BACKGROUND This case report presents the rare occurrence of hematochezia due to an internal iliac artery aneurysm leading to an arterioenteric fistula,expanding the differential diagnosis for gastrointestinal bleeding...BACKGROUND This case report presents the rare occurrence of hematochezia due to an internal iliac artery aneurysm leading to an arterioenteric fistula,expanding the differential diagnosis for gastrointestinal bleeding.It emphasizes the importance of considering vascular origins in cases of atypical hematochezia,particularly in the absence of common gastrointestinal causes,and highlights the role of imaging and multidisciplinary management in diagnosing and treating such unusual presentations.CASE SUMMARY A 75-year-old man with a history of hypertension presented with 12 d of hematochezia,experiencing bloody stools 7-8 times per day.Initial computed tomography(CT)scans revealed an aneurysmal rupture near the right internal iliac artery with suspected hematoma development.Hemoglobin levels progressively decreased to 7 g/dL.Emergency arterial angiography and iliac arterycovered stent placement were performed,followed by balloon angioplasty.Despite initial stabilization,minor rectal bleeding and abdominal pain persisted,leading to further diagnostic colonoscopy.This identified a neoplasm and potential perforation at the proximal rectum.An exploratory laparotomy confirmed the presence of a hematoma and an aneurysm invading the rectal wall,necessitating partial rectal resection,intestinal anastomosis,and ileostomy.Postoperative recovery was successful,with no further bleeding incidents and normal follow-up CT and colonoscopy results after six months.CONCLUSION In cases of unusual gastrointestinal bleeding,it is necessary to consider vascular causes for effective diagnosis and intervention.展开更多
BACKGROUND Alimentary tract duplication is a rare congenital disease that may occur in any part of the alimentary tract,whereas thoracoabdominal duplications only account for approximately 2%of all alimentary tract du...BACKGROUND Alimentary tract duplication is a rare congenital disease that may occur in any part of the alimentary tract,whereas thoracoabdominal duplications only account for approximately 2%of all alimentary tract duplication cases.Many symptoms,including abdominal pain,abdominal distension,vomiting,gastrointestinal bleeding,chest discomfort,chest pain,and shortness of breath,may be present in patients with abdominal or thoracic duplication.CASE SUMMARY A 10-mo-old infant,with a free previous medical history,was admitted to our hospital with melena three times in 6 d.Enhanced magnetic resonance imaging of the thoracic vertebrae revealed multiple cervicothoracic vertebral deformities,spina bifida,meningomyelocele towards the posterior mediastinum,and possible concurrent infection.Upper gastroenterography indicated intestinal malrotation.A laparoscopic abdominal examination was performed,and the operation was intraoperatively converted to laparotomy.This case was diagnosed intraoperatively as thoracoabdominal intestinal duplication.The intestinal duplications in the abdomen and large part of the thorax were excised.The results of postoperative pathological examination confirmed that this case was alimentary tract duplication and that part of the duplication contained gastric mucosa.The infant recovered well and was discharged 1 wk after the surgery.A follow-up computed tomography scan 3 mo after operation showed myelomeningocele while the posterior mediastinal cyst was significantly reduced.CONCLUSION Thoracoabdominal duplication should be considered if a child has suspected abdominal intestinal duplication with hematochezia as an onset symptom.展开更多
