1/11. Recurrent upper gastrointestinal bleeding due to the Dieulafoy's lesion.Dieulafoy's lesion of the gastrointestinal tract, an abnormally dilated artery that penetrates through the mucosa, has been diagnosed more frequently in recent years. Bleeding occurs when the vessel ruptures. Despite widespread awareness of this entity, it remains a diagnostic challenge for gastroenterologists because of its small size and hidden location. Several different diagnostic methods and treatments have been introduced throughout the years. endoscopy plays a major role in diagnosis and therapy. In this case report, the patient was successfully treated endoscopically using epinephrine injection and heater probe thermoco-agulation. The characteristics of the Dieulafoy's lesion, its current diagnosis, treatment, and complications are discussed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/11. Chronic epigastric blood collection after coronary artery bypass grafting: case report.A clinical case of epigastric pain 3 months after coronary artery bypass grafting (CABG) is presented. The CT finding of an abdominal mass with thick wall, internal horizontal by-gravity level and linear contrast enhancement at the border between the two different components was correctly interpreted for a chronic hematoma with separation of the formed blood elements from blood serum; in particular, the linear contrast enhancement was related to an artery-feeding vessel.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/11. A case report of localized gastric amyloidosis.AIM: To elucidate the clinical and laboratory features of localized gastric amyloidosis via a rare report along with a review of related literatures. methods: The clinical manifestations, laboratory results and surgical treatment of a female patient with localized gastric amyloidosis in our hospital were summarized. The relevant literatures were reviewed on the etiology, clinical features, diagnosis, treatment and prognosis of this disease. RESULTS: The patient was lack of specific clinical manifestations and positive laboratory results. Prior to the treatment, she was suspected to be of malignization from gastric ulcer by both gastroscopy and endoscopic ultrasonography, which was denied by the gastric biopsy. The patient was treated with subtotal gastrectomy and clearance of perigastric lymph nodes. The postoperative pathological diagnosis determined the lesion to be the deposition of amyloid materials in the gastric mucosa, submucosa and blood vessel walls with intestinal metaplasia and atrophy of the gastric glands, in which no malignant tumor was found. congo red staining with prior potassium permanganate incubation confirmed the AA type of amyloid in this case. Multiple biopsies from esophagus, remnant stomach, duodenum, colon and bone marrow in the follow-up survey showed no amyloidal deposition in these tissues and organs. Up to the present, no signs of recurrence have been found in this patient. CONCLUSION: Localized gastric amyloidosis, being rare in incidence, should be considered in the differentiation of gastric tumors, in which biopsy is the only means to confirm the diagnosis. Currently, surgical resection of pathological tissue and circumambient lymph nodes may be a preferable therapeutic strategy for the localized amyloidosis to prevent possible complications. Although with a benign prognosis, gastric amyloidosis possesses a recurrent tendency as suggested by the literatures.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/11. Tuberculous gastric perforation: report of a case.A 21-year-old woman presented with a 2-day history of acute abdominal pain. Contrast-enhanced computed tomography (CT) showed a perforation in the lesser curve of the stomach. The patient suffered a bout of hematemesis, following which an endoscopy showed a bleeding blood vessel at the edge of the perforation. We performed an emergency distal gastrectomy, including the ulcer site. Histopathological examination revealed tuberculous granulation tissue and acid-fast bacilli in the ulcer. The patient was given antituberculosis therapy (ATT) postoperatively, and was well when last seen 1 year 5 months after surgery. We analyzed the clinical data of five cases of tuberculous gastric perforation (TGP), reported between 1948 and 2003, including our patient. The patients ranged in age from 21 to 45 years, with a mean age of 36.8 years (SD /- 10.21), and a male to female ratio of 3 : 2. The diagnosis was confirmed by surgery or autopsy. Abdominal lymphadenopathy was present in all patients. gastrectomy was performed in four patients, and two were given ATT. All four patients in the previous reports died of their disease.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/11. Recurrent gastric hemorrhaging with large submucosal hematomas in a patient with primary AL systemic amyloidosis: endoscopic and histopathological findings.A 64-year-old woman who suffered intractable gastric ulcers with hemorrhaging showed huge submucosal hematomas in her stomach on the endoscopic examination. Since gastric mucosal biopsy revealed amyloid deposition and IgG lambda type M protein was detectable in her serum, she was diagnosed as having primary AL systemic amyloidosis. The gastric hemorrhages did not improve despite intensive medication, so total gastrectomy was performed, resulting in an unfavorable outcome. Massive deposition of amyloid with A lambda immunoreactivity was seen on the submucosal vessels in her stomach. This is a rare primary AL systemic amyloidosis case showing recurrent and fatal gastric submucosal hematomas.