长期反复消化道出血小肠间质瘤1例

正病例:患者女性,54岁,以"反复解黑便3年,加重1 d"于2015-08-03入院。患者入院当天无明显诱因解黑便1次,量约300 g,糊状,有血凝块,伴腹痛、心悸、头晕、乏力、面色苍白,无恶心呕吐、呕血,无黑朦、晕厥,拟"消化道出血原因待查"收住入院。追问病史,患者近3年无明显诱因反复解黑便,每隔6~9个月发作一次,发作期每次黑便量约50~200 g,病程中多次住院行胃镜、结肠镜、数字减影血管造影(DSA)等检查,均     

以黑便为主要表现的原发性胃霍奇金淋巴瘤1例

<正>病例:患者男性,67岁,主因"解黑便2 d"于2015年7月13日入院。患者入院前2 d起无明显诱因解成形黑便,每日1次,每次量约200 g,伴头晕、乏力、上腹部不适。入院当日解黑便2次,总量约300 g,伴晕厥,无四肢抽搐、偏瘫等,于当地卫生院输液治疗后稍缓解,为进一步诊治至南宁市第二人民医院就诊。经胃镜检查后,门诊拟"消化道出血,胃癌"收治入院。患者发病以来精神、睡眠、食欲欠佳,体质量无明显变化。5年前有类似"解黑便"病史。     

胃镜治疗Billroth Ⅱ式胃大部切除术后输出襻嵌顿性胃石1例

正病例:患者女性,68岁,因"上腹部饱胀不适伴呕吐1周,黑便2 d"于2015-11-22入院。入院前1周患者无明显诱因出现上腹部饱胀不适,进食后明显,伴恶心呕吐,呕吐物为胃内容物,无呕血,呕吐后症状短暂好转。入院前2 d出现黑便,1次/d,每次量约50~100 g,无头昏乏力。起病后精神可,无明显体质量下降。20年前曾行"胃淋巴瘤切除术"。1年前胃镜检查诊断:吻合口炎,残胃炎。2个月前曾进食柿     

巨大食管裂孔疝伴胃扭转倒置一例

患者男，61岁，因“黑便伴上腹痛4d，进食哽噎2d”入院。患者入院前4天吸烟及饮酒后上腹正中钝痛，无放散，恶心，剧烈呕吐1次，为少量黄色液体，伴反酸、烧心、嗳气、腹胀，随后出现黑便，每日1次，共4次，每次约50～200g，伴乏力、心悸、多汗、改变体位后黑朦，无发热及腹泻。自服云南白药未见好转。     

十二指肠球部多孔潜腔假憩室一例

患者男,58岁,因间断性上腹饱胀不适伴反酸10年,黑便1d住院。患者近10年常在进食不当后出现反酸、上腹饱胀不适,自服药物可缓解,未行胃镜及钡餐检查。入院前一天解黑色稀便2次,呕吐咖啡色物1次,伴头晕和乏力。     

Dieulafor病1例报告

患者,男,64岁,因上腹部隐痛伴反复呕血、黑便5天,于2008年5月26日急诊入院.患者入院前5天晨起未进食,突感上腹部隐痛,排黑便1次,伴轻微头昏、乏力,中午进食后再次排黑便1次,随即呕吐3次,始为胃内容物,后为红色血液并混有暗红色血块,量约800 ml,即在当地医院非手术治疗:禁食、止血、扩容等治疗.     

十二指肠及胃恶性淋巴瘤并回肠结核一例

患者男,63岁,因“上腹痛1周,黑便2d”入院。1周前出现上腹及左上腹痛,无反酸、烧心。2d前黑便,每日1次,每次量约500g,伴乏力,无头晕,无心悸。患者平素大便正常,无腹痛、腹泻及便秘,无发热及盗汗,无明显消瘦。     

以上消化道出血为首发症状的低T_3综合征一例并文献复习

正1病例资料1.1病史及体格检查病人男性,87岁,因"3 d内解黑便2次,呕吐咖啡样物1次",于2015年10月18日收治入院。病人于入院前3 d无明显诱因下出现阵发性腹痛,多为夜间发作,伴黑便1次,呈柏油样,量约100 g。入院前4 h无明显诱因下呕吐咖啡色样胃内容物1次,约200 ml,并解黑便1次,为柏油样,量约200g,伴意识模糊及出冷汗。病人既往2013年曾有上消     

