A 35-year-old man was admitted due to bloody stool and anemia. The bleeding source could not be detected by esophagogastroduodenoscopy or colonoscopy. Double balloon endoscopy (DBE) revealed a diverticulum-like hole i...A 35-year-old man was admitted due to bloody stool and anemia. The bleeding source could not be detected by esophagogastroduodenoscopy or colonoscopy. Double balloon endoscopy (DBE) revealed a diverticulum-like hole in which coagula stuck in the ileum at 1 meter on the oral side from the ileocecal valve. The adjacent mucosa just to the oral side of the hole was elevated like a submucosal tumor. The lesion was considered the source of bleeding and removed surgically. It was determined to be a cyst with an ileal structure on the mesenteric aspect accompanying gastric mucosa. The diagnosis was a duplication cyst of the ileum,which is a rare entity that can cause gastrointestinal bleeding. In the present case,DBE was used to fi nd the hemorrhagic duplication cyst in the ileum.展开更多
Small intestinal hemolymphangioma is a very rare benign tumor.There was only one report of a hemolymphangioma of the pancreas invading to the duodenum until March 2011.Here we describe the first case of small intestin...Small intestinal hemolymphangioma is a very rare benign tumor.There was only one report of a hemolymphangioma of the pancreas invading to the duodenum until March 2011.Here we describe the first case of small intestinal hemolymphangioma with bleeding in a 57-year-old woman.She presented with persistent gastrointestinal bleeding and endoscopy revealed a small intestinal tumor.Partial resection of the small intestine was thus performed and the final pathological diagnosis was hemolymphangioma.We also highlight the difficultly in making an accurate preoperative diagnosis in spite of modern imaging techniques.To arrive at a definitive diagnosis and exclude malignancy,partial resection of the small intestine was considered to be the required treatment.展开更多
To assess the use of serum levels of angiopoietin-1 (Ang1), Ang2 and tumor necrosis factor-α (TNFα) as predictive factors for small bowel angiodysplasia (SBA). METHODSSerum samples were collected from patients under...To assess the use of serum levels of angiopoietin-1 (Ang1), Ang2 and tumor necrosis factor-α (TNFα) as predictive factors for small bowel angiodysplasia (SBA). METHODSSerum samples were collected from patients undergoing capsule endoscopy for any cause of obscure gastrointestinal bleeding (OGIB) or anaemia. Based on small bowel findings patients were divided into 3 groups: (1) SBA; (2) other bleeding causes; and (3) normal, according to diagnosis. Using ELISA technique we measured serum levels of Ang1, Ang2 and TNFα and compared mean and median levels between the groups based on small bowel diagnosis. Using receiver operator curve analysis we determined whether any of the factors were predictive of SBA. RESULTSSerum samples were collected from a total of 120 patients undergoing capsule endoscopy for OGIB or anaemia: 40 with SBA, 40 with other causes of small bowel bleeding, and 40 with normal small bowel findings. Mean and median serum levels were measured and compared between groups; patients with SBA had significantly higher median serum levels of Ang2 (3759 pg/mL) compared to both other groups, with no significant differences in levels of Ang1 or TNFα based on diagnosis. There were no differences in Ang2 levels between the other bleeding causes (2261 pg/mL) and normal (2620 pg/mL) groups. Using Receiver Operator Curve analysis, an Ang2 level of > 2600 pg/mL was found to be predictive of SBA, with an area under the curve of 0.7. Neither Ang1 or TNFα were useful as predictive markers. CONCLUSIONElevations in serum Ang2 are specific for SBA and not driven by other causes of bleeding and anaemia. Further work will determine whether Ang2 is useful as a diagnostic or prognostic marker for SBA.展开更多
The small intestine is an uncommon site of gastro-intestinal(GI)bleeding;however it is the commonest cause of obscure GI bleeding.It may require multiple blood transfusions,diagnostic procedures and repeated hospitali...The small intestine is an uncommon site of gastro-intestinal(GI)bleeding;however it is the commonest cause of obscure GI bleeding.It may require multiple blood transfusions,diagnostic procedures and repeated hospitalizations.Angiodysplasia is the commonest cause of obscure GI bleeding,particularly in the elderly.Inflammatory lesions and tumours are the usual causes of small intestinal bleeding in younger patients.Capsule endoscopy and deep enteroscopy have improved our ability to investigate small bowel bleeds.Deep enteroscopy has also an added advantage of therapeutic potential.Computed tomography is helpful in identifying extra-intestinal lesions.In cases of difficult diagnosis,surgery and intra-operative enteroscopy can help with diagnosis and management.The treatment is dependent upon the aetiology of the bleed.An overt bleed requires aggressive resuscitation and immediate localisation of the lesion for institution of appropriate therapy.Small bowel bleeding can be managed by conservative,radiological,pharmacological,endoscopic and surgical methods,depending upon indications,expertise and availability.Some patients,especially those with multiple vascular lesions,can re-bleed even after appropriate treatment and pose difficult challenge to the treating physician.展开更多
Digestive tract hemorrhage is a common disease of the digestive system, but about 0. 4% -5% intestinal bleeding can not be detected with gastroscope or colonscope. 1 Since the intestine is long, tortuous, far away fro...Digestive tract hemorrhage is a common disease of the digestive system, but about 0. 4% -5% intestinal bleeding can not be detected with gastroscope or colonscope. 1 Since the intestine is long, tortuous, far away from both ends of the digestive tract and unfixed in position, clinical diagnosis of the bleeding is relatively difficult. Yamamoto and Sugano2 reported the clinical application of double-balloon enteroscope at American DDW in 2003. Since this new instrument can help to observe the entire intestine, obtain biopsy sample, mark lesions and carry out treatments, it has drawn the attention of researchers all over the world. In 2003, we successfully used Japanese Fujinon double-balloon enteroscope in detecting suspected intestinal hemorrhage in 57 patients.展开更多
文摘A 35-year-old man was admitted due to bloody stool and anemia. The bleeding source could not be detected by esophagogastroduodenoscopy or colonoscopy. Double balloon endoscopy (DBE) revealed a diverticulum-like hole in which coagula stuck in the ileum at 1 meter on the oral side from the ileocecal valve. The adjacent mucosa just to the oral side of the hole was elevated like a submucosal tumor. The lesion was considered the source of bleeding and removed surgically. It was determined to be a cyst with an ileal structure on the mesenteric aspect accompanying gastric mucosa. The diagnosis was a duplication cyst of the ileum,which is a rare entity that can cause gastrointestinal bleeding. In the present case,DBE was used to fi nd the hemorrhagic duplication cyst in the ileum.
