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Gastrointestinal Bleeding
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
In general, LGIB will present with hematochezia, but about 10% of UGIB will present in a similar fashion. While insertion of an NGT with lavage has been used to differentiate UGIB from LGIB, the sensitivity of the test is so low as to obviate its use. In all cases of hematochezia, upper and lower GI endoscopy should be utilized as the primary means of identifying the etiology of the hemorrhage.
Endometriosis
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Ceana Nezhat, Pavan Ananth, Dahlia Admon
Although mucosal involvement of the gastrointestinal tract with endometriosis is uncommon, when it does occur, it can cause significant morbidity. In a cohort of 80 patients with severe, ongoing hematochezia from an unknown source, 28 patients were female, and endometriosis was one of the pathologies diagnosed after emergent colonoscopy. The patients in the study had all been actively bleeding for 6 hours and had been admitted to an intensive care unit for resuscitation due to blood loss. They had been transfused with a mean of 6.5 units of blood and had already undergone anoscopy, rigid sigmoidoscopy, and nasogastric tube aspiration in an effort to diagnose the etiology of the hematochezia. This demonstrates that endometriosis can be a cause of severe, intractable rectal hemorrhage and should be in the differential diagnosis, particularly in patients with consistent history and physical exam findings [14].
Laparoscopic Surgery in Obstructed and Recurrent Tumors
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Ramraj Vemala Nagendra Gupta, Govind Nandakumar
Clinical manifestations indicate the site and morphology of a tumor to an extent and aid in planning treatment. Colorectal cancers typically present with altered bowel habits (74%), rectal bleeding (71%), unexplained iron deficiency anaemia (9.6%), or abdominal pain (3.8%) [4]. Altered bowel habits and hematochezia is more common with left-sided tumors and unexplained iron deficiency anaemia is more common with right-sided tumors [5]. Abdominal pain may arise from tumors at any site and usually indicate intestinal obstruction, perforation, or peritoneal dissemination.
A giant hemangioma of the sigmoid colon as a cause of lower gastrointestinal bleeding in a young man
Published in Baylor University Medical Center Proceedings, 2022
Lucas Fair, Benjamin Gough, Adatee Oknokwo, Ronney Stadler
Recent large retrospective reviews have evaluated the role of endoscopy in young patients. One study evaluated endoscopy reports of 9,098 young patients with outlet bleeding, suspicious bleeding, hemorrhage, and occult bleeding. In patients with classic outlet bleeding, defined as bright red blood after defecation with no family history of colorectal neoplasia or change in bowel habits, the yield of a complete diagnostic colonoscopy was low. Only 6.7% of patients with classic outlet bleeding had lesions seen on colonoscopy. Younger patients with outlet bleeding had a particularly low yield on colonoscopy, as only 3/703 (1.6%) had adenomas >1 cm, and no invasive cancers were detected. Notably, hemangioma was not recorded as a cause of bleeding in any of the 9,098 patients.11 Another retrospective study reviewed the results of 361 patients who underwent colonoscopies for hematochezia and found that the most common cause was hemorrhoids (69.6%). Again, hemangiomas were not recorded as a cause of bleeding.12 CT can be considered a key diagnostic adjunct, as wall thickening and extraluminal extension of any masses seen on colonoscopy can be accurately evaluated prior to surgical intervention.7
Meckel’s Diverticulum with Dieulafoy’s Lesion: A Cause of Severe Hematochezia
Published in Fetal and Pediatric Pathology, 2021
This study examined 10 cases of pediatric patients who underwent the surgical removal of MD initially presenting with severe hematochezia at Miyagi Children’s Hospital, Japan. Pertinent clinical and histological information is summarized in Table 1. The patients included 9 males and 1 female, and the mean age at presentation was 6.8 years (range, 1.8–14.8 years). All 10 patients exhibited moderate to severe anemia due to hematochezia, and 4 cases required blood transfusion. Technetium-99m pertechnetate (Tc-99m) scintigraphy demonstrated abnormal uptake in the expected area of occurrence of MD in 8 cases. For histological examination, the resected specimens were fixed in 10% formalin, sliced at 5 mm intervals, embedded in paraffin, sectioned at 3.0 µm thickness, and stained with hematoxylin-eosin and Elastica-Masson stains. If the specimen was not immediately diagnostic, up to 50 30-μm step sections were added to detect the vascular lesion.
Cytomegalovirus enteritis with intractable diarrhea in infants from a tertiary care center in China
Published in Scandinavian Journal of Gastroenterology, 2020
Yuhuan Wang, Zhiheng Huang, Ziqing Ye, Cuifang Zheng, Zhinong Jiang, Ying Huang
Five patients were born via cesarean delivery, and five were born via vaginal delivery. Seven patients were breastfed, two were fed breast milk and formula, and one patient was fed formula. All 10 CMV colitis patients were immunocompetent. All patients had diarrhea. Five patients had disease onset within 1 month after birth, with a median age of disease onset of 2.5 months [2.0, 6.3 months]. The average duration of disease was 57.5 days [29.3, 68.8 days]. Diarrhea and hematochezia were the main GI symptoms for these patients. Fever, retinitis, hearing impairment, and anemia were the main extraintestinal symptoms. Detailed information on the clinical phenotype and treatment of patients with CMV colitis is provided in Table 1.