1/350. Haemosuccus pancreaticus: a clinical challenge.BACKGROUND: Haemosuccus pancreaticus is a rare complication of pancreatitis. It is a diagnostic problem for even the most astute clinician and a challenge for the expert endoscopist. We report a 25-year-old male patient who had all the features usually seen in haemosuccus pancreaticus patients: recurrent obscure upper gastrointestinal bleeding, pancreatitis, pseudocyst formation, ductal disruption, fistula and pancreatic ascites. The patient was treated by subtotal pancreatectomy, splenectomy and drainage of the pseudocyst. Although pancreatic duct communication with the surrounding vasculature could not be ascertained, we strongly believe the patient had haemosuccus pancreaticus because, over a follow-up period of 3 years, the patient was not only ascites free, but did not experience any further upper gastrointestinal bleeding. We believe that in evaluating patients with recurrent obscure gastrointestinal bleeding, one should always remember that the pancreas is a part of the gastrointestinal tract and, like other organs, is prone to blood loss.- - - - - - - - - - ranking = 1keywords = duct (Clic here for more details about this article) |
2/350. A case of fibrosing mediastinitis with obstruction of superior vena cava and downhill esophageal varices: a rare cause of upper gastrointestinal hemorrhage.Fibrosing mediastinitis (FM) is an excessive fibrotic reaction that occurs in the mediastinum and may lead to compression of mediastinal structures (especially vascular or bronchial). In the present study we describe the first case report of FM, in a patient who developed downhill esophageal varices and bleeding, which was secondary to superior vena cava obstruction.- - - - - - - - - - ranking = 19.244014190804keywords = obstruction (Clic here for more details about this article) |
3/350. 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.- - - - - - - - - - ranking = 1keywords = duct (Clic here for more details about this article) |
4/350. Pancreatic arteriovenous malformation observed to bleed from the bile duct and a duodenal ulcer: report of a case.A 48-year-old man with recurrent episodes of biliary colic and subsequent pancreatitis was admitted to undergo a cholecystectomy. A gastroduodenal fiberscopic examination was performed because of massive melena on the seventh day after admission. It revealed a shallow ulcer on the posterior wall of a duodenal bulbus with rubor and an exposed vessel, which was clipped endoscopically to stop the bleeding. Further observations showed the papilla of Vater to be bleeding from the papilla. A contrast-enhanced abdominal computed tomography scan demonstrated a dilatation of the common bile duct and several dilated vasculatures around the portal vein, some of which drained into the portal vein. Based on the angiography findings, a diagnosis of arteriovenous malformation in the pancreas head was obtained and an embolization of the gastroduodenal artery was performed. Although the melena subsided, he underwent a pylorus-preserving pancreatoduodenectomy to prevent the recurrence of hemorrhaging. The histopathological findings of the bile duct revealed inflammatory cell infiltration and a detachment of the epithelium, except in a small part of the bile duct. A rupture of a damaged vessel inside the bile duct was observed, which was thought to be the cause of hemobilia. Sections of the pancreatic head demonstrated an inflammatory lesion with fibrosis and saponification as well as a large degree of arteriovenous anastomosis. The patient was discharged on the 35th day after the operation following an uneventful postoperative course.- - - - - - - - - - ranking = 20.021330471487keywords = bile duct, duct, bile (Clic here for more details about this article) |
5/350. Autoimmune pancreatitis, pancreatic mass, and lower gastrointestinal bleed.Autoimmune pancreatitis (AIMP) is a recently described clinical entity causing chronic pancreatitis. It often presents with diffuse enlargement of the pancreas and/or a focal mass at the head of the pancreas causing common bile duct obstruction and jaundice. In most instances, AIMP is mistaken for pancreatic cancer. A number of laboratory abnormalities such as positive antinuclear antibody, hypergammaglobulinemia, and antibody to carbonic anhydrase are often present in these patients. Currently, pancreatic biopsy demonstrating characteristic histopathologic changes is essential to establish the diagnosis. We report the first case of AIMP presenting as a pancreatic tail mass and lower gastrointestinal bleed.- - - - - - - - - - ranking = 6.3514691470967keywords = obstruction, bile duct, duct, bile (Clic here for more details about this article) |
