RESUMEN
Gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal (GI) tract. Intermittent GI bleeding is the most common manifestation. Massive GI bleeding leading to syncopal episodes and hemorrhagic shock is a rare presentation of these tumors. Herein, we describe a case of a jejunal GIST presenting as massive bleeding.
RESUMEN
A primary aortoenteric fistula is a rare clinical entity that leads to severe upper gastrointestinal bleeding and carries a high risk of mortality, yet diagnosing aortoenteric fistulas remains challenging. Diagnosis is frequently delayed due to the uncommon and non-specific nature of the abdominal signs and symptoms. Rapid diagnosis and prompt surgical intervention are paramount to the successful management of this condition which is known for its profoundly poor prognosis. This report describes two cases of primary aortoenteric fistulas, one of which presented with melena and hematemesis, and the other presented with hematemesis and abdominal pain. In both cases, computed tomography angiography (CTA) demonstrated findings suggestive of an aortoenteric fistula, namely, locules of gas within the aortic lumen, which led to emergent surgical intervention. One patient underwent esophagogastroduodenoscopy while in the operating room before surgical intervention. One patient underwent repair with axillo-bifemoral bypass and the other with juxtarenal abdominal aortic aneurysm repair with a rifampin-soaked gelsoft dacron graft followed by primary bowel repair. Postoperative complications for one of the patients included duodenal repair breakdown as well as colonic ischemia. One patient made a meaningful recovery and remained without complications until the first postoperative visit two months after the repair. The other patient was discharged and then subsequently lost to follow-up. The two patients' successful outcomes of such a lethal condition were in large part due to rapid diagnosis with CTA and prompt surgical intervention.
RESUMEN
Duodenal varices pose a significant clinical challenge due to their association with severe gastrointestinal bleeding. This condition requires attention because of its acute severity, high morbidity, and mortality rates. The presented case underscores the importance of advancing both knowledge and treatment approaches for duodenal varices. This pursuit is aimed not only at improving immediate clinical outcomes but also at deepening our understanding of complications related to portal hypertension.
RESUMEN
Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) are a rare group of heterogeneous tumors, consisting of an endocrine and a nonendocrine component, which can develop throughout the gastrointestinal (GI) tract. This case presents a 70-year-old man with a complex medical history who initially presented with an upper GI bleed. After being stabilized, he underwent an esophagogastroduodenoscopy (EGD) that revealed a suspicious gastroesophageal junction (GEJ) mass. Histopathological studies paired with immunohistochemical investigations of the mass confirmed the rare diagnosis of MiNENs. He then underwent an endoscopic submucosal dissection (ESD) with subsequent chemotherapy and adjunct radiotherapy, with no recurrence noted on post-treatment surveillance. This case highlights the need for an EGD, histopathological examination, and immunohistochemical staining for detecting the underlying etiology of an upper GI bleed.
RESUMEN
Histoplamsa capsulatum, the causative organism for histoplasmosis, is a dimorphic fungus seen abundantly along the river valleys of Ohio and Mississippi in the United States of America as well as in other parts of the world. The infection is primarily acquired by inhaling the fungal spores which are often found in bird and bat droppings. Histoplasmosis can have a wide range of presentations ranging from no symptoms to mild flu-like or life-threatening consequences if severe. Chronic histoplasmosis can be akin to tuberculosis with a history of weight loss or hemoptysis. In patients with weak immune systems, histoplasmosis can become disseminated, affecting different parts of the body, which can be fatal if left untreated. We present a 40-year-old male with a past medical history of alcoholic cirrhosis and portal hypertension presenting with lower GI bleed found to have rectal and colonic ulcers as well as multiple brain lesions from disseminated histoplasmosis.
