We report the case of a 17-year-old male admitted to our academic hospital with massive rectal bleeding.Since childhood he had reported recurrent gastrointestinal bleeding and had two exploratory laparotomies 5and 2 y...We report the case of a 17-year-old male admitted to our academic hospital with massive rectal bleeding.Since childhood he had reported recurrent gastrointestinal bleeding and had two exploratory laparotomies 5and 2 years previously.An emergency abdominal computed tomography scan,gastroscopy and colonoscopy,performed after hemodynamic stabilization,were considered normal.High-dose intravenous proton pump inhibitor(PPI)therapy was initiated and bleeding stopped spontaneously.Two other massive rectal bleeds occurred 8 h after each cessation of PPI which led to a hemostatic laparotomy after negative gastroscopy and small bowel capsule endoscopy.This showed long tubular duplication of the right colon,with fresh blood in the duplicated colon.Obscure lower gastrointestinal bleeding is a difficult medical situation and potentially life-threatening.The presence of ulcerated ectopic gastric mucosa in the colonic duplication explains the partial efficacy of PPI therapy.Obscure gastrointestinalbleeding responding to empiric anti-acid therapy should probably evoke the diagnosis of bleeding ectopic gastric mucosa such as Meckel’s diverticulum or gastrointestinal duplication,and gastroenterologists should be aware of this potential medical situation.展开更多
A 61-year-old woman had cholangitis secondary to two cholelithiases[one in the common bile duct(CBD)and one in the cystic duct(Mirizzi syndrome)],which was treated by antibiotics.The patient subsequently underwent a s...A 61-year-old woman had cholangitis secondary to two cholelithiases[one in the common bile duct(CBD)and one in the cystic duct(Mirizzi syndrome)],which was treated by antibiotics.The patient subsequently underwent a shincterotomy with endoscopic retrograde cholangiopancreatography(ERCP)and,finally,a cholecystectomy by coelioscopy.The postoperative course was marked by biliary leakage.She was transferred to our hospital due to haemorrhagic shock and abdominal pain.展开更多
文摘We report the case of a 17-year-old male admitted to our academic hospital with massive rectal bleeding.Since childhood he had reported recurrent gastrointestinal bleeding and had two exploratory laparotomies 5and 2 years previously.An emergency abdominal computed tomography scan,gastroscopy and colonoscopy,performed after hemodynamic stabilization,were considered normal.High-dose intravenous proton pump inhibitor(PPI)therapy was initiated and bleeding stopped spontaneously.Two other massive rectal bleeds occurred 8 h after each cessation of PPI which led to a hemostatic laparotomy after negative gastroscopy and small bowel capsule endoscopy.This showed long tubular duplication of the right colon,with fresh blood in the duplicated colon.Obscure lower gastrointestinal bleeding is a difficult medical situation and potentially life-threatening.The presence of ulcerated ectopic gastric mucosa in the colonic duplication explains the partial efficacy of PPI therapy.Obscure gastrointestinalbleeding responding to empiric anti-acid therapy should probably evoke the diagnosis of bleeding ectopic gastric mucosa such as Meckel’s diverticulum or gastrointestinal duplication,and gastroenterologists should be aware of this potential medical situation.
文摘A 61-year-old woman had cholangitis secondary to two cholelithiases[one in the common bile duct(CBD)and one in the cystic duct(Mirizzi syndrome)],which was treated by antibiotics.The patient subsequently underwent a shincterotomy with endoscopic retrograde cholangiopancreatography(ERCP)and,finally,a cholecystectomy by coelioscopy.The postoperative course was marked by biliary leakage.She was transferred to our hospital due to haemorrhagic shock and abdominal pain.
