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An unusual cause of hematemesis:Goiter

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World Journal of Gastroenterology 2006年第33期12卷 5412-5415页

作者： Astrid AM van der Veldt Mohammed Hadithi Marinus A Paul Fred G van den Berg Chris JJ Mul-der Mikael E Craanen Department of Gastroenterology VU University Medical Center Amsterdam The Netherlands Department of Surgery VU University Medical Center Amsterdam The Netherlands Department of Radiology VU University Medical Center Amsterdam The Netherlands

Downhill varices are located in the upper part of the esophagus and are usually related to superior vena cava obstruction. Bleeding from these varices is extremely rare. We describe a 77-year-old patient with hematemesis due to downhill varices as a result of recurrent goiter. A right lobe thyroidectomy was carried out with disappearance of the varices.

关键词： Downhill Esophageal Varices Goiter hematemesis

Dieulafoy Gastric Lesion: An Unusual Cause of Pediatric hematemesis

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Open Journal of Pediatrics 2016年第1期6卷 120-123页

作者： Giulia Maria Tronconi Lucia Cococcioni Maria Chiara Petrone Patrizia Corsin Martina Fomasi Pier Alberto Testoni Graziano Barera Department of Pediatrics San Raffaele Scientific Institute Vita-Salute San Raffaele University Milan Italy Gastroenterology and Gastrointestinal Endoscopy Unit San Raffaele Scientific Institute Vita-Salute San Raffaele University Milan Italy

Dieulafoy lesion is a vascular anomaly predominantly found in the stomach, which represents a rare cause of gastrointestinal bleeding and life-threatening haemorrhages in pediatric age with few cases reported in the literature. We experienced a 7-year-old previously healthy boy with hematemesis endoscopically diagnosed and successfully treated for a Dieulafoy lesion in the stomach. This case report illustrates the initial diagnostic workup and the possible differential diagnosis in presence of an acute episode of hematemesis in children. It focuses on an uncommon cause of gastrointestinal bleeding that is probably underestimated because of missing diagnosis. Any unusual and acute case of upper gastrointestinal bleeding should raise the suspicion of Dieulafoy lesion also in children, especially in those who have a past medical history negative for peptic disease and varices due to portal hypertension: a promptly endoscopy can provide visual diagnostic criteria and ensure an adequate hemostasis that is generally the definitive treatment of the lesion.

关键词： Dielafoy Lesion hematemesis Pediatric Endoscopy

Esophageal tuberculosis presenting with hematemesis

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World Journal of Gastrointestinal Endoscopy 2013年第11期5卷 581-583页

作者： Samit S Jain Piyush O Somani Rajeshkumar C Mahey Dharmesh K Shah Qais Q Contractor Pravin M Rathi Department of Gastroenterology Bai Yamunabai Laxman Nair HospitalTopiwala National Medical College Department of General Surgery Bai Yamunabai LaxmanNair HospitalTopiwala National Medical College

Esophageal tuberculosis is rare, constituting about 0.3% of gastrointestinal tuberculosis. It presents commonly with dysphagia, cough, chest pain in addition to fever and weight loss. Complications may include hemorrhage from the lesion, development of arterioesophageal fistula, esophagocutaneous fistula or tracheoesophageal fistula. There are very few reports of esophageal tuberculosis presenting with hematemesis due to ulceration. We report a patient with hematemesis that was due to the erosion of tuberculous subcarinal lymph nodes into the esophagus. A 15-year-old boy presented with hemetemesis as his only complaint. Esophagogastroduodenoscopy(EGD) revealed an eccentric ulcerative lesion involving 50% of circumference of the esophagus. Biopsy showed caseating epitheloid granulomas with lymphocytic infiltrates suggestive of tuberculosis. Computerised tomography of the thorax revealed thickening of the mid-esophagus with enlarged mediastinal lymph nodes in the subcarinal region compressing the esophagus along with moderate right sided pleural effusion. Patient was treated with anti-tuberculosis therapy(Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) for 6 mo. Repeat EGD showed scarring and mucosal tags with complete resolution of the esophageal ulcer.