文摘Small intestinal hemolymphangioma is a very rare benign tumor.There was only one report of a hemolymphangioma of the pancreas invading to the duodenum until March 2011.Here we describe the first case of small intestinal hemolymphangioma with bleeding in a 57-year-old woman.She presented with persistent gastrointestinal bleeding and endoscopy revealed a small intestinal tumor.Partial resection of the small intestine was thus performed and the final pathological diagnosis was hemolymphangioma.We also highlight the difficultly in making an accurate preoperative diagnosis in spite of modern imaging techniques.To arrive at a definitive diagnosis and exclude malignancy,partial resection of the small intestine was considered to be the required treatment.
文摘To assess the use of serum levels of angiopoietin-1 (Ang1), Ang2 and tumor necrosis factor-α (TNFα) as predictive factors for small bowel angiodysplasia (SBA). METHODSSerum samples were collected from patients undergoing capsule endoscopy for any cause of obscure gastrointestinal bleeding (OGIB) or anaemia. Based on small bowel findings patients were divided into 3 groups: (1) SBA; (2) other bleeding causes; and (3) normal, according to diagnosis. Using ELISA technique we measured serum levels of Ang1, Ang2 and TNFα and compared mean and median levels between the groups based on small bowel diagnosis. Using receiver operator curve analysis we determined whether any of the factors were predictive of SBA. RESULTSSerum samples were collected from a total of 120 patients undergoing capsule endoscopy for OGIB or anaemia: 40 with SBA, 40 with other causes of small bowel bleeding, and 40 with normal small bowel findings. Mean and median serum levels were measured and compared between groups; patients with SBA had significantly higher median serum levels of Ang2 (3759 pg/mL) compared to both other groups, with no significant differences in levels of Ang1 or TNFα based on diagnosis. There were no differences in Ang2 levels between the other bleeding causes (2261 pg/mL) and normal (2620 pg/mL) groups. Using Receiver Operator Curve analysis, an Ang2 level of > 2600 pg/mL was found to be predictive of SBA, with an area under the curve of 0.7. Neither Ang1 or TNFα were useful as predictive markers. CONCLUSIONElevations in serum Ang2 are specific for SBA and not driven by other causes of bleeding and anaemia. Further work will determine whether Ang2 is useful as a diagnostic or prognostic marker for SBA.
文摘The small intestine is an uncommon site of gastro-intestinal(GI)bleeding;however it is the commonest cause of obscure GI bleeding.It may require multiple blood transfusions,diagnostic procedures and repeated hospitalizations.Angiodysplasia is the commonest cause of obscure GI bleeding,particularly in the elderly.Inflammatory lesions and tumours are the usual causes of small intestinal bleeding in younger patients.Capsule endoscopy and deep enteroscopy have improved our ability to investigate small bowel bleeds.Deep enteroscopy has also an added advantage of therapeutic potential.Computed tomography is helpful in identifying extra-intestinal lesions.In cases of difficult diagnosis,surgery and intra-operative enteroscopy can help with diagnosis and management.The treatment is dependent upon the aetiology of the bleed.An overt bleed requires aggressive resuscitation and immediate localisation of the lesion for institution of appropriate therapy.Small bowel bleeding can be managed by conservative,radiological,pharmacological,endoscopic and surgical methods,depending upon indications,expertise and availability.Some patients,especially those with multiple vascular lesions,can re-bleed even after appropriate treatment and pose difficult challenge to the treating physician.
文摘Digestive tract hemorrhage is a common disease of the digestive system, but about 0. 4% -5% intestinal bleeding can not be detected with gastroscope or colonscope. 1 Since the intestine is long, tortuous, far away from both ends of the digestive tract and unfixed in position, clinical diagnosis of the bleeding is relatively difficult. Yamamoto and Sugano2 reported the clinical application of double-balloon enteroscope at American DDW in 2003. Since this new instrument can help to observe the entire intestine, obtain biopsy sample, mark lesions and carry out treatments, it has drawn the attention of researchers all over the world. In 2003, we successfully used Japanese Fujinon double-balloon enteroscope in detecting suspected intestinal hemorrhage in 57 patients.
