly group were: gastric ulcer, duodenal bulb ulcer, esophageal and stomach bottom varices bleeding in hepatitis B cirrhosis, esophageal and stomach bottom varices bleeding in cirrhosis of schistosomiasis, gastric cancer. The first 5 causes of lower digestive tract hemorrhage in middle-aged and young group were: ulcerative colitis, colorectal polyps, hemorrhoids, crohn’s disease, ischemic bowel disease. The first 5 causes of lower digestive tract hemorrhage in elderly group were: colorectal polyps, colon cancer, ulcerative colitis, ischemic bowel disease, hemorrhoids. Conclusion: In the cases of upper digestive tract hemorrhage, peptic ulcer should be paid attention to in middle-aged and young people, and elderly should be noted in gastric cancer. Ulcerative colitis should be paid attention to in middle-aged and young people with lower digestive tract hemorrhage, and elderly should be noted in colorectal polyps and colon cancer.
Hepatic Metastatic GIST: Diagnostic and Therapeutic Difficulties in Souro Sanou Teaching Hospital in Bobo Dioulasso, Burkina Faso  [PDF]
Ollo Roland Somé, Ida A?da Tankoano, Mali Koura, Valentin Konségré, Damien Konkobo, Jér?me Koulidiaty
Open Journal of Gastroenterology (OJGas) , 2018, DOI: 10.4236/ojgas.2018.812047
Abstract: Introduction: Gastrointestinal stromal tumor (GIST) is the most common non-epithelial, mesenchymal tumor of the digestive tract. Targeted therapy has improved the prognosis but the diagnosis must be accurate before using the existing drugs. Aim: To report the diagnostic difficulty in our context through the clinical polymorphism and define the position of targeted therapy in the management of GIST metastatic stomach. Casuistry: We report 3 cases of gastric GIST with liver metastasis in different circumstances of discovery. Patients were 21, 45, and 73 years old. Discovery circumstances were respectively digestive hemorrhage, severe clinical anemia, abdominal tumor and gastric tumor. There was hepatic metastasis in the three cases. The three patients received Imatinib treatment, adjuvant treatment for the first two cases, and neo-adjuvant treatment for the third case, with a very good clinical response and CT response on metastases. Conclusion: Because of their rarity, GISTs are often difficult to diagnose, and necessarily require immunohistochemistry which is not available in our work context. The effectiveness of targeted therapy even on metastasis needs a rigorous diagnostic approach to improve patient survival.
THE ACTUAL CONDUCT IN SURGERY OF BLEEDING GASTRIC AND DUODENAL ULCER  [PDF]
C. V. P?unescu
Jurnalul de Chirurgie , 2007,
Abstract: In a study of 642 patients with superior digestive hemorrhage, the most frequent cause was the ulcer (n=344; 53,83%). 117 patients (34,01%) had gastric ulcer, 224 patients (65,12%) had duodenal ulcer and in three cases (0,87%) we met the association between gastric and duodenal ulcer. The surgical intervention on 97 patients (28,2%) with ulcer was more frequent at the male (n=75; 77,30%), for duodenal ulcer (n=61; 62,89%), at the patients with ulcer in antecedents (n=49; 50,52%) and with many hemorrhagic episodes (n=62; 63,92%). The hemorrhage had a higher intensity at 73 patients (75,26%). In postoperative evolution have been registered 11 (11,34%) deads. The risk factors that have been involved in the cause of dead were: the age over 50 years (p<0,05), the severity of hemorrhage (p<0,05) confirmed by endoscopy, the hemorrhagic episodes in antecedents (p<0,01) and the moment of intervention (p<0,005). The superior digestive hemorrhage is the pathology domain were the problems of technical and surgical performance, of discipline and professional ethics and economical reasons join.
"Downhill" varices: A rare cause of esophageal hemorrhage
Areia,M.; Rom?ozinho,J. M.; Ferreira,M.; Amaro,P.; Freitas,D.;
Revista Espa?ola de Enfermedades Digestivas , 2006, DOI: 10.4321/S1130-01082006000500006
Abstract: "downhill" varices or upper esophageal varices are a rare cause of proximal digestive tract hemorrhage with only 16 cases described in the literature. in our series, hemorrhage due to "downhill" varices represents 0.1% of all acute esophageal variceal bleeding. their etiology differs from that of the usual "uphill' varices secondary to portal hypertension, and the clinical management should be directed to vascular obstruction if present. we report a case of an 89-year-old male with hemorrhagic "downhill" varices not associated, as usually, with superior vena cava obstruction or compression, but with severe pulmonary hypertension and drug-related hemorrhagic risk factors, whose removal proved sufficient to prevent rebleeding.
