1/76. Painless intussusception and altered mental status.A 7-month-old child presented to the emergency department (ED) with 2 hours of painless, nonprojectile emesis and a normal mental status. Over a 3-hour period in the ED, the child remained pain-free, but developed hematemesis, hematochezia, and lethargy, progressing to unresponsiveness. The patient was evaluated for toxic ingestion, intracranial bleed, sepsis/meningitis, and intraabdominal pathology. The diagnosis was made by an abdominal ultrasound, which demonstrated an ileal-cecal intussusception that ultimately required surgical reduction. This case illustrates an insidious and poorly understood presentation of a common childhood affliction, as well as the utility of abdominal ultrasound in evaluating a hemodynamically stable patient with intussusception.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/76. Gastric leiomyosarcoma presenting as a sentinel hemorrhage.A 43-year-old Asian woman who was initially seen because of hematemesis later had a gastric leiomyosarcoma diagnosed. Epigastric palpation, computed tomography, and magnetic resonance imaging assisted in determining the size, borders, and location of the tumor while a second esophagogastroduodenoscopy revealed friable gastric mucosa with erosions. biopsy specimens taken for frozen section during surgical abdominal exploration revealed a malignant gastric stromal tumor. An en bloc excision of the mass then followed, with the final pathologic diagnosis a gastric leiomyosarcoma. Metastases were later found in the liver, peritoneum, and mesentery. Differentiation of gastric leiomyosarcoma from other stromal tumors is difficult and requires standardized nuclear and cellular evaluation of atypia, necrosis, mitosis, and tumor doubling time. The most common symptoms at initial presentation are abdominal pain and gastrointestinal bleeding. Abdominal computed tomography remains more specific in suggesting gastric stromal tumors than esophagogastroduodenoscopy and upper gastrointestinal barium series. lymph node involvement in gastric leiomyosarcoma is rare and affords the first-line therapy of laparoscopic wedge gastrectomy with a good prognosis in tumors less than 6 cm in diameter. The prognostic factors include metastasis, size of the tumor, histologic grade, dna ploidy of the tumor, and ulceration of overlying gastric mucosa.- - - - - - - - - - ranking = 5.7589906879646keywords = abdominal pain, upper, pain (Clic here for more details about this article) |
3/76. theophylline intoxication mimicking diabetic ketoacidosis in a child.A 5-year-old boy presented with abdominal pain, nausea and vomiting of blood. Twelve hours after admission, "diabetic ketoacidosis" was diagnosed on the basis of elevated glycaemia, glycosuria, ketonuria and a low bicarbonate blood level, which led to treatment with fluids and regular insulin infusion. Over a 36-hour period, insulin was progressively decreased and finally stopped because of the rapid fall and normalization of blood glucose concentration. Drug poisoning was suspected on the basis of persistent tachycardia in the absence of other signs of dehydration. Salicylate intoxication was excluded, and theophylline was finally incriminated. This compound, used by adults in the child's home, had caused accidental theophylline poisoning, mimicking diabetic ketoacidosis. Pre-diabetic immune markers were repeatedly negative, and no diabetes has developed after four years of follow-up. Thus, the transient increase in blood glucose was not related to a pre-diabetic status. A diagnosis of masked theophylline poisoning should be considered in similar situations involving a rapid decrease of insulin requirements.- - - - - - - - - - ranking = 3.7530844527147keywords = abdominal pain, pain (Clic here for more details about this article) |
4/76. Hemorrhage from the gastroesophageal junction. A cryptic angiographic diagnosis.The angiographic localization of gastroesophageal-junction hemorrage emanating from the left inferior phrenic artery (which originated from the abdominal aorta) is described. The diagnosis was established after conventional selective celiac and left gastric arteriography failed to demonstrate extravasation. The arteriographic evaluation of upper gastrointestinal hemorrhage requires consideration of the variable arterial distribution to the gastroesophageal junction and an awareness of the variable causes of dense opacification (including superimposed adrenal glands) that may mimic extravasation.- - - - - - - - - - ranking = 2.0059062352499keywords = upper (Clic here for more details about this article) |
5/76. Haematemesis and Melaena: surgical management.A prospective study of the surgical management of 100 consecutive patients with benign, non-variceal upper gastrointestinal bleeding is presented. The manner of presentation, precipitating factors, investigations and associated medical problems are discussed. Chronic duodenal ulceration was the most common cause of haemorrhage. vagotomy and drainage with oversewing or excision of the bleeding ulcer was the surgical procedure performed in 71 of the patients in the series. The incidence of recurrent bleeding was 7%; no patient in this category required further operation. The mortality rate was 6%, and there were no deaths recorded in the patients who underwent vagotomy and drainage. The reasons for the relatively low surgical mortality are discussed.- - - - - - - - - - ranking = 2.0059062352499keywords = upper (Clic here for more details about this article) |
