Sengstaken-Blakemore tube for control of massive bleeding from gastric varices in hiatal hernia.

Hemorrhage from varices in a hiatal hernia sac was controlled by a Sengstaken-Blakemore tube. There is little data available regarding the safety and effectiveness of balloon tamponade in patients with hiatal hernia. Therefore we review the available literature and discuss balloon tamponade in patients with a hiatal hernia.     

Gastric zygomycosis--an unusual cause of massive upper gastrointestinal bleed.

We report a 62-year-old man with cardiac failure and acute renal failure, who had massive hematemesis. Upper GI endoscopy showed a large gastric lesser curvature ulcer. Billroth II gastrectomy specimen showed fungal invasion. He received amphotericin B postoperatively, and recovered uneventfully.     

Angiodysplasia as a cause of upper gastrointestinal bleeding

Angiodysplasia of the stomach, the proximal part of the small intestine, or both was diagnosed in 30 patients by upper gastrointestinal (Gl) endoscopy over a 40-month period. This diagnosis represented 4% of 676 patients referred over the same time period for endoscopic examination of suspected upper Gl bleeding. Twenty-three patients (77%) had experienced at least one episode of overt bleeding (hematemesis or melena) prior to diagnosis. Multiple gastroduodenal angiodysplastic lesions were found in 19 (63%) of the patients, and additional colonic angiodysplasia was detected in six of 12 patients who also underwent colonoscopy. Renal insufficiency was significantly more prevalent in the patients with angiodysplasia than in a comparison group of similar age with upper Gl bleeding from other lesions (60% v 24%). We conclude that angiodysplasia, although uncommon, should be considered in the differential diagnosis of both occult and overt upper Gl bleeding. The lesion appears to be associated with renal insufficiency.     

Watermelon stomach: a rare cause of upper gastrointestinal bleeding.

Watermelon stomach is a rare cause of upper gastrointestinal bleeding. We report a middle-aged woman who had been having recurrent bleeding from watermelon stomach. She was treated surgically by gastrectomy and Billroth II anastomosis.     

Pancreatic pseudocyst as a cause of upper gastrointestinal bleeding

A 67-year-old man with a history of an attack of pancreatitis was repeatedly investigated for recurrent gastrointestinal bleeding necessitating blood transfusions. Routine investigations did not reveal the source of bleeding. Repeated angiograms also were not diagnostic. A hot spot identified on a ^99mTc-pertechnate-labelled erythrocyte scan prompted an endoscopic retrograde cholangio-pancratography (ERCP), which showed bleeding through the papilla of Vater. The source of bleeding appeared to be a small pancreatic pseudocyst. The patient was treated with a duodenopancreatectomy in which the pylorus was preserved. No rebleeding occurred since the operation. Pancreatic pseudocysts must be considered as a source of upper gastrointestinal bleeding in patients with bleeding of “obscure” origin. ^99mTc-pertechnate-labelled erythrocyte scanning and ERCP may be helpful, even when angiography is normal.