Acute massive gastrointestinal hemorrhage in jejunal diverticulosis

Two cases which presented with acute massive lower gastrointestinal hemorrhage from jejunal diverticulosis are reported. The various clinical presentations of this rare disease are discussed. The life-threatening complication of massive bleeding is specially outlined. The cases reported in the literature resemble the Dieulafoy ulcer lesion of the stomach.     

Upper digestive hemorrhage due to aortoesophageal fistula

We describe the case of a 60-year-old woman who presented with thoracic pain followed by hematemesis. Aortoesophageal fistula was diagnosed. Double aortic and esophageal protheses were placed with good clinical outcome. After 15 days, the patient presented migration of the esophageal prothesis and a further endoscopic examination was performed. A fishbone was visualized in the fistula orifice.     

Octreotide treatment of massive hemorrhage due to cytomegalovirus colitis.

Cytomegalovirus (CMV)-associated colitis can result in abdominal pain, diarrhea, significant blood loss and perforation. The standard therapy for CMV colitis includes supportive measures and antiviral medications. Severe hemorrhage due to CMV colitis often necessitates surgical resection. We present a case of a patient who was undergoing chemotherapy for acute B-cell lymphoblastic leukemia and developed significant abdominal pain and diarrhea followed by massive hematochezia. Colonoscopy showed numerous actively bleeding deep ulcers in the cecum. A provisional diagnosis of CMV colitis was made and she was started on ganciclovir. Histological assessment confirmed the diagnosis of CMV colitis. She continued to bleed profusely per rectum over the following five days, passing up to 1 L to 1.5 L of blood per day. She required 10 units of packed red blood cells over this time period. The patient refused surgical intervention and after discussion of possible options, octreotide was instituted. Her blood loss stopped almost immediately and she required no further transfusions. She tolerated the medication well and was discharged home at a later date in stable condition. This is the first reported case of the use of octreotide in the treatment of massive hematochezia from CMV colitis.     

Gastric granulocytic sarcoma revealed by a massive digestive hemorrhage]

We report the case of a 37-year-old-man having a chronic myelogenous leukemia, who presented, one month after a splenic acutization, massive gastrointestinal bleeding from ulcerated nodules of the gastric fundus. The histologic examination of one of these nodules showed granulocytic sarcoma. In spite of an endoscopic treatment by sclerotherapy with adrenalined serum, the death occurred during a hemorrhagic recurrence. This observation, which is the third case reported of gastric granulocytic sarcoma during the acutization of a myelogenous chronic leukemia, and the first revealed by fatal gastrointestinal bleeding, shows the particular gravity of gastrointestinal bleeding complicating granulocytic sarcoma.     

Cardiac hamartoma. Case report and literature review

Primary cardiac tumors are infrequent and usually benign. They can manifest as dyspnea, chest pain, palpitations, sudden death, peripheral embolism, cyanosis, or general symptoms. They are sometimes an incidental finding in an asymptomatic patient. We describe a 33-year-old man who was seen because of dyspnea and palpitations. Transthoracic echocardiography revealed, on the lateral wall of the left ventricle, an intramyocardial mass that was successfully resected surgically. The pathologic diagnosis was hamartoma of mature cardiac myocytes. We discuss the usefulness of imaging techniques for identifying cardiac masses.     

Utility of endoscopy in digestive hemorrhage due to vasculitis

Vasculitides constitute a heterogeneous group of diseases characterized by inflammation of blood vessels. The skin is mainly affected, although the gastrointestinal tract mucosa can also be involved. The contribution of endoscopy in these cases has not been clearly determined. We report three cases of systemic vasculitis (polyarteritis nodosa, Schonlein-Henoch purpura and Behcet's disease) presenting with acute digestive bleeding. Endoscopy was an effective technique for completing the diagnosis and in establishing an effective nonsurgical therapeutic approach in these potentially lethal cases of gastrointestinal hemorrhage.     

Unique massive pulmonary hamartoma. Case report with review of hamartomata treated at Brompton Hospital in 27 years.

A 30-cm tumor was removed from a 32-year-old man. It consisted of a collection of multiple small tumors, each histologically typical of a chondromatous hamartoma. Sixteen years earlier, identical histologic findings were noted in "cysts" in the right lower lobe. A review of other cases of cartilaginous hamartoma treated at Brompton Hospital since 1950 and a study of the literature suggest that this tumor is unique.     

Acute massive pulmonary hemorrhage in systemic lupus erythematosus.

Acute massive pulmonary hemorrhage is described as part of the clinical picture of SLE. Seven patients had sudden onset of high fever, dyspnea, tachycardia, and cough with blood-tinged sputum that within hours progressed to massive hemoptysis and death. There were no vasculitis or other inflammatory lung changes found at autopsy. Only one of the seven reported cases survived when treated with 2 g of intravenous hydrocortisone daily. The mechanism of this pulmonary bleeding is unknown but seems to be an immune complex mediated phenomenon.     

Both massive upper and lower gastrointestinal hemorrhage secondary to tuberculosis

We report a case of gastrointestinal tuberculosis, presenting with both massive upper and lower gastrointestinal bleeding that required two emergency operations. Massive bleeding is rare in gastrointestinal tuberculosis because of associated obliterative endarteritis. Tuberculosis should be considered in the differential diagnosis of massive gastrointestinal bleeding in the appropriate clinical setting even in an immunocompetent patient.     

Case report. Paraphimosis due to erotic dancing

Paraphimosis usually develops when a tight foreskin is retracted over the glans penis for a prolonged period. Many esoteric aetiologies have been implicated in the development of paraphimosis including piercing the foreskin, Plasmodium falciparum infection, application of celadine juice to the foreskin, chancroid, pessaries and the implantation of pearls. We report the first two cases of paraphimosis developing during wining, an erotic dance native to Trinidad & Tobago.     

Solitary gastric ulcer due to cytomegalovirus: a cause of acute digestive hemorrhage

A 29-year-old homosexual man, with acquired immune deficiency syndrome was admitted to the hospital for evaluation of severe and recurrent epigastric pain, and important weight loss of 3-5 month duration. An upper gastrointestinal GI hemorrhage required an endoscopic examination which demonstrated a larger ulcer of the gastric antrum interpreted as suspicious of malignancy. Gastric cytomegalovirus (CMV) inclusion bodies, indicating CMV infection, were detected in the biopsy tissue from the edge of the gastric ulcer.     

Acute lower gastrointestinal hemorrhage. Diagnosis and management

In most cases (80%), acute lower gastrointestinal bleeding stops spontaneously, but rebleeding is frequent (25%). The intensity and quality of the bleeding--hematochezia, melena, or occult bleeding--determines the diagnostic and therapeutic strategy (endoscopic evaluation of the upper and lower gastrointestinal tract, mesenteric angiography, scintigraphy, enteroscopy, capsule endoscopy) and its urgency. Acute lower gastrointestinal bleeding can mostly be treated conservatively or by endoscopic interventions (injection therapy, clip application, coagulation and ligation methods). Severe hemorrhage can render colonoscopy and the identification of the bleeding source technically difficult. Emergency operations are only indicated when patients with severe hemorrhage cannot be stabilized by interventional endoscopy or angiography with selective embolization.     

Acute retroperitoneal bleeding due to inferior mesenteric artery aneurysm: Case report

Background  

Visceral artery aneurysms (VAA), although uncommon, are increasingly being detected. We describe a case of spontaneous retroperitoneal hemorrhage from a ruptured IMA aneurysm associated with stenosis of the superior mesenteric artery (SMA) and celiac trunk, successfully treated with surgery.