Peptic ulcer disease is uncommon in children and rarely suspected as a cause of abdominal complaints in this age group; the diagnosis is therefore made almost exclusively when complications develop. Peptic ulcer disea...Peptic ulcer disease is uncommon in children and rarely suspected as a cause of abdominal complaints in this age group; the diagnosis is therefore made almost exclusively when complications develop. Peptic ulcer disease is usually not considered in the differential diagnosis of pediatric patients. We present the case of a 30-month-old boy with duodenal perforation due to a peptic ulcer without a known etiology. The patient was admitted through the emergency department due to severe hematochezia and ongoing anemia; he presented with neither abdominal pain nor abdominal distension. There were no medical problems, and no drugs, such as corticosteroids or nonsteroidal anti-inflammatory drugs, had been prescribed or administered recently. We tried to control the active bleeding by medical treatment including arterial embolization, but the active bleeding was not controlled. Finally, an exploratory laparotomy was performed. A discrete anterior perforation with active bleeding of the duodenal wall was found. After the operation, there were no complications and the patient recovered fully.展开更多
AIM: To relate the endoscopic findings in patients with hematochezia with regard to age in “low and average risk” for colorectal cancer (CRC) and to localize signifi cant lesions in order to identify patients who ne...AIM: To relate the endoscopic findings in patients with hematochezia with regard to age in “low and average risk” for colorectal cancer (CRC) and to localize signifi cant lesions in order to identify patients who need sigmoidoscopy or total colonoscopy. METHODS: This prospective study was performed in an open access GI endoscopy unit. Out of 4322 consecutive patients undergoing colonoscopy, 918 reported hema- tochezia. The fi nal study group comprized 180 patients aged below 45 and 237 over 45. Main exclusion criteria were a 1st-degree family history of colorectal carcinoma, patients reporting blood mixed with stools and/or pro- gressive colonic symptoms, or patients who had under- gone colon surgery for neoplastic lesions. RESULTS: Total colonoscopy could be performed in 96% of patients. Abnormal findings were observed in 34.3% of the younger and in 65.7% of the older ones. Findings were the presence of polyps in the distal colon (n = 2) and IBD in the proximal colon (n = 29) in the group of the younger patients, and polyps (n = 15), IBD (n = 13), and carcinoma (n = 6, 4 of the lesions were located proximal to the splenic flexure) in the elderly. Our f indings suggest that the diagnostic potential of total colonoscopy in patients younger than 45 referring scant hematochezia, is not mandatory. By exploring only the distal tract of the colon we have misdiagnosed two cases of IBD located in the ascending colon. In this group of patients additional risk factors must be identifi ed before performing a total colonoscopy. Regarding the patients older than 45 yr, the exploration of the distal colon would have led to our overlooking a carcinoma, two neoplastic polyps and one IBD located in the proximal colon. CONCLUSION: Young patients with scant hematochezia but without risk factors for neoplasia do not need a totalcolonoscopy, whereas is mandatory performing a total colonoscopy in older patients even in the presence of anal pathology.展开更多
A 76 year old woman with bloody stools and symp-tomatic anemia presented to the Emergency Department approximately 2 wk after computed tomography (CT)-guided cryoablation to a 4.5 cm renal cell car-cinoma on her left ...A 76 year old woman with bloody stools and symp-tomatic anemia presented to the Emergency Department approximately 2 wk after computed tomography (CT)-guided cryoablation to a 4.5 cm renal cell car-cinoma on her left posterior kidney. The patient was initially prepped for a colonoscopy to view possible causes of lower gastrointestinal bleeding. However, the patient had a CT with PO contrast that revealed a variation of a renoalimentary fistula. The patient was subsequently brought to the operating room, and it was discovered that a colo-renal fistula had formed, with transmural perforation of the posterior descending colon. A left nephrectomy, left colectomy with colostomy and Hartmann's pouch was performed.展开更多
