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Abdominal emergencies
Published in Sam Mehta, Andrew Hindmarsh, Leila Rees, Handbook of General Surgical Emergencies, 2018
Sam Mehta, Andrew Hindmarsh, Leila Rees
A Sengstaken–Blakemore tube may be temporarily used to control the bleeding until definitive therapy is arranged (which may require transfer to a liver unit for transjugular intrahepatic porto-systemic shunt (TIPSS)88 insertion or surgery).
Stomach and duodenum
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The management of bleeding gastric varices is very challenging. Fortunately, most bleeding from varices is oesophageal and this is much more amenable to sclerotherapy, banding and balloon tamponade. Gastric varices may also be injected, although this is technically more difficult. Banding can also be used, again with difficulty. The gastric balloon of the Sengstaken-Blakemore tube can be used to arrest the haemorrhage if it is occurring from the fundus of the stomach or gastro-oesophageal junction. Octreotide is a somatostatin analogue that reduces portal pressure in patients with varices, and trials suggest that it is of value in arresting haemorrhage in these patients, although its overall effect on mortality remains in doubt. Glypressin is also said to be of use.
Diagnosis and Treatment of Variceal Hemorrhage Due to Cirrhosis
Published in Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba, Acute Care Surgery and Trauma, 2016
Robert M. Esterl, Aaron Lewis, Juan Marcano, Abdul Alarhayem, Gregory A. Abrahamian, K. Vincent Speeg
Balloon tamponade with a Sengstaken–Blakemore tube should only be used as a bridge to definitive therapy, whether transjugular intrahepatic portosystemic shunt (TIPSS) or surgical shunt. Although effective in controlling hemorrhage in >80% of patients, its usefulness is limited by a prohibitive side-effect profile (aspiration, tube migration, esophageal necrosis, and perforation), which carries a 20% mortality rate [1,3].
Risk factors for emergency endoscopic variceal ligation treatment failure of acute variceal bleeding
Published in Scandinavian Journal of Gastroenterology, 2022
Kunyi Liu, Rui Zhang, Chengyi Shi, Botao Wu, Siqi Liu, Hui Tian, Hongwei Du, Yan Li, Na Wang
A total of 219 patients who underwent emergency EVL treatment to control oesophageal variceal bleeding were collected. One hundred ninety-nine patients (90.9%) were successfully treated. Among them, 57 patients who had insufficient medical records were excluded. One hundred forty-two patients were classified into the ‘success group’. Twenty patients (9.1%) who experienced emergency EVL failure. Among them, one patient who had insufficient medical records were excluded. 19 patients were classified into the “failure group”. One hundred sixty-one patients were analysed in our study. Of the 19 failed patients, 9 patients underwent emergency endoscopic treatment again. Six patients were treated with a Sengstaken–Blakemore tube for haemostasis and endoscopic treatment again. Four patients received drug therapy. Among them, 2 failed patients died within five days and 2 failed patients gave up treatment and discharged (Figure 1). The two patients died of haemorrhagic shock and circulatory failure. The baseline characteristics of 161 patients are shown in Table 1. The cohort comprised 102 men (63.4%) and 59 women (36.6%), with a mean age of 55.0 years old (range: 26–80). The main aetiology of cirrhosis was hepatitis B virus (HBV) (92 cases, 57.1%). PVT was present in 43 patients (26.7%). There were 15 patients (9.3%) with SGRS/SSRS and 51 patients (31.7%) with moderate/abundant ascites. A total of 99 patients (61.5%) had first bleeding, and 34 cases (21.1%) had a previous EVL history. Of the 161 enrolled patients, 32 patients (19.9%) were given orotracheal intubation under intravenous anaesthetic induction during treatment. The number of patients with concomitant HCC was 30 (18.6%). During the endoscopic operations, 118 cases (73.3%) were observed as oesophageal varices F3, and 73 cases (45.3%) had active bleeding.
Different scoring systems to predict 6-week mortality in cirrhosis patients with acute variceal bleeding: a retrospective analysis of 202 patients
Published in Scandinavian Journal of Gastroenterology, 2018
Fang Wang, Shu Cui, Fengmei Wang, Fenghui Li, Fei Tang, Xu Zhang, Yanying Gao, Hongmin Lv
Emergency endoscopy was performed within 12–48 h after admission. According to Chinese Society of Hepatology guildlines, emergency endoscopy should be performed within 12h–24h after admission. In our study, most of patients were performed endoscopy within 12–24h after admission. Others delayed endoscopy because their clinical conditions were instable, such as blood transfusion and Sengstaken–Blakemore tube therapy. But all patients complicated endoscopy within 12h–48h after admission.