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1/202. Massive gastrointestinal hemorrhage after transoesophageal echocardiography probe insertion.

    PURPOSE: To describe a case of a massive gastric bleeding following emergency coronary artery bypass surgery associated with transoesophageal echocardiographic (TEE) examination. CLINICAL FEATURES: A 50-yr-old man was referred for an acute myocardial infarction and pulmonary edema (Killip class 3). Twelve hours after his myocardial infarction, he was still having chest pain despite an i.v. heparin infusion. coronary angiography revealed severe three-vessel disease with multifocal stenosis of the left anterior descending, circumflex and total occlusion of the right coronary artery. The patient was transferred to the operating room for emergency coronary artery bypass graft surgery. After total systemic heparinization (3 mg.kg-1) was obtained for cardiopulmonary bypass, a multiplane TEE probe was inserted without difficulty to monitor myocardial contractility during weaning from CPB. During sternal closure, the TEE probe was removed and an orogastric tube was inserted with immediate drainage of 1,200 ml red blood. Endoscopic examination demonstrated a mucosal tear near the gastro-oesophageal junction and multiple erosions were seen in the oesophagus. These lesions were successfully treated with submucosal epinephrine injections and the patient was discharged from the hospital eight days after surgery. CONCLUSION: This is a report of severe gastrointestinal hemorrhage following TEE examination in a fully heparinized patient. This incident suggest that, if the use of TEE is expected, the probe should preferably be inserted before the administration of heparin and the beginning of CPB.
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ranking = 1
keywords = chest
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2/202. Duodenal ulceration into the cystic artery with massive hemorrhage.

    This is a case presentation of a unique cause of intestinal bleeding. A duodenal ulcer eroded into the superficial branch of the cystic artery, causing massive intestinal hemorrhage. The patient, a 76-year-old woman, presented with left upper abdominal and left back pain secondary to cystic lesions in the pancreas body and tail. Stress after operation and complication of leakage of pancreatic juice after distal pancreatectomy with splenectomy and diclofenac sodium administration may have caused a deep peptic ulcer to erode the cystic artery. We performed a transfixing ligation of the bleeding vessel, serosal suture of ulcer of the gallbladder, and simple closure of the duodenal ulcer with covering greater omentum. There were no serious complications after the operation, and the patient made an uneventful recovery.
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ranking = 0.21365677242379
keywords = back
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3/202. Hemosuccus pancreaticus in a heterotopic jejunal pancreas.

    Heterotopic pancreas is a congenital anomaly defined as pancreatic tissue occurring outside its normal anatomical location, lacking both anatomic and vascular connections. Ninety percent of heterotopic pancreas is found in the upper part of the gastrointestinal tract. Symptoms, when present, are normally non-specific and include abdominal pain, nausea, vomiting and bleeding. However, aberrant pancreas is not often recognized as patients are usually symptom-free. We report on a 29 year-old man with acute and severe gastrointestinal hemorrhage through the duct of an aberrant pancreas located in the upper jejunum, without clinical or histological evidence of pancreatic inflammation. We believe that our case is the first description of a pancreatic ductal hemorrhage in an aberrant pancreas.
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ranking = 289.30583626624
keywords = abdominal pain
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4/202. Splenic angiosarcoma--an unusual cause of bleeding gastrointestinal tract.

    Splenic angiosarcoma is a rare malignant vascular tumour with about 100 reported cases to date. The presentation of splenic angiosarcoma is highly variable, frequently causing diagnostic difficulty. It usually presents with splenomegaly, abdominal pain and occasionally with a microangiopathic type of anaemia. Here we report an additional case of primary angiosarcoma of the spleen presenting as a problem of bleeding from the gastrointestinal tract.
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ranking = 289.30583626624
keywords = abdominal pain
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5/202. Ruptured primary splenic angiosarcoma into the colon. Presentation as anal bleeding.