Conducta ante la hemorragia digestiva alta por úlcera gastroduodenal en el anciano: consideraciones actuales Behavior in face of a high digestive hemorrhage from gastroduodenal ulcer in elderly: current considerations
Zenén Rodríguez Fernández,Daniel Acosta González,Juana Fong Estrada,Odalis Pagés Gómez
Revista Cubana de Cirugía , 2010,
Abstract: La hemorragia digestiva alta reviste singular importancia en el anciano porque es un evento que puede rápidamente poner en peligro la vida. En el adulto mayor, la alta incidencia de enfermedades osteomioarticulares y cardiovasculares asociadas, que además condicionan la ingestión de medicamentos como los antiinflamatorios no esteroideos y aspirina, y los hábitos tóxicos frecuentes en la tercera edad, como el consumo de alcohol, café y tabaco, constituyen factores que ejercen efecto ulcerógeno sobre la mucosa del tracto digestivo superior. La causa más común de hemorragia es la úlcera gastroduodenal. En la actualidad se considera de importancia capital la realización precoz de la endoscopia para el diagnóstico y tratamiento médico consecuente, y se limita la cirugía sólo para los ancianos en los cuales, por su estado general y la cuantía o persistencia del sangrado, no sea posible la realización de aquella, cuando fracase el tratamiento endoscópico, el farmacológico o ambos. High digestive hemorrhage has a peculiar significance in elderly because of it is an event putting quickly at risk the life. In elderly, the high incidence of associated osteomyoarticular and cardiovascular diseases that also fitting the drugs ingestion, e.g. the non-steroid anti-inflammatory and the aspirin and the toxic habits frequent in third age, since the alcohol, coffee and tobacco consumption are factors having an ulcerative effect on the high digestive tract mucosa. The commonest cause of hemorrhage is the gastric ulcer. At present time we considered as of supreme significance the early carrying out of the endoscopy for the consequent medical treatment and diagnosis limiting surgery only for elderlies, who due to its general status and the bleeding extent or persistence be impossible its carrying out when there is a failure of endoscopic and/or pharmacologic treatment.
Gastrointestinal stromal tumors (GIST) of the stomach as a cause of upper gastrointestinal bleeding  [PDF]
Ebrahimi K.,Veli?kovi? D.,?pica B.,Sabljak P.
Acta Chirurgica Iugoslavica , 2007, DOI: 10.2298/aci0701115e
Abstract: Gastrointestinal stromal tumors (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. GIST is currently defined as a gastrointestinal tract mesenchymal tumor containing spindle cells (less commonly epitheloid cells or rarely both) and showing CD 117 (c-kit protein) positivity in more than 95% of cases. Although they may arise throughout the gut, the commonest site are stomach (60-70%), small intestine (20-30%), colorectum (5%) and esophagus (up to 5%). Rarely, GISTs develop in the retroperitoneum, omentum or mesentery. GIST originates from the intestinal cell of Cajal (ICC). ICCs are located in and around the myenteric plexus and are thought to function as intestinal pacemaker cells. Historically, GIST were often misclassified as leiomyomas or leiomyosarcomas. Subsequently, it has been determined that GISTs have distinct ultrastructural features and immunophenotypical markers compared with smooth muscle and smooth muscle tumors. GIST predominantly occur in middle aged and older patients, with no significant difference in the sex incidence. Data from the recent population study suggest an incidence of about 10-22 cases per million persons per year. Clinical presentation of GIST varies widely, and depends on tumor size and location. GISTs that caused symptoms tended to be larger with an average size of 6cm versus 2cm for asymptomatic GISTs. Symptoms are most commonly related to mass effect or bleeding. GISTs can grow very large before producing symptoms. Commonest symptom of gastric GIST is manifest or occult bleeding. Abundant, life-threatening bleeding that require urgent surgery is rare. For patient with primary, localized, nonmetastatic GIST, complete surgical resection represents the only chance for cure. Lymhadenectomy is not necessary, because lymph node metastasis is very rare. The 5 year survival rate in patients with resected primary GISTs ranges from 48-65%. Conventional che- Br. 1 GIST eluca kao uzrok krvarenja iz gornjih partija 117 digestivnog trakta motherapy and radiation therapy is ineffective in the treatment of GIST. Imatinib mesilate (a tyrosine kinase inhibitor) was confirmed to be effective against metastatic or unresectable GISTs.