关键词： Esophageal tuberculosis Esophagogastroduodenoscopy hematemesis

Etiologies of Splenic Venous Hypertension:A Review

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Journal of Clinical and Translational Hepatology 2024年第6期12卷 594-606页

作者： Jasmine Tidwell Bianca Thakkar George Y.Wu Department of Medicine University of Connecticut Health CenterFarmingtonCTUSA Division of Gastroenterology-Hepatology University of Connecticut Health CenterFarmingtonCTUSA

Splenic venous hypertension or left-sided portal hypertension is a rare condition caused by an obstruction of the splenic ***,it presents with upper gastrointestinal bleeding in the absence of liver *** can be classified based on the mechanism of development of splenic vein hypertension:compression,stenosis,inflammation,thrombosis,and surgically decreased splenic venous *** is established by various imaging modalities and should be suspected in patients with gastric varices in the absence of esophageal varices,splenomegaly,or *** management and prognosis vary depending on the underlying etiology but generally involve reducing splenic venous *** aim of this review was to summarize the etiologies of splenic venous hypertension according to the mechanism of development.

关键词： Splenic venous hypertension Left-sided portal hypertension Sinistral portal hypertension Splenic vein thrombosis Gastric varices hematemesis Upper gastrointestinal bleeding

Cholecystoduodenal fistula presenting with upper gastrointestinal bleeding: A case report

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World Journal of Clinical Cases 2021年第2期9卷 410-415页

作者： Jin Myung Park Chang Don Kang Ji Hyun Kim Sang Hoon Lee Seung-Joo Nam Sung Chul Park Sung JoonLee Seungkoo Lee Department of Internal Medicine Kangwon National University School of MedicineChuncheon 24289Kangwon DoSouth Korea Department of Gastroenterology Kangwon National University HospitalChuncheon 24289Kangwon DoSouth Korea Anatomy and Pathology Kangwon National University School of MedicineChuncheon 200947Kangwon DoSouth Korea Department of Pathology Kangwon National University HospitalChuncheon 24289Kangwon DoSouth Korea

BACKGROUND Cholecystoduodenal fistula is a rare complication of *** are usually non-specific and often indistinguishable from those of etiologic diseases,but it rarely presents as severe gastrointestinal *** associated with cholecystoduodenal fistula usually requires surgery because significant bleeding from the cystic artery is unlikely to be resolved by conservative management or endoscopic *** SUMMARY We report a case of cholecystoduodenal fistula that presented with hematemesis which was diagnosed by endoscopy and computed *** hemostasis could not be achieved,but surgical treatment was ***,we have presented a literature *** Cholecystoduodenal fistula should be considered as differential diagnosis when a patient with history of gallstone disease presents with gastrointestinal bleeding.

关键词： Biliary fistula hematemesis Cholecystitis Gallstones Cholecystectomy Case report

Ruptured high flow gastric varices with an intratumoral arterioportal shunt treated with balloon-occluded retrograde transvenous obliteration during temporary balloon occlusion of a hepatic artery

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World Journal of Gastroenterology 2006年第33期12卷 5404-5407页

作者： Motoki Nakai Morio Sato Hirohiko Tanihata Tetsuo Sonomura Shinya Sahara Nobuyuki Kawai Masashi Kimura Masaki Terada Department of Radiology Hidaka General Hospital 116-2 Sono Gobo Shi Wakayama 644-8655 Japan Department of Radiology Wakayama Medical University 811-1 Kimiidera Wakayama Shi Wakayama 641-8510 Japan

A patient presented with hematemesis due to gastric variceal bleeding with an intratumoral arterioportal shunt. Contrast-enhanced CT revealed gastric varices and hepatocellular carcinoma with tumor thrombi in the right portal vein. Angiography and angio-CT revealed a marked intratumoral arterioportal shunt accompanied with reflux into the main portal vein and gastric varices. Balloon-occluded retrograde venography from the gastro-renal shunt showed no visualization of gastric varices due to rapid blood flow through the intratumoral arterioportal shunt. The hepatic artery was temporarily occluded with a balloon catheter to reduce the blood flow through the arterioportal shunt, and then concurrent balloon-occluded retrograde transvenous obliteration （BRTO） was achieved. Vital signs stabilized immediately thereafter, and contrast-enhanced CT revealed thrombosed gastric varices. Worsening of hepatic function was not recognized. BRTO combined with temporary occlusion of the hepatic artery is a feasible interventional procedure for ruptured high flow gastric varices with an intratumoral arterioportal shunt.