Upper gastrointestinal bleeding remains a significant cause of hospital admissions. Even though the incidence of peptic ulcer disease and gastritis is decreasing, the incidence rates in neoplasm, Dieulafoy’s lesions,...Upper gastrointestinal bleeding remains a significant cause of hospital admissions. Even though the incidence of peptic ulcer disease and gastritis is decreasing, the incidence rates in neoplasm, Dieulafoy’s lesions, angiodysplasia, and esophagitis are trending up, which necessities physicians to be aware of those pathologies and their specifics. Here, we represent a case of a 62-year-old male on dual antiplatelet therapy who was transferred to our hospital due to severe melena with suspicion of upper gastrointestinal bleeding. Due to hemodynamic instability, the patient was intubated and started on vasopressors. However, several repeated EGDs and CTs of the abdomen with GI bleeding protocol did not reveal the location of active bleeding to stop it. At the same time, clinically, the patient was hemodynamically unstable with continued melena. On the last EGD, a small area of concern resembling gastric varix was clipped for identification purposes, and the patient underwent a selective angiogram with further diagnosis of Dieulafoy’s lesion, which was successfully embolized. Our case demonstrates that Dieulafoy’s lesions can present as severe life-threatening hemorrhage, hard to diagnose with traditional methods such as EGD or CTs, in which case it is recommended to proceed with an angiogram sooner rather than later for further diagnosis and treatment if needed.展开更多
目的:研究治疗便血方剂的用药规律及其“核心配伍-作用靶点”的关联性。方法:从《中医方剂大辞典》中筛选治疗便血的方剂,录入数据库,进行频数、聚类和关联分析,从中发现配伍组方规律。找到核心配伍组合后,再使用中药分子机制的生物信...目的:研究治疗便血方剂的用药规律及其“核心配伍-作用靶点”的关联性。方法:从《中医方剂大辞典》中筛选治疗便血的方剂,录入数据库,进行频数、聚类和关联分析,从中发现配伍组方规律。找到核心配伍组合后,再使用中药分子机制的生物信息学分析工具(Bioinformatics Analysis Tool for Molecular Mechanism of Traditional Chinese Medicine,BATMAN-TCM)对核心配伍组合进行活性成分-靶点预测,从而分析核心配伍组合的共同作用靶点。结果:共收录便血方剂616首,涉及中药340味;排名前10的高频药物依次是当归、甘草、黄连、芍药、枳壳、生地黄、黄芩、地榆、槐花、黄芪;主要使用的中药类别依次是补虚药、清热药、止血药。发现生地黄、黄芩、赤芍,人参、白术、茯苓,侧柏叶、地榆、槐花,当归和川芎等是治疗便血的四组核心配伍组合;经分析发现这四组核心配伍组合均有AR、ESR1、NR3C1、PGR、VDR这5个共同作用靶点,即治疗便血的11个核心药物有5个共同作用靶点。结论:《中医方剂大辞典》所载便血方剂的核心配伍组合关联的AR、NR3C1、PGR、VDR等靶点与肠炎、结直肠癌、胃癌等常导致便血的相关疾病密切相关,提示其“核心配伍-作用靶点”的关联性对于指导临床用药以及相关基础研究和新药开发有一定参考意义。展开更多
BACKGROUND Klippel-Trenaunay syndrome(KTS) is a congenital vascular malformation with a complicated etiology. It is sporadic and clinically rare in occurrence. The typical characteristics are capillary malformation(al...BACKGROUND Klippel-Trenaunay syndrome(KTS) is a congenital vascular malformation with a complicated etiology. It is sporadic and clinically rare in occurrence. The typical characteristics are capillary malformation(also known as port-wine stain),varicose veins and malformations, and bony and/or soft tissue hypertrophy with or without lymphatic malformation, which are known as the “classic clinical triad”. Herein, a rare case of KTS characterized by crossed-bilateral limb hypertrophy accompanied by intermittent hematochezia and hematuria is reported.CASE SUMMARY We described a 37-year-old female with KTS. She was admitted to our hospital owing to the gradual enlargement of the left lower extremity along with intermittent hematochezia and hematuria. The patient was diagnosed to have hemorrhoid bleeding by other hospitals and treated with conventional hemostatic drugs, but continued to have intermittent gastrointestinal bleeding and hematuria. Therefore, she visited our hospital to seek further treatment. During hospitalization, relevant imaging and laboratory examinations and colonoscopy were performed. In combination with the patient’s history and relevant examinations, we considered that the patient had a complex form of KTS. We recommended a combined diagnosis and treatment from the vascular, interventional,anorectal, and other departments, although she declined any further treatment for financial reasons.CONCLUSION The clinical manifestations of KTS are extensive and diverse and chiefly include the typical triad. However, Vascular malformations of KTS can also involve several parts and systems such as digestive and urogenital systems. Therefore, the atypical manifestations and rare complications necessitate the clinician’s attention and are not to be ignored.展开更多