6/350. A new technique for intraoperative enteroscopy using a 12-mm trocar.Intraoperative enteroscopy is a valuable method for localizing gastrointestinal bleeding of obscure origin. The insertion and manipulation of an endoscope through an enterotomy, however, may result in significant trauma to the intestinal wall, as well as contamination of the abdominal cavity. We have devised a new technique for the introduction of the endoscope that lessens trauma to the bowel wall and allows a complete enteroscopy with minimal contamination.- - - - - - - - - - ranking = 0.5keywords = duct (Clic here for more details about this article) |
7/350. Embolization of the vasa recta in acute lower gastrointestinal hemorrhage: A report of five cases.PURPOSE: To present our preliminary experience in embolization of the vasa recta in acute gastrointestinal hemorrhage. methods: In four of five patients with acute gastrointestinal hemorrhage superselective embolization of the vasa recta was performed. In one patient in whom superselective catheterization of the bleeding vas rectum was technically impossible, the origin of this vessel was embolized at the level of the terminal arcade. The following embolization materials were used: microcoils and polyvinyl alcohol particles (355-500 microm), n = 2; microcoils only, n = 2; Gelfoam particles, n = 1. RESULTS: Bleeding was found in two patients in the small bowel (jejunum and ileum) and in three patients in the colon. Immediate hemostasis was achieved in all patients. No signs of ischemia or infarction were observed after intervention. CONCLUSIONS: Superselective embolization of the vasa recta proved efficient and safe in our small patient group. Advantages of this technique are reduction of the embolized area to a minimum and direct control of hemostasis.- - - - - - - - - - ranking = 0.5keywords = duct (Clic here for more details about this article) |
8/350. Intestinal ulceration, obstruction, and haemorrhage in congenital syphilis.intestinal obstruction and bleeding are uncommon complications of congenital syphilis (CS). A VDRL-positive infant developed incomplete intestinal obstruction and rectal bleeding. Despite conservative management, his symptoms continued. At laparotomy, terminal ileal inflammation and stenosis were demonstrated. He underwent ileal resection and primary end-to-end anastomosis with resolution of his symptoms. Histopathological examination demonstrated heavy plasmacytic infiltration of the lamina propria and submucosa with ulceration of the mucosa, consistent with syphilitic ileitis. This report documents for the first time bleeding from ileal ulcers associated with intestinal obstruction in CS and highlights an unusual presentation of the disease.- - - - - - - - - - ranking = 26.941619867126keywords = obstruction (Clic here for more details about this article) |
9/350. intestinal obstruction and gastrointestinal bleeding due to systemic amyloidosis in a woman with occult plasma cell dyscrasia.A 60-year-old woman presented to our hospital with repeated vomiting. Upper gastrointestinal endoscopy revealed a 1 cm diameter ulcer with clean base on the roof of the gastric antrum. Histological examination of gastric biopsies revealed abundant amorphous eosinophilic deposits in the submucosa. congo red stain for amyloid was positive. A barium follow-through study revealed a mass in the jejunum causing incomplete obstruction. urine for bence jones protein was negative. serum protein electrophoresis did not reveal any abnormal band and serum immunoelectrophoresis did not detect any monoclonal immunoglobulin. bone marrow examination, however, revealed an increased proportion of plasma cells. Subsequent immunohistochemical staining demonstrated monoclonal lambda light chains in the marrow plasma cells, thereby confirming a plasma cell dyscrasia. amyloidosis involving the gastrointestinal tract can produce a wide variety of non-specific symptoms and signs. A high index of suspicion is necessary to arrive at an early diagnosis. Management consists of supportive therapy for the gastrointestinal tract as well as treatment of the underlying condition.- - - - - - - - - - ranking = 19.244014190804keywords = obstruction (Clic here for more details about this article) |
10/350. Use of adrenal vein conduit for splenorenal shunts: a case report.We report a case with extrahepatic portal venous obstruction (EHPVO), who presented with recurrent bleeding following a previous devascularization procedure and needed an emergency distal spleno-renal shunt (DSRS). Due to technical difficulty because of previous scarring, the adrenal vein was used as a conduit between the splenic vein and renal vein. The shunt's patent and the patient has been bleed-free for 2 years.- - - - - - - - - - ranking = 451.80013961939keywords = extrahepatic, obstruction (Clic here for more details about this article) |
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