RESUMEN
Background Esophagogastroduodenoscopy (EGD) is typically performed within 24 hours of presentation for patients admitted to a hospital for patients presenting with a non-variceal upper gastrointestinal bleed (UGIB). To date, no studies have been performed to identify the impact of patient age on the timing of inpatient EGD and patient outcomes in non-variceal UGIB. Our aim was to assess the differences in the timing of EGD, blood transfusion requirements, development of hemorrhagic shock, development of acute renal failure, mortality, length of stay, and total hospital charges for patients aged 18-59 and those aged 60 and older. Methods Admissions for non-variceal UGIB were identified from the National (Nationwide) Inpatient Sample (NIS) database from 2016 and 2017. Patients who initially presented with hemorrhagic shock were excluded. Patients were divided into two age groups, those aged 18-59 and those aged 60 or older. We classified EGDs as early and delayed. Since the NIS database identifies days as midnight to midnight, we categorized early EGDs as those performed on day 0 and day 1. Delayed EGD were categorized as those performed on days 2 and 3. Multivariate logistic regression was performed on propensity-matched data to compare EGD timing, blood transfusion requirements, development of post-hospitalization hemorrhagic shock, development of acute renal failure, and mortality. The following patient and hospital variables were used in regression models: race, sex, insurance status, income quartile, mortality risk score, illness severity score, admission month, admission day, type of admission, region, bed size, and hospital teaching status. Finally, weighted two-sample T-tests were used to compare the length of stay and total hospitalization cost. Results A total of 12,449 weighted cases of inpatient non-variceal UGIB were included in this study. Patients aged 60 and older were more likely to die during the hospitalization (OR= 1.661, 95%CI: 1.108-2.490, p= 0.014), require blood transfusion (OR= 1.257, 95%CI: 1.131-1.396, p<0.001), and develop acute renal failure (OR= 1.672, 95%CI: 1.447-1.945, p<0.001). Patients aged 60 and older were also less likely to receive an early EGD (OR= 0.850, 95%CI: 0.752-0.961, p= 0.009). Total hospital costs (95%CI: -1397.77 - -4005.68, p<0.001) and length of stay (95%CI: -0.428 - -0.594, p<0.001) were both lower in patients aged 18-59 years. There was no difference in the development of post-hospitalization hemorrhagic shock between the two groups (OR= 0.984, 95%CI: 0.707-1.369, p= 0.923). Conclusions Patients aged 60 and older were less likely to have an early EGD and more likely to have worse outcomes. They had increased rates of inpatient mortality, blood transfusion requirements, development of acute renal failure, increased total hospital costs, and longer lengths of stay. There were no differences in the development of post-hospitalization hemorrhagic shock between the two groups.
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Pancreaticobiliary obstruction is a rare but life-threatening complication. Plastic biliary stents are a temporary utility to maintain the patency of the common bile ducts, typically lasting about four months. Biliary stents can rarely have complications, with the most common being migration through the gastrointestinal tract. We present a case of a patient with a plastic stent placed over five years, which was complicated by severe hematochezia due to the retention of the stent in a diverticulum. Given the increased risk of life-threatening complications post-stent life expectancy, there should be systems in place to prevent patients from being lost to follow-up.
RESUMEN
Background Aortic stenosis (AS) has been established as a precipitating factor in the development of colonic angiodysplasia, resulting in lower gastrointestinal bleeding (LGIB). While the association between AS and LGIB, termed "Heyde syndrome," has been examined extensively, few studies assess the impact of comorbid AS on rates of LGIB in patients with colorectal cancer (CRC). Our goal is to examine this association. Methods Patients hospitalized from 2001 to 2013 diagnosed with CRC were identified via ICD-9 codes, further stratified by a diagnosis of AS. Continuous and categorical variables were analyzed by independent sample t-tests and chi-squared analyses respectively. Assessed outcomes included mortality, length of stay (LOS), hospital costs, rates of LGIB, colonic obstruction, colonic perforation, iron-deficiency anemia (IDA), and colectomy. Multivariate analysis via binary logistic regression was utilized to control confounding variables. Results Patients with CRC and AS had higher rates of mortality, lower gastrointestinal bleeding, iron deficiency anemia, and colectomy, while those without AS had higher rates of colonic obstruction. Length of stay and total hospital charges were higher in patients with AS. Discussion CRC outcomes were worse in patients with AS. This could be due to higher rates of LGIB secondary to the prevalence of angiodysplasia among AS patients. More retrospective studies are required to assess the impact of comorbid AS in patients with CRC.