1/16. 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 = 1keywords = vessel (Clic here for more details about this article) |
2/16. Dieulafoy's lesion of the jejunum.Dieulafoy's lesion is a rare vascular anomaly but a potentially life-threatening disease. This lesion can also be found in the small intestine, which can be diagnosed only by angiography. However, the angiography may be normal when the bleeding is inactive. We report a case of jejunal Dieulafoy's lesion with a repeated attack of massive gastrointestinal bleeding with a normal initial angiography. The pathological examination found an unusual picture as a dilated submucosal vessel protruded like a submucosal tumor.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/16. Multiple duodeno-jejunal diverticula causing massive intestinal bleeding.A case of massive intestinal blood loss from multiple duodeno-jejunal diverticula is described. A 39-year-old man was referred to our hospital because of recurrent bloody stool and worsening anemia. Upper and lower endoscopy, selective abdominal angiography, and radionuclide scanning were performed to seek the cause of the intestinal bleeding, but none of these studies revealed the source of bleeding. Small-bowel barium follow-through examination showed numerous diverticula in the distal duodenum and proximal jejunum. Excision of the duodenal diverticulum and resection of the involved portion of the jejunum cured the patient. On histopathological examination, an ulcerative lesion with an exposed vessel suggestive of the source of bleeding was seen in the resected duodenal diverticulum. Although duodeno-jejunal diverticula are rare, the importance of a careful search for this malformation in a patient with intestinal blood loss is stressed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/16. Massive bleeding from multiple jejunal diverticula associated with an angiodysplasia: report of a case.We report herein the case of a 70-year-old woman who presented with massive bleeding from multiple jejunal diverticula. She was initially admitted to our hospital with massive melena. An upper gastrointestinal endoscopic examination revealed no bleeding site. colonoscopy revealed clotted and red blood throughout the colon, and a small diverticulum in the ascending colon which was thought to be the source of bleeding. Following admission, she was treated conservatively at first, but melena continued and the anemia did not improve despite blood transfusions. A laparotomy was performed and multiple jejunal diverticula, distributed from 10 to 40 cm distal to the ligament of Treitz, were found. A segment of the jejunum containing all diverticula was resected. The most distal diverticulum contained a clot of blood, but no ulceration was observed. A histological examination revealed many dilated blood vessels in the mucosa and submucosa of this diverticulum, which were compatible with the findings of angiodysplasia. Based on these findings, we believe that angiodysplasia was the cause of bleeding from the jejunal diverticula in this case.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/16. Endovascular repair of aortojejunal fistula.A 64-year-old male with vascular occlusive disease involving multiple vessels is presented with a history of aortobifemoral bypass grafting and bilateral femoral false aneurysm surgery. More recently, he had cystectomy for bladder carcinoma and repeated urinary stents and sepsis. Gastrointestinal bleeding developed due to the aortic graft anastomotic false aneurysm eroding into the distal jejunum. Endograft placement stabilized the critical situation and served as a bridge to a safer, more elective resection of the previous graft, the false aneurysm, and the endograft with closure of the jejunum.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/16. Combined use of preoperative provocative angiography and highly selective methylene blue injection to localize an occult small-bowel bleeding site in a patient with Crohn's disease: report of a case.PURPOSE: Gastrointestinal bleeding in patients with Crohn's disease presents both a diagnostic and therapeutic challenge. The bleeding site may be difficult to localize preoperatively and multiple segments of gross disease can lead to uncertainty as to the precise source at the time of laparotomy. methods: We describe a patient with Crohn's disease and recurrent gastrointestinal bleeding in whom the combined use of provocative angiography and highly selective methylene blue injection was used preoperatively to accurately identify the site of hemorrhage and direct bowel resection. RESULTS: Provocative angiography identified the bleeding point in the jejunum. methylene blue, which had been injected distally into the bleeding vessel during angiography, stained the bowel wall at the bleeding site. Segmental bowel resection was subsequently performed and no further bleeding occurred during the 18-month follow-up period. CONCLUSIONS: The combined use of provocative angiography and highly selective methylene blue injection may aid in the preoperative and intraoperative localization of occult bleeding sites in patients with Crohn's disease. This allows the bleeding lesion to be removed with a limited resection, thus preserving bowel length.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/16. Jejunal perforation associated with cytomegalovirus infection in a patient with adult T-cell leukemia-lymphoma.A patient with adult T-cell leukemia-lymphoma suffered a jejunal perforation, which we believe was directly attributable to cytomegalovirus (CMV) infection. In the areas of ulceration and perforation in the small bowel, blood vessels penetrating the muscularis propria showed extensive lining of cytomegalic endothelial cells with CMV inclusions, accompanied by occasional disruption of the walls, partial occlusion of the lumina, fibrin thrombi, and hemorrhage. The CMV-induced vascular damage seemed to be closely related to the occurrence of ulcers and perforation. The recognition of CMV as a cause of lethal gastrointestinal lesions in immunocompromised hosts has become more important with the advent of anti-CMV therapy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/16. Massive lower gastrointestinal bleeding after rejection of pancreatic transplants.BACKGROUND: This article highlights two cases of massive lower gastrointestinal bleeding in patients on dialysis after rejection of kidney-pancreas transplants. Patient 1 was a 34-year-old female with 27 years of type I diabetes, who had a kidney-pancreas transplant in 1996, which was complicated by rejection of the kidney and pancreas in 2000 and 2002, respectively. Later in 2002, she presented in shock after experiencing cramping abdominal pain and passage of large bloody stools. Patient 2 was a 38-year-old male with 26 years of type I diabetes, who had a pancreas-kidney transplant in 1998, which was complicated by rejection of the kidney and pancreas in early 2003. He presented in late 2003 with a single episode of coffee-ground emesis and two episodes of brisk hematochezia. INVESTIGATION: Arterial angiography. DIAGNOSIS: Pseudoaneurysm and small-bowel fistula from the arterial supply to the transplanted pancreas. MANAGEMENT: Angiographic embolization of the aneurysmal vessel and fistula achieved hemostasis. Patient 1 did not have her transplanted organ surgically removed and suffered a recurrent massive lower gastrointestinal bleed that proved fatal. In Patient 2, subsequent surgery and removal of the rejected pancreas was performed and the patient continues to do well.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/16. Benign lymphangioma of the jejunal mesentery: an unusual cause of small bowel obstruction.Lymphangiomas are rare tumours of lymphatic vessels, most commonly found in children. We present the unusual case of small bowel obstruction caused by benign lymphangioma in a middle aged woman.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/16. Vascular compromise in chronic volvulus with midgut malrotation.Three cases of chronic volvulus of the small bowel in midgut malrotation are presented, all of whom manifested similar angiographic findings: proximal occlusion of the superior mesenteric artery and vein and development of collateral vessels. These findings may indicate the pathophysiology of chronic volvulus in midgut malrotation; the volvulus is progressive and eventually results in the twisting of the mesenteric root itself, but because of its chronic nature collateral circulation develops, eliminating bowel necrosis. Computed tomography (CT), performed in two cases, revealed dilated, tortuous vessels in the mesentery in addition to the known CT finding of a whirl-like pattern of the volvulated small bowel loops. Sonography, performed in one case, showed an unique feature of whirling sonolucent layers probably representing the volvulated small bowel loops intermixed with dilated mesenteric collateral vessels. We would like to emphasize the usefulness of CT and sonography in the early diagnosis of those cases with vague and nonspecific clinical manifestations.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
| | Next -> |