Acute Gastric Dilatation Resulting in Gastric Emphysema Following Postpartum Hemorrhage
Suhail Aslam Khan,Edmond Boko,Haseeb Anwar Khookhar,Sheila Woods,A. H. Nasr
Case Reports in Surgery , 2012, DOI: 10.1155/2012/230629
Abstract: Acute gastric dilatation is a rare entity, with varying aetiologies the majority of which are benign. Delay in diagnosis and treatment could result in sequelae such as gastric emphysema (pneumatosis), emphysematous gastritis, gangrene, and perforation. Gastric emphysema as a result of a benign nongangrenous condition such as gastroparesis, adynamic ileus can be successfully managed conservatively. Here, we present an interesting case of acute gastric dilatation resulting in gastric emphysema following massive postpartum hemorrhage.
LAPAROSCOPIC TREATMENT OF GASTRIC GIST: A NEW GOLD STANDARD?  [PDF]
G. Silecchia
Jurnalul de Chirurgie , 2010,
Abstract: BACKGROUND: The laparoscopic approach of gastric stromal tumors (GIST) is today the surgical option for majority of gastric small tumors. METHODS: Between 1994 to 2008, 15 consecutive patients with benign and low-grade gastric stromal tumors underwent laparoscopic resection using intraoperative endoscopy. 7 lesions located on the anterior wall, a direct approach was utilized. Lesions located on the posterior wall (6 cases) were resected via a transgastric approach or through a small opening on the omentum or on the gastrocolic ligament. In 2 cases we performed wedge resection for 2 tumors located for great curvatures. RESULTS: All patients were successfully treated laparoscopically; there were no conversions to open surgery. Operative time ranged from 75 to 120 min. There was one bleeding from the suture line of the gastric wall postoperatively that was treated conservatively. The average postoperative hospital stay was 4 days (range, 2-6). CONCLUSIONS: Laparoscopic approach is safe and effective in resectable gastric GISTs and should be the first option in small,medium-sized and uncomplicated lesions. Combined laparoscopic-endoscopic procedures are easy to perform and offer a curative approach for almost all gastric submucosal lesions.
Emergency Atypical Resection for Perforated Gastric Gist  [PDF]
Manuel Muinelo Lorenzo, Lucia Dorado Castro, Maria Isabel Perez Moreiras, Jose Conde Vales, Jose Antonio Costa Buján
Open Journal of Gastroenterology (OJGas) , 2014, DOI: 10.4236/ojgas.2014.43018
Abstract: We report the case of a 77-year-old male who came to the emergency department with epigastric pain accompanied by fever and chills. After the diagnosis of intra-abdominal abscess and gastric tumor, emergency surgery was performed with resection of the tumor and abscess drainage. The patient had a good postoperative course.
Gastric Polyps in a Digestive Endoscopy Center in Dakar  [PDF]
Marie Louise Bassene, Salamata Diallo, Mame A?sse Thioubou, A?chetou Diallo, Mamadou Ngone Gueye, Mamadou Lamine Diouf
Open Journal of Gastroenterology (OJGas) , 2017, DOI: 10.4236/ojgas.2017.710029
Abstract: Introduction: The gastric polyp is a tumor protruding into the gastric lumen. It is asymptomatic most often with a risk of malignant degeneration closely related to its histological nature. These data are very rare in Africa. Objectives: Reporting the frequency and endoscopic and histological characteristics of gastric polyps in the digestive endoscopy center of Aristide Le Dantec hospital in Dakar. Patients and methods: This was a retrospective study carried out in the digestive endoscopy center of Aristide Le Dantec Hospital in Dakar from January 2012 to December 2016. We have included all patients with one or more gastric polyps coupled with histological findings available. Results: There were 60 patients with gastric polyps, hence a prevalence of 0.8%. We included 37 patients. Their mean age was 46 years [21 years - 75 years]. The sex-ratio was 0.48. Epigastralgia was the most frequent endoscopic indication (51.3%). The polyp was unique in 26 patients (70.3%) with an average size of 6.87 mm [2 - 15 mm]. Polyps were sessile in 31 cases (83.8%) and pediculate in 6 cases (16.2%). They were most often in the antrum (51.4%). Antral erosions (13.5%) and fundic atrophy (13.5%) were the main associated endoscopic lesions. These were hyperplastic polyps in 27% of cases and adenoma in 16.2% of cases. Chronic atrophic gastritis (10.8%) and intestinal metaplasia (10.8%) were the main histological lesions associated with polyps. Helicobacter pylori (Hp) were present in 17 patients (45.9%). Conclusion: The prevalence of gastric polyps is 0.8% in the endoscopy center of Aristide Le Dantec hospital. They are usually hyperplastic or adenomatous.
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