6/76. Isolated gastric tuberculosis presenting as massive hematemesis: report of a case.Tuberculous involvement of the stomach is rare. We report herein the unusual case of a 25-year-old man in whom a benign gastric ulcer was found along the lesser curvature after he presented with massive upper gastrointestinal bleeding. Histopathological examination helped to confirm a diagnosis of tuberculosis. The granulomas typical of tuberculosis were caseation with epithelioid and giant cells. The patient was successfully treated by a combination of appropriate surgical therapy and prompt institution of antituberculosis medication.- - - - - - - - - - ranking = 2.0059062352499keywords = upper (Clic here for more details about this article) |
7/76. Jejunogastric intussusception presented with hematemesis: a case presentation and review of the literature.BACKGROUND: Jejunogastric intussusception (JGI) is a rare but potentially very serious complication of gastrectomy or gastrojejunostomy. To avoid mortality early diagnosis and prompt surgical intervention is mandatory. CASE PRESENTATION: A young man presented with epigastric pain and bilous vomiting followed by hematemesis,10 years after vagotomy and gastrojejunostomy for a bleeding duodenal ulcer. Emergency endoscopy showed JGI and the CT scan of the abdomen was compatible with this diagnosis. At laparotomy a retrograde type II, JGI was confirmed and managed by reduction of JGI without intestinal resection. Postoperative recovery was uneventful. CONCLUSIONS: JGI is a rare condition and less than 200 cases have been published since its first description in 1914. The clinical picture is almost diagnostic. endoscopy performed by someone familiar with this rare entity is certainly diagnostic and CT-Scan of the abdomen could also help. There is no medical treatment for acute JGI and the correct treatment is surgical intervention as soon as possible.- - - - - - - - - - ranking = 0.5keywords = pain (Clic here for more details about this article) |
8/76. Case report: right subclavian artery pseudoaneurysm due to perforation of esophageal cancer.A 51-year-old man presented with massive hematemesis. Perforation of upper esophageal cancer, which had already occurred at least six days earlier, progressed to upper mediastinitis. The mediastinitis contiguous to the right subclavian artery was considered to have caused a pseudoaneurysm. rupture of the pseudoaneurysm into the esophagus resulted in massive hematemesis. Both enhanced computed tomography and angiography were diagnostic for the pseudoaneurysm. Transluminal endovascular stent-grafts placement was successful in preventing subsequent hemorrhage.- - - - - - - - - - ranking = 4.0118124704998keywords = upper (Clic here for more details about this article) |
9/76. Bouveret's syndrome presenting as upper gastrointestinal hemorrhage without hematemesis.A 74-year-old woman with a recent diagnosis of peptic ulcer disease diagnosed by endoscopy after presentation with an episode of upper gastrointestinal bleeding returned 6 1/2 weeks later with a 5-day history of nausea and vomiting without associated symptoms. An ultrasound was nondiagnostic except for a large gallstone and a poorly visualized gallbladder. Repeat endoscopy revealed a hard mass that was presumed to have formed secondarily to an ulcer-induced stricture, and a 6-cm filling defect just proximal to the duodenal bulb was seen on a preoperative upper gastrointestinal series. At laparotomy the mass was actually a large gallstone and two smaller stones, which had eroded into and become impacted in the duodenal bulb creating a gastric outlet obstruction. The stones were extracted via a duodenotomy, and the remaining portion of the gallbladder was removed with repair of the cholecystoduodenal fistula. The patient was discharged home after an uncomplicated postoperative course. gastric outlet obstruction by a duodenal gallstone is a condition known as Bouveret's syndrome, which is a rare complication of gallstone disease. Upper gastrointestinal hemorrhage is an especially rare form of presentation.- - - - - - - - - - ranking = 12.035437411499keywords = upper (Clic here for more details about this article) |
10/76. Gastric sarcoidosis presenting with haematemesis.sarcoidosis is a very rare disease in singapore. Sarcoid granuloma involving the stomach alone is even more rare, and only about 21 cases have been reported in the literature up to 1953 (Scott et alii, 1953). In a review of the literature, Wadina and Melamed (1966) found 34 cases of granulomatous involvement of the stomach, all purporting to be sarcoidosis. However, on closer examination of the evidence, many of these 34 cases of so-called sarcoidosis of the stomach were subject to doubt. Bleeding from gastric sarcoidosis is also rare, and only about eight cases have been reported in the literature up to 1970. The present report presents a further example of this rare cause of upper gastrointestinal bleeding and attempts to review the significance of sarcoid granulomas in the stomach.- - - - - - - - - - ranking = 2.0059062352499keywords = upper (Clic here for more details about this article) |
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