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/11. Laceration of gastric mucosa associated with dialysis-related amyloidosis.We report a 72-year-old female on long-term hemodialysis, who was admitted to the hospital because of hematemesis. On emergency laparotomy, pylorogastrectomy was performed. The resected specimen showed a giant hematoma and traversing fissure along the lesser curvature of the body of the stomach. Histologically, the specimen showed wide hematoma formation and amyloid deposits in the submucosal layer, especially in the wall of blood vessels. These deposits reacted positively to antihuman beta2-microglobulin antibody. The post-operative course was favorable, and the patient was discharged on the 35th hospital day. In this case, the laceration site on the gastric mucosa was almost intact and did not demonstrate ischemic change, suggesting that the giant hematoma was caused by submucosal vessel rupture, which led to the gastric mucosa laceration. To our knowledge, this is the first case of gastric mucosa laceration associated with dialysis-related amyloidosis.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
7/11. Ischemic gastroparesis: resolution after revascularization.patients with chronic nausea and vomiting frequently present challenging diagnostic and therapeutic problems. In such patients, gastroparesis of unknown cause, or "idiopathic" gastroparesis, may be the only objective finding. Two middle-aged women with nausea, vomiting, and weight loss of 10 and 26 kg over 6 and 18 months, respectively, were evaluated. Routine laboratory and barium study results were normal. Solid-phase gastric emptying studies showed severe gastroparesis in both patients. Upper endoscopies excluded gastric outlet obstruction. Gastric dysrhythmias (4-cpm and 1-cpm patterns) were recorded using cutaneous electrodes. An abdominal bruit was ascultated in one patient. Abdominal arteriograms in both patients showed total occlusion of all three major mesenteric vessels with collaterals supplied via hemorrhoidal arteries. Bypass grafting procedures of the celiac and superior mesenteric arteries in one patient and of the celiac artery in the other patient were performed. Six months after mesenteric artery revascularization, upper gastrointestinal symptoms had resolved and original weights were regained. Furthermore, normal 3-cpm gastric myoelectrical activity and normal gastric emptying of solids were restored in both patients. In these patients, chronic mesenteric ischemia resulted in a novel and reversible cause of gastroparesis, gastric dysrhythmias, and accompanying symptoms.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/11. Diffuse neonatal gastric infarction.Diffuse neonatal gastric infarction can be a devastating complication of invasion of the gastric wall and vessels by fungi colonizing the gastric mucosa. Even in the presence of extensive transmural necrosis, however, the radiographs do not necessarily show evidence of gastric mucosal abnormality. Instead, plain films and positive contrast studies may erroneously suggest a mechanical gastric outlet obstruction. Ancillary evidence of a devitalized viscus in a baby who appears to have complete gastric outlet obstruction should suggest the diagnosis of gastric infarction.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/11. Blind total gastrectomy for massive bleeding from the stomach.The source of massive haemorrhage from the stomach cannot always be identified even with the use of fibreoptic endoscopy and angiography. Six patients with massive, continuing, non-variceal haemorrhage from the stomach are described in whom total gastrectomy was eventually required. Three patients were shown to have bled from submucosal arteriovenous malformations, two from erosive gastritis and one from a vessel in an ulcer at the oesophagogastric junction. One patient died as a result of surgery and another died later of disseminated malignant disease. The functional results in the remaining patients were surprisingly good and rebleeding has not occurred. Total gastrectomy is a satisfactory 'last resort' treatment for life-threatening gastric haemorrhage for which no cause can be found.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/11. Endoscopic local injection of hypertonic saline-epinephrine solution to arrest hemorrhage from the upper gastrointestinal tract.For the purpose of arresting hemorrhage from the upper gastrointestinal tract we developed a method of endoscopic local injection of hypertonic saline-epinephrine solution, consisting of 3.6% or 7.1% sodium chloride with 0.005% epinephrine, which was locally injected around the base of the bleeding vessel under endoscopy. During the period between October 1978 and September 1983, a total of 158 patients underwent treatment for hemostasis by this method. The major causes of bleeding in our study consisted of gastric ulcers (114) and duodenal ulcers (15). The overall effective rate of hemostasis was 98.1%. By applying this method, the rate of emergency operation for patients with bleeding from the upper gastrointestinal tract was significantly reduced from 21.7% (15/69) to 0.8% (1/128).- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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