Ischemic colitis is the most common form of intestinal ischemia.It is a condition that is commonly seen in the elderly and among individuals with risk factors for ischemia.Common predisposing conditions for ischemic c...Ischemic colitis is the most common form of intestinal ischemia.It is a condition that is commonly seen in the elderly and among individuals with risk factors for ischemia.Common predisposing conditions for ischemic colitis are major vascular occlusion,small vessel disorder,shock,some medications,colonic obstructions and hematologic disorders.Ischemic colitis following colonoscopy is rare.Here,we report two cases of ischemic colitis after a routine screening colonoscopy in patients without risk factors for ischemia.展开更多
文摘BACKGROUND This case report presents the rare occurrence of hematochezia due to an internal iliac artery aneurysm leading to an arterioenteric fistula,expanding the differential diagnosis for gastrointestinal bleeding.It emphasizes the importance of considering vascular origins in cases of atypical hematochezia,particularly in the absence of common gastrointestinal causes,and highlights the role of imaging and multidisciplinary management in diagnosing and treating such unusual presentations.CASE SUMMARY A 75-year-old man with a history of hypertension presented with 12 d of hematochezia,experiencing bloody stools 7-8 times per day.Initial computed tomography(CT)scans revealed an aneurysmal rupture near the right internal iliac artery with suspected hematoma development.Hemoglobin levels progressively decreased to 7 g/dL.Emergency arterial angiography and iliac arterycovered stent placement were performed,followed by balloon angioplasty.Despite initial stabilization,minor rectal bleeding and abdominal pain persisted,leading to further diagnostic colonoscopy.This identified a neoplasm and potential perforation at the proximal rectum.An exploratory laparotomy confirmed the presence of a hematoma and an aneurysm invading the rectal wall,necessitating partial rectal resection,intestinal anastomosis,and ileostomy.Postoperative recovery was successful,with no further bleeding incidents and normal follow-up CT and colonoscopy results after six months.CONCLUSION In cases of unusual gastrointestinal bleeding,it is necessary to consider vascular causes for effective diagnosis and intervention.
基金National Natural Science Foundation of China,No.81801498Shanghai Municipal Health Commission Foundation,No.20174Y0018Shanghai“Rising Stars of Medical Talent”Youth Development Program,No.2019-72.
文摘BACKGROUND Alimentary tract duplication is a rare congenital disease that may occur in any part of the alimentary tract,whereas thoracoabdominal duplications only account for approximately 2%of all alimentary tract duplication cases.Many symptoms,including abdominal pain,abdominal distension,vomiting,gastrointestinal bleeding,chest discomfort,chest pain,and shortness of breath,may be present in patients with abdominal or thoracic duplication.CASE SUMMARY A 10-mo-old infant,with a free previous medical history,was admitted to our hospital with melena three times in 6 d.Enhanced magnetic resonance imaging of the thoracic vertebrae revealed multiple cervicothoracic vertebral deformities,spina bifida,meningomyelocele towards the posterior mediastinum,and possible concurrent infection.Upper gastroenterography indicated intestinal malrotation.A laparoscopic abdominal examination was performed,and the operation was intraoperatively converted to laparotomy.This case was diagnosed intraoperatively as thoracoabdominal intestinal duplication.The intestinal duplications in the abdomen and large part of the thorax were excised.The results of postoperative pathological examination confirmed that this case was alimentary tract duplication and that part of the duplication contained gastric mucosa.The infant recovered well and was discharged 1 wk after the surgery.A follow-up computed tomography scan 3 mo after operation showed myelomeningocele while the posterior mediastinal cyst was significantly reduced.CONCLUSION Thoracoabdominal duplication should be considered if a child has suspected abdominal intestinal duplication with hematochezia as an onset symptom.
