1/83. Rare presentation of small bowel leiomyosarcoma with liver metastases.Intraabdominal sarcomas are rare tumours usually diagnosed at an advanced stage. These lesions at presentation are bulky and symptoms are often related to pressure effects on adjacent organs. This case report describes a rare presentation of a small bowel leiomyosarcoma whose initial presentation was free haemorrhage into the abdominal cavity and concomitant liver metastases. This case report also demonstrates that, even with such a rare presentation, an aggressive surgical approach is indicated in this type of tumour and helps a patient with advanced disease to live a few disease-free months with a good quality of life.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/83. Massive esophageal variceal hemorrhage triggered by complicated endotracheal intubation.Esophageal variceal hemorrhage is frequently a catastrophic event. The specific events that trigger variceal rupture are not well understood. Acute elevations in systemic blood pressure and increased splanchnic blood flow, however, may lead to increased intravariceal pressure followed by variceal rupture and hemorrhage. This report describes a strong temporal association between complicated endotracheal intubation and abrupt onset of life-threatening variceal hemorrhage. A 52-year-old man with a history of portal hypertension was intubated emergently for airway protection because of respiratory insufficiency due to sepsis. intubation was complicated by initial inadvertent esophageal intubation and by a peak mean arterial blood pressure of 155 mmHg. At the conclusion of the procedure, the patient sustained large volume hematemesis due to esophageal variceal rupture. This case suggests a risk of triggering variceal hemorrhage as a result of intubation-induced increase in blood pressure. A number of agents, including fentanyl, have been shown to be effective in attenuating the cardiovascular response to intubation. This case report provides strong evidence in support of administering fentanyl, or a suitable alternative adjunctive medication, before intubation of patients with documented portal hypertension and a history of esophageal variceal hemorrhage.- - - - - - - - - - ranking = 4keywords = pressure (Clic here for more details about this article) |
3/83. Recurrent gastrointestinal bleeding and high output cardiac failure caused by hereditary hemorrhagic telangiectasia.Hereditary hemorrhagic telangiectasia, commonly known as Osler-Weber-Rendu disease, is a systemic autosomal dominant inherited disorder, that occurs in Caucasian populations. We report the case of a 56-year-old housewife who was admitted to the gastrointestinal and cardiovascular ward because she had suffered from recurrent gastrointestinal bleeding and heart failure from 1994 to 1997. Panendoscopy showed vascular ectasia scattered over the tongue, larynx, esophagus, and posterior wall of the gastric body. colonoscopy showed clusters of telangiectasia over the cecum and ascending colon. arteriovenous malformations (AVMs) were found in the liver and lungs on computerized tomography. Recurrent gastrointestinal bleeding was controlled by estrogen treatment during the follow-up period. In July 1997, the patient was readmitted to our cardiovascular section due to aggravated dyspnea, orthopnea and bilateral lower leg edema. cardiac catheterization showed a large fistula from the left pulmonary artery to the left atrium and left ventricle, pulmonary arterial pressure of 37/13 mmHg and cardiac output of 9.61/minute. Other studies excluded the possibility of sepsis, and high-output cardiac failure was suspected. The patient was discharged in a stable condition and scheduled for AVM embolization management. Unfortunately, she died of a suspected heart attack at home two weeks following discharge.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/83. Recurrent variceal hemorrhage following successful Warren shunt.Recurrent variceal hemorrhages are demonstrated following a technically successful Warren shunt. Serial barium esophagrams show the progressive enlargement of distal esophageal varices. Results of celiac arteriograms and direct examination confirmed the patency of the distal splenorenal shunt. hemorrhage from varices was shown by fiberoptic esophagoscopy; end-to-side portacaval anastomosis reduced portal pressure and stopped the bleeding.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/83. Idiopathic splenic vein stenosis: a cause of gastric variceal hemorrhage.We report the case of a patient with isolated gastric variceal bleeding. obesity precluded the use of noninvasive means for assessing splenic vein patency. splenic vein stenosis was diagnosed by transhepatic portal and splenic venography with pressure measurements. A cause for the stenosis could not be found. splenectomy was used as a curative measure.