Hemosuccus pancreaticus from a traumatic gastroduodenal pseudoaneurysm: an unusual cause of upper gastrointestinal bleeding

Hemosuccus pancreaticus, blood entering the gastrointestinal tract through the pancreatic duct, is a rare and elusive form of gastrointestinal bleeding with diagnostic difficulties. We report a 37-year-old man who had recurrent gastrointestinal bleeding from erosion of a pseudoaneurysm of the gastroduodenal artery into the pancreatic duct. The lack of history of pancreatitis, associated symptoms, equivocal endoscopic findings, and the rarity of this entity resulted in a delay in diagnosis. Pancreatic duct stenosis detected during surgery suggested the lesion might have been caused by blunt abdominal trauma. A nearly total pancreatectomy and splenectomy were performed. The patient remained symptom-free 8 months after the operation. This obscure cause of gastrointestinal bleeding should be considered when common causes of bleeding have been ruled out, even in the absence of pancreatitis.     

An unusual cause of upper GI bleeding: gastric antral vascular ectasia

Gastric antral vascular ectasia (GAVE) is characterized by red patches or spots in either a diffuse or linear array in the antrum of the stomach. This syndrome is commonly referred to as watermelon stomach because of its typical endoscopic appearance. Patients with GAVE frequently have occult bleeding requiring continual transfusions. It is important to distinguish the differences while treating GAVE in cirrhotics and portal hypertensive gastropathy (PHG) since the treatment options are vastly different.     

Gastric epithelioid haemangioendothelioma: a rare cause of upper gastrointestinal bleeding

Vascular tumours of the stomach are rare, representing 0.9%-3.3% of all gastric neoplasms. A 58 year old man was admitted as an emergency with a one day history of haematemesis and melaena. He underwent an emergency laparotomy for a tumour in the lesser curve of the stomach. The tumour showed the characteristic histological and immunohistochemical features of epithelioid haemangioendothelioma. Surgery in the form of wide excision seems to be the treatment of choice for this rare neoplasm. This case highlights the difficulty in diagnosing this rare tumour preoperatively and emphasises the need for long term follow up in view of its uncertain metastatic potential.     

Solitary caecal ulcer as a cause of gastrointestinal bleeding

A case of solitary caecal ulcer in an elderly woman who developed rectal bleeding is reported. The difficulties encountered in the detection of this rare lesion are described, and the importance of excluding other gastrointestinal disorders in a patient with peptic ulcer disease are highlighted.     

1例以下消化道出血(LGIB)为表现的阑尾出血

 下消化道出血（lower gastrointestinal bleeding,LGIB）是发生在Treitz韧带以下的消化道出血,可发生于小肠、结肠、直肠及肛管等部位,发生原因多样,但阑尾出血在临床上较为罕见。本文报道1例以LGIB为表现入院的阑尾出血患者,并结合内镜下诊断、治疗和相关文献分析阑尾出血诊治过程的难点和要点。     

Gastric angiodysplasia--a missed cause of gastrointestinal bleeding

We report a case of severe chronic iron deficiency anaemia secondary to blood loss from gastric angiodysplasia. The clinical features, diagnosis and management of this uncommon condition are discussed.     

老年与青年患者上消化道出血的临床分析研究

目的探讨老年与青年患者上消化道出血的临床特征。方法回顾性分析2007年3月～2010年3月在我科住院救治的148例上消化道出血并经胃镜或CT检查的临床病历资料。结果老年与青年组上消化道出血均有明显的诱因,两组患者都存在饮食不当的病史,40.54%的老人有非甾体类药物史,而60.81%青年人有酗酒史;两组患者的临床表现差异无统计学意义;老年组上消化道出血以胃溃疡占首位（50.00%）,其次是胃癌（13.51%）;青年组以十二指肠溃疡多见（52.70%）,其次是胃粘膜病变（28.38%）;老年组患者常合并基础疾病高血压、冠心病、肝硬化分别为52.7%、28.38%、13.51%,86.49%有并发症。结论老年患者与青年患者上消化道出血的发病诱因、出血原因以及伴发疾病等均有各自的特点;消化性溃疡是不同年龄组上消化道出血的主要原因。     

Arteriovenous malformation of the stomach: a rare cause of upper gastrointestinal bleeding

Haemorrhage arising from gastric arteriovenous malformation (AVM) is rare and normally occurs in the elderly. Bleeding gastric AVM presenting in the younger age group is even rarer. We report a case of a 14 year old boy who presented with recurrent episodes of haematemesis. He subsequently underwent a proximal gastrectomy and the histological examination confirmed a gastric AVM. After reviewing the literature we believe this is the youngest ever reported case of bleeding gastric AVM reported in English literature.