基金Supported by (in part) The Chung-Ang University Research Grant in 2009
文摘Peptic ulcer disease is uncommon in children and rarely suspected as a cause of abdominal complaints in this age group; the diagnosis is therefore made almost exclusively when complications develop. Peptic ulcer disease is usually not considered in the differential diagnosis of pediatric patients. We present the case of a 30-month-old boy with duodenal perforation due to a peptic ulcer without a known etiology. The patient was admitted through the emergency department due to severe hematochezia and ongoing anemia; he presented with neither abdominal pain nor abdominal distension. There were no medical problems, and no drugs, such as corticosteroids or nonsteroidal anti-inflammatory drugs, had been prescribed or administered recently. We tried to control the active bleeding by medical treatment including arterial embolization, but the active bleeding was not controlled. Finally, an exploratory laparotomy was performed. A discrete anterior perforation with active bleeding of the duodenal wall was found. After the operation, there were no complications and the patient recovered fully.
文摘AIM: To relate the endoscopic findings in patients with hematochezia with regard to age in “low and average risk” for colorectal cancer (CRC) and to localize signifi cant lesions in order to identify patients who need sigmoidoscopy or total colonoscopy. METHODS: This prospective study was performed in an open access GI endoscopy unit. Out of 4322 consecutive patients undergoing colonoscopy, 918 reported hema- tochezia. The fi nal study group comprized 180 patients aged below 45 and 237 over 45. Main exclusion criteria were a 1st-degree family history of colorectal carcinoma, patients reporting blood mixed with stools and/or pro- gressive colonic symptoms, or patients who had under- gone colon surgery for neoplastic lesions. RESULTS: Total colonoscopy could be performed in 96% of patients. Abnormal findings were observed in 34.3% of the younger and in 65.7% of the older ones. Findings were the presence of polyps in the distal colon (n = 2) and IBD in the proximal colon (n = 29) in the group of the younger patients, and polyps (n = 15), IBD (n = 13), and carcinoma (n = 6, 4 of the lesions were located proximal to the splenic flexure) in the elderly. Our f indings suggest that the diagnostic potential of total colonoscopy in patients younger than 45 referring scant hematochezia, is not mandatory. By exploring only the distal tract of the colon we have misdiagnosed two cases of IBD located in the ascending colon. In this group of patients additional risk factors must be identifi ed before performing a total colonoscopy. Regarding the patients older than 45 yr, the exploration of the distal colon would have led to our overlooking a carcinoma, two neoplastic polyps and one IBD located in the proximal colon. CONCLUSION: Young patients with scant hematochezia but without risk factors for neoplasia do not need a totalcolonoscopy, whereas is mandatory performing a total colonoscopy in older patients even in the presence of anal pathology.
文摘A 76 year old woman with bloody stools and symp-tomatic anemia presented to the Emergency Department approximately 2 wk after computed tomography (CT)-guided cryoablation to a 4.5 cm renal cell car-cinoma on her left posterior kidney. The patient was initially prepped for a colonoscopy to view possible causes of lower gastrointestinal bleeding. However, the patient had a CT with PO contrast that revealed a variation of a renoalimentary fistula. The patient was subsequently brought to the operating room, and it was discovered that a colo-renal fistula had formed, with transmural perforation of the posterior descending colon. A left nephrectomy, left colectomy with colostomy and Hartmann's pouch was performed.
文摘Upper gastrointestinal bleeding remains a significant cause of hospital admissions. Even though the incidence of peptic ulcer disease and gastritis is decreasing, the incidence rates in neoplasm, Dieulafoy’s lesions, angiodysplasia, and esophagitis are trending up, which necessities physicians to be aware of those pathologies and their specifics. Here, we represent a case of a 62-year-old male on dual antiplatelet therapy who was transferred to our hospital due to severe melena with suspicion of upper gastrointestinal bleeding. Due to hemodynamic instability, the patient was intubated and started on vasopressors. However, several repeated EGDs and CTs of the abdomen with GI bleeding protocol did not reveal the location of active bleeding to stop it. At the same time, clinically, the patient was hemodynamically unstable with continued melena. On the last EGD, a small area of concern resembling gastric varix was clipped for identification purposes, and the patient underwent a selective angiogram with further diagnosis of Dieulafoy’s lesion, which was successfully embolized. Our case demonstrates that Dieulafoy’s lesions can present as severe life-threatening hemorrhage, hard to diagnose with traditional methods such as EGD or CTs, in which case it is recommended to proceed with an angiogram sooner rather than later for further diagnosis and treatment if needed.