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/83. association of transjugular intrahepatic portosystemic shunt with embolization in the treatment of bleeding duodenal varix refractory to sclerotherapy.BACKGROUND: Bleeding from duodenal varices are often severe (mortality as high as 40%), and more difficult to sclerose than esophageal varices. We report a patient with a bleeding duodenal varix, refractory to sclerotherapy, successfully treated by the association of portosystemic shunt placement and varix embolization, via the same transjugular intrahepatic route. methods: A 40-year-old Black male underwent emergency TIPS and duodenal varix embolization after failure of endoscopic sclerotherapy. The portosystemic pressure gradient droped from 16 to 9 mm Hg following TIPS. At 5 months from TIPS, the patient is well, with a patent shunt at Doppler ultrasound. CONCLUSION: The present report of successful control of duodenal varix, actively bleeding and refractory to sclerotherapy, by means of combined TIPS and embolization, supports the role of TIPS and suggests that its association to embolization can be valuably considered in the difficult setting of portal hypertension with bleeding duodenal varices.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/83. Transjugular intrahepatic portosystemic shunt performed in a 2-year-old infant with uncontrollable intestinal bleeding.Although transjugular intrahepatic portosystemic shunt (TIPS) is widely accepted in adults, there have been few successful reports in infants. The authors describe a 2-year-old boy with postoperative biliary atresia who underwent TIPS for uncontrollable lower intestinal bleeding and achieved hemostasis. Massive melena developed, which was not controlled by conservative therapy and devascularization. A shunt was created between the right hepatic vein and the right portal vein with a 6- x 50-mm Wallstent. After TIPS, the porto-systemic pressure gradient decreased from 15 to 11 mm Hg, and collaterals markedly reduced. He has not had recurrent bleeding for over 7 months. TIPS may be a technically feasible and effective treatment to control intestinal bleeding in infants. However, further experience and long-term follow-up will be required.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/83. mallory-weiss syndrome with severe bleeding: treatment by endoscopic ligation.There is no consensus as to the best treatment for Mallory-Weiss tears with severe bleeding. Endoscopic ligation is an inexpensive, readily available, and easily learned technique, in contrast to conventional thermocoagulation or hemoclipping. To evaluate the utility of endoscopic ligation, we performed this technique during emergency endoscopy to treat severe bleeding from Mallory-Weiss tears in four patients in our hospital with continuous active bleeding from Mallory-Weiss tears. The patients were all male with an average age of 40.5 years. Symptoms associated with increased intra-abdominal pressure, including retching and vomiting were reported by all patients. The bleeding points were aspirated and controlled by endoscopic ligation, and complete hemostasis was achieved in all cases. We conclude that endoscopic ligation is easy to perform and may provide an alternative treatment for severe bleeding from Mallory-Weiss tears.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/83. The watermelon rectum.This is the first reported case of rectal vascular ectasia in association with gastric antral vascular ectasia (watermelon stomach). The patient, a 39-year-old woman with systemic sclerosis, reported chronic gastrointestinal blood loss and iron deficiency anemia. She had aperistalsis of the distal esophagus, decreased lower esophageal sphincter pressure leading to severe gastroesophageal reflux, and dysmotility of the small intestine. diagnosis was made by endoscopic appearance of visible linear watermelon-like vascular stripes in the gastric antrum and rectum. histology confirmed the vascular nature of this disorder, showing dilated and thrombosed capillaries in the lamina propria. Gastric biopsy showed associated fibromuscular hyperplasia in the lamina propria. However, the colonic biopsy showed only focal hyalinization in the lamina propria. The patient was successfully treated using endoscopic bipolar electrocautery. Watermelon stomach has previously been described in association with systemic sclerosis. Based on the histopathologic similarity between rectal vascular ectasia, gastric antral vascular ectasia, and systemic sclerosis, we suggest that the rectal vascular lesion may represent a component of the gastrointestinal manifestations of systemic sclerosis.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/83. octreotide for severe acute bleeding from portal hypertensive colopathy: a case report.A 56-year-old man developed severe lower gastrointestinal bleeding. He was classified as child-Pugh grade C. colonoscopy revealed multiple angiodysplasia-like lesions and mucosal friability throughout the entire colon (portal hypertensive colopathy, PHC). Haemostasis was immediately achieved with octreotide treatment, although melaena recurred after discontinuation of the infusion. propranolol treatment before discontinuation of octreotide infusin prevented the recurrence of bleeding from PHC. octreotide is a safe and effective treatment for severe acute bleeding from PHC, especially if the patient is not a candidate for transjugular intrahepatic portosystemic shunt (TIPS) or treatment with a beta-blocker due to the severity of liver disease or haemodynamic instability. However, a sufficient reduction of portal pressure by propranolol or other medical treatment may be needed in order to discontinue octreotide infusion without the recurrence of bleeding.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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