关键词： Gastric varices Hepatocellular carcinoma Arterioportal shunt Balloon-occluded retrogradeobliteration hematemesis

Vascular emergencies in cholelithiasis and cholecystectomy: our experience with two cases and literature review

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Hepatobiliary & Pancreatic Diseases International 2008年第2期7卷 217-220页

作者： Narasimhaiah Srinivasaiah Maneesh Bhojak Ralph Jackson Sean Woodcock Department of Surgery North Tyneside General Hospital Tyne and Wear UK Department of Radiology Freeman Hospital Tyne and Wear UK

BACKGROUND:Complications from gallstones and laparoscopic cholecystectomy can be serious and fatal if there is a delay in recognition and treatment. We aim to present two unusual, life threatening vascular complications as a result of gallstones and laparoscopic cholecystectomy. Their management is highlighted with a brief review of literature. METHODS:Data for the article were gathered from clinical case note review. Radiology database was used for images. A brief literature review was undertaken using Pubmed search. The keyword used included hemobilia, pseudoaneurysm, arterio-biliary fistula and laparoscopic cholecystectomy. RESULTS:The article highlights two individual case reports. The first case constitutes an 81-year woman who had cystic arterial erosion causing hematemesis, while the second patient was a 57-year man who presented with hemobilia from a pseudoaneurysm of right hepatic artery (RHA) following laparoscopic cholecystectomy. Cystic arterial erosion was treated with subtotal cholecystectomy with duodenal defect closure while the pseudoaneurysm underwent radiological intervention. CONCLUSIONS:Cystic artery erosion and pseudoaneurysm causing arteriobiliary fistula are rare vascular complications related to the biliary tree. A high index of suspicion and timely intervention is important. Trauma to arteries should be avoided during laparoscopic cholecystectomy.

关键词： laparoscopic cholecystectomy hemobilia hematemesis pseudoaneurysm

To restrict indication for stenting of the inferior vena cava and liver transplantation in patients with Budd-Chiari syndrome

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Frontiers of Medicine 2007年第2期1卷 130-135页

作者： WANG Zhonggao Vascular Institute&Xuan Wu Hospital Capital Medical UniversityBeijing 100053China

The Budd-Chiari syndrome(BCS)used to be a very rare disorder and lacked a means of ***,various shuntings and radical procedures have emerged in the last three decades with quite encouraging *** minimally invasive therapies,such as stenting of the inferior vena cava(IVC),are simple and easy to ***,it has been realized that the IVC stent may compromise the hepatic veins and cause catastrophic consequences,thus the indication for IVC stenting should be reevaluated and especially not to be ***,it should be applied by percutaneous transangiography(PTA)only,which may be repeated when *** BCS in China predominantly belongs to the IVC type rather than the intrahepatic type in Western;the outcome from its conventional therapy,at least for the moment,is better than that of liver *** is thus suggested that,before liver transplantation is decided,the conventional means for managing BCS be *** final suggestion is to restrict the indication both for stenting of the IVC and liver *** this paper,ten examples are given with figures.

关键词： Budd-Chiari syndrome stenting shunting liver transplantation inferior vena cava ascites hematemesis PTA

A Retrospective and Clinical Analysis of Dieulafoy's Lesion (DL)

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A Retrospective and Clinical Analysis of Dieulafoy's Lesion ...

作者： Satish Gurung 大连医科大学

学位级别：硕士

Aim: Dieulafoy’s Lesion is an emergency condition. It’s a rare disease causing massive GI bleeding. It accounts for 1.5% of cases of acute GI bleeding. Its obvious clinical features are hematemesis or melena or both hematemesis and melena accompanied by hemodynamic symptoms such as fatigue, palpitation, dyspnea and upper abdominal discomfort. Endoscopy plays the crucial role in both diagnosing and treating the DL. Under endoscopies, there are many alternatives as a treatment such as hemoclips, sclerotherapy, purified ethanol, and epinephrine injection. Its mortality is still high despite of advanced endoscopic therapies. However compare to past records, its mortality has somehow decreased. We aim to report our experience in the clinical features, diagnosis and treatment choice along with mortality rate.Methods: A retrospective and clinical analysis of 18 patients with DL between 1990-2005 was done. The clinical characteristics including sex, age, presenting symptoms, shock, bleeding amount, blood pressure and hemoglobin at the time of hospitalization, blood transfusion requirement and its amount, patients past history along with requirement of surgery and total number of days hospitalized were recorded. The study was designed as a retrospective, analysis of importance of endoscopy in diagnosing and treating DL during its active bleeding of DL. Based on the endoscopic findings, the location of DL, picture of bleeding, presence of *** and endoscopic treatment were recorded.

关键词： Dieulafoy’s Lesion (DL) hematemesis Endoscopy Hemostasis