文摘目的:研究治疗便血方剂的用药规律及其“核心配伍-作用靶点”的关联性。方法:从《中医方剂大辞典》中筛选治疗便血的方剂,录入数据库,进行频数、聚类和关联分析,从中发现配伍组方规律。找到核心配伍组合后,再使用中药分子机制的生物信息学分析工具(Bioinformatics Analysis Tool for Molecular Mechanism of Traditional Chinese Medicine,BATMAN-TCM)对核心配伍组合进行活性成分-靶点预测,从而分析核心配伍组合的共同作用靶点。结果:共收录便血方剂616首,涉及中药340味;排名前10的高频药物依次是当归、甘草、黄连、芍药、枳壳、生地黄、黄芩、地榆、槐花、黄芪;主要使用的中药类别依次是补虚药、清热药、止血药。发现生地黄、黄芩、赤芍,人参、白术、茯苓,侧柏叶、地榆、槐花,当归和川芎等是治疗便血的四组核心配伍组合;经分析发现这四组核心配伍组合均有AR、ESR1、NR3C1、PGR、VDR这5个共同作用靶点,即治疗便血的11个核心药物有5个共同作用靶点。结论:《中医方剂大辞典》所载便血方剂的核心配伍组合关联的AR、NR3C1、PGR、VDR等靶点与肠炎、结直肠癌、胃癌等常导致便血的相关疾病密切相关,提示其“核心配伍-作用靶点”的关联性对于指导临床用药以及相关基础研究和新药开发有一定参考意义。
基金Supported by the Basic Research Projects of Science and Technology Department of Guizhou Province,No. Qian Ke He-zk[2022]-646Master Start-up Foundation of Affiliated Hospital of Zunyi Medical College,No. 2016-45Collaborative Innovation Center of Chinese Ministry of Education,No. 2020-39。
文摘BACKGROUND Klippel-Trenaunay syndrome(KTS) is a congenital vascular malformation with a complicated etiology. It is sporadic and clinically rare in occurrence. The typical characteristics are capillary malformation(also known as port-wine stain),varicose veins and malformations, and bony and/or soft tissue hypertrophy with or without lymphatic malformation, which are known as the “classic clinical triad”. Herein, a rare case of KTS characterized by crossed-bilateral limb hypertrophy accompanied by intermittent hematochezia and hematuria is reported.CASE SUMMARY We described a 37-year-old female with KTS. She was admitted to our hospital owing to the gradual enlargement of the left lower extremity along with intermittent hematochezia and hematuria. The patient was diagnosed to have hemorrhoid bleeding by other hospitals and treated with conventional hemostatic drugs, but continued to have intermittent gastrointestinal bleeding and hematuria. Therefore, she visited our hospital to seek further treatment. During hospitalization, relevant imaging and laboratory examinations and colonoscopy were performed. In combination with the patient’s history and relevant examinations, we considered that the patient had a complex form of KTS. We recommended a combined diagnosis and treatment from the vascular, interventional,anorectal, and other departments, although she declined any further treatment for financial reasons.CONCLUSION The clinical manifestations of KTS are extensive and diverse and chiefly include the typical triad. However, Vascular malformations of KTS can also involve several parts and systems such as digestive and urogenital systems. Therefore, the atypical manifestations and rare complications necessitate the clinician’s attention and are not to be ignored.
文摘Ischemic colitis is the most common form of intestinal ischemia.It is a condition that is commonly seen in the elderly and among individuals with risk factors for ischemia.Common predisposing conditions for ischemic colitis are major vascular occlusion,small vessel disorder,shock,some medications,colonic obstructions and hematologic disorders.Ischemic colitis following colonoscopy is rare.Here,we report two cases of ischemic colitis after a routine screening colonoscopy in patients without risk factors for ischemia.