小肠原发性恶性黑色素瘤一例

24岁男性,主因间断黑便7个月,伴乏力1个月于2004年12月1日以“消化道出血”收入我院。患者7个月前无诱因出现黑便,约3次,量约100~200g/次,伴反酸、烧心,未诊治。1个月前出现乏力、心悸,无呕血、黑便、腹痛。来我院查Hb74g/L,便潜血阴性,建议行内镜检查明确原因。患者回当地住院     

肝硬化自发性胃肾分流1例

正患者,女,67岁。主诉"腹胀2月,黑便1月,呕血1 d"。2月前无明显诱因出现腹胀,进食后加重,排便后稍缓解。无反酸、暖气、恶心、呕吐,不伴腹痛,未行相关检查及治疗。1月前解柏油样大便3次,50g/次,排便后感头晕,不伴头痛。1大前呕血1次,量约10mL,伴昏迷,遂人院。该患者10年前发现"慢性乙型病毒性肝炎",7年前诊断为"肝炎后肝硬化",均未正规抗病毒治疗。入院查体:呼吸18次/min,心率76次/min,     

Bleeding pattern before admission as guideline for emergency endoscopy

In a prospective study of 539 patients admitted because of hematemesis and melena the bleeding pattern before admission was compared with the findings obtained on emergency endoscopy and the subsequent clinical course. Ranked in order of prognostic importance, red hematemesis with melena, black hematemesis with melena, and red hematemesis alone increased the probability of massive hemorrhage. Moreover, black hematemesis with melena was the superior predictor of bleeding ulcer, the commonest lesion carrying the risk of massive hemorrhage. In contrast, in patients with melena or black hematemesis alone massive hemorrhage occurred comparatively infrequently. The order of prognostic importance was supported by the transfusion requirement. In screening for a potentially life-threatening ulcer hemorrhage, emergency endoscopy is recommended in patients with black hematemesis with melena or with red hematemesis with or without melena. In patients presenting with black hematemesis or melena alone endoscopy may be postponed to the next convenient daytime.     

Diagnostic considerations in evaluation of patients presenting with melena and nondiagnostic esophagogastroduodenoscopy

Proper evaluation of patients with melena and nondiagnostic esophagogastroduodenoscopy is comparatively undefined. We sought to determine the percentage of patients with melena and nondiagnostic upper endoscopy and assess the yield of further evaluation. Of 209 patients presenting with melena, 180 underwent esophagogastroduodenoscopy as the initial study, which was nondiagnostic in 43 cases (24%). Further evaluation was pursued in 30. A presumed source of melena was found in 11 patients (37%), identified by colonoscopy in seven, bleeding scan in three, and barium enema plus flexible sigmoidoscopy in one. Nearly all such defined cases originated from the right colon. Small bowel contrast studies, flexible sigmoidoscopy or barium enema alone, and angiography failed to reveal a source. Our findings suggest that many (24%) patients presenting with melena will have nondiagnostic upper endoscopy; further evaluation reveals a potential source in 37% of this group, with the right colon being the most likely location of pathology; and colonoscopy is the test of choice in this cohort.     

Extensive hemorrhagic erosive gastritis associated with acute pancreatitis successfully treated with a somatostatin analog

In massive hemorrhage from acute gastric mucosal lesions, it is occasionally difficult to control the bleeding with nonsurgical therapy. We used the somatostatin analog, octreotide, which suppresses gastric and pancreatic function, to treat severe hemorrhagic erosive gastritis in a patient with acute pancreatitis. A 22-year-old man presented with epigastralgia and melena. Blood levels of pancreatitis markers were elevated. Computed tomography revealed diffuse enlargement of the pancreas, without fluid collection around the organ. An endoscopic examination showed extensive hemorrhagic erosions over almost the whole gastric mucosa. We diagnosed extensive hemorrhagic erosive gastritis with acute pancreatitis. A protease inhibitor (nafamostat mesilate 50 mg/day) and an H₂ receptor antagonist (famotidine 40 mg/day) were administered by injection for 6 days; the patient's serum and urine amylase levels fell, but the gastric erosions with hemorrhage were not attenuated. Octreotide was given subcutaneously, at a daily dose of 100 μg for 5 days, without famotidine administration. His melena disappeared, and the gastric erosions were markedly decreased. Administration of the somatostatin analog, octreotide, proved to be effective treatment in a patient with severe hemorrhagic erosive gastritis associated with acute pancreatitis. Received: February 20, 2001 / Accepted: May 25, 2001 Reprint requests to: K. Yabuki     

Thrombocytopenia associated with octreotide

A 42-year-old woman with a history of hepatitis C-induced cirrhosis, gastrointestinal bleeding, and alcohol abuse presented to the hospital with hematemesis and melena. Based on our previous experience, octreotide (Sandostatin) therapy was started at 50 mg/hr and continued for 5 days. Platelet count on admission (122 x 10(9)/L) dropped immediately after octreotide therapy was started; upon discontinuation, platelet count began trending up from 72 x 10(9)/L. However, octreotide was not suspected at this point as the cause of thrombocytopenia. In a subsequent admission, octreotide was again administered with a resultant prompt decrease in platelet count. To our knowledge, this is only the second case report of octreotide-induced thrombocytopenia, and the first case of this adverse effect demonstrated by inadvertent rechallenge.     