    A 71-year-old woman presented with a six month history of constipation and abdominal discomfort, with anal bleeding during the last days. ultrasonography and CT-scan of the abdomen showed a large heterogeneous mass that was located in the splenic region, but the nature and origin of the tumour could not be clearly established preoperatively. The clinical diagnosis was of abdominal tumour with colonic and splenic involvement, and a left hemicolectomy and splenectomy were performed. Pathologic examination revealed a primary angiosarcoma of the spleen with penetration and fistulization of the tumour into the large bowel. The patient received adjuvant radiation therapy, but she died of extensive metastastic disease from her primary angiosarcoma of the spleen nine months after surgery. In summary, splenic angiosarcoma is very difficult to diagnose preoperatively. This highly aggressive neoplasm has an overall poor prognosis, specially if it is associated with rupture and haemoperitoneum. As this case highlights, unusual forms of rupture may lead to atypical clinical presentations, increasing even more the difficulty in the diagnosis.
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ranking = 23.590588769991
keywords = discomfort
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6/202. Spontaneous intramural hematoma of the esophagus.

    Spontaneous intramural hematoma of the esophagus (SIHE) is a rare condition, usually presenting with severe acute chest pain. vomiting, dysphagia, odynophagia, and hematemesis may appear later. We herein report a case of this disease in a patient treated with low doses of aspirin, and review the literature for possible etiologies for this condition. In addition, we compare the utility of the various diagnostic modalities in this uncommon condition.
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ranking = 1
keywords = chest
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7/202. Haemosuccus pancreaticus due to mucinous cystadenocarcinoma: the significance of recurrent abdominal pain, hyperamylasaemia and a pancreatic cyst in association with recurrent gastrointestinal bleeding.

    Haemosuccus pancreaticus is a rare cause of gastrointestinal haemorrhage, and when it presents in otherwise healthy people, can prove difficult to diagnose. The cardinal features are episodic epigastric pain associated with a raised serum amylase and the passage of melaena. Failure to make the connection between recurrent gastrointestinal bleeding and apparently unrelated symptoms attributable to pancreatitis may lead to a significant delay in diagnosis.
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ranking = 1157.223345065
keywords = abdominal pain
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8/202. Anesthetic management of high-risk cardiac patients undergoing noncardiac surgery under the support of intraaortic balloon pump.

    patients with severely impaired left ventricular function, an uncorrectable coronary artery disease, and a recent myocardial infarction are at high risk of cardiac complications after major noncardiac surgery. We present two patients with extensive three-vessel coronary artery disease who underwent intraperitoneal surgery under the support of intraaortic balloon pump (IABP). In one patient, the IABP was inserted urgently because of the development of chest pain with significant ST depression on arrival in the operating room, and the other patient was managed with prophylactic IABP. There were no intraoperative or postoperative cardiac events in either patient. Thus, IABP should be considered in the perioperative management of patients with severe cardiac diseases.
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ranking = 1
keywords = chest
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9/202. Rectus sheath hematoma.

    We describe 3 patients with rectus sheath hematoma presenting to the emergency department. Prompt consideration of this uncommon cause of abdominal pain may prevent more expensive and invasive diagnostic tests and, in some cases, unnecessary hospitalization and laparotomy.
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ranking = 289.30583626624
keywords = abdominal pain
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10/202. A case of jejunal intussusception with gastrointestinal bleeding caused by metastatic testicular germ cell cancer.

    BACKGROUND/AIM: We report an unusual case of metastatic testicular germ cell tumor with its unusual presentation. METHOD: A patient presented to the San Joaquin General Hospital with gastrointestinal bleeding and obstruction and a testicular mass is described. The patient's clinical course is followed and the literature reviewed. RESULTS: The patient presented with jejunal intussusception due to metastatic testicular cancer. He was treated with orchiectomy and bowel resection followed by postoperative chemotherapy. CONCLUSION: This case illustrates the need to consider metastatic small-bowel obstruction and/or intussusception in patients presenting with testicular mass and abdominal pain. copyright copyright 1999 S. Karger AG, Basel
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ranking = 289.30583626624
keywords = abdominal pain
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