Successful treatment of giant rectal varices by modified percutaneous transhepatic obliteration with sclerosant： Report of a case

INTRODUCTIONEctopic varices outside the esophagogastric lesion are rare in patients with portal hypertension[1]. Among ectopic varices, rectal varices are comparatively common, but their rupture is often fatal although it is rarely reported[2]. Though the…     

Massive bleeding from a gastric erosion after transcatheter arterial chemoembolization for hepatocellular carcinoma in a patient with mild haemophilia A.

We observed massive bleeding from a gastric erosion following transcatheter arterial chemoembolization (TAE) in a patient with mild haemophilia A. A 78-year-old haemophiliac (factor VIII level over 60%) received TAE with farmorubicin and spongel. Haematemesis and melena with loss of consciousness occurred 3 days [corrected] after TAE, and endoscopy revealed superficial erosions with oozing. Toxic effects of the anticancer drug in conjunction with the bleeding disorder may have caused the massive bleeding. We should always consider the possibility of unexpected complications in patients with bleeding disorders; gastrointestinal bleeding can develop during treatment for liver tumours.     

Jejunal Adenocarcinoma Presenting with Hematemesis

We wish to report a case of jejunal adenocarcinoma with melena, hematemesis and anemia. To the best of our knowledge the presentation of jejunal adenocarcinoma with hematemesis has not been previously described.     

Cytomegalovirus-induced small intestinal bleeding complicated with cutaneous vasculitis: a case report

 A 17-year-old woman who was being treated with prednisolone for cutaneous vasculitis developed recurrent massive melena and abdominal pain. An emergency resection was performed because of uncontrollable melena, revealing many small intestinal ulcers with cytomegalic inclusion bodies, which were found by immunopathological staining. However, the cytomegalovirus (CMV) antigenemia (CMV-Ag) assay and the IgM antibody titer for CMV were negative on admission. This case indicates that a high state of alertness for CMV infection in immunocompromised patients with gastrointestinal bleeding is required even if the CMV-Ag assay and IgM antibody are both negative. Received: September 6, 2001 / Accepted: December 25, 2001 Correspondence to: Y. Ota     

Gastric Ulcer Hemorrhage Treated by Endoscopic Hemostasis with Histoacryl

Abstract: We report a case of hemorrhagic gastric ulcer in which endoscopic injection of Histoacryl effectively achieved hemostasis. The patient was an 86-year-old woman with complaints of hematemesis and melena, and emergent endoscopic examination revealed fresh bleeding from the gastric ulcer. Neither endoscopic injection of Aethoxysklerol and ethanol nor clipping stopped the active bleeding, while the injection of Histoacryl produced an immediate hemostatic effect. Unfortunately, she died of pneumonia and heart failure seven days after this treatment. Autopsy revealed Histoacryl polymer localized in the gastric wall, but the gastric ulcer that had caused the massive bleeding was covered with exudate and the site of arterial rupture was unclear. The significant hemostatic effect of Histoacryl injection and the histological findings in this case suggest that this procedure may be useful for managing refractory hemorrhagic gastric ulcer.     

A case of terminal ileal ulcer of Henoch-Sch?nlein purpura treated with high dose steroid.]

Henoch-Schonlein purpura (H-S purpura) is a systemic small-vessel vasculitis involving skin, joint, gastrointestinal tract, and kidney. It is characterized by the classic tetrad of abdominal pain, arthralgia, typical rash, and renal involvement. All of these clinical findings can occur in any order and at any time over several days to weeks. Gastrointestinal manifestations such as abdominal pain, melena, or hematochezia occur in 45-85% and preceed skin lesions up to 40% in H-S purpura. However, endoscopically proven gastrointestinal lesion is rare because majority of involved sites are small intestine. We report a case of Henoch-Schonlein purpura with terminal ileal ulcer, healed after treatment with high dose steroid, proven by colonoscopy.