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Yomogida D, Kuwano H, Miyakoshi T, Mizuta S, Horikawa S, Koshida Y, Mochizuki K. Severe Duodenal Bleeding with Heterotaxy Syndrome Controlled by Combined Hemostatic Strategies. Intern Med 2025; 64:711-715. [PMID: 39085066 PMCID: PMC11949671 DOI: 10.2169/internalmedicine.4115-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 06/16/2024] [Indexed: 08/02/2024] Open
Abstract
A 73-year-old man with a history of heterotaxy syndrome and intestinal malrotation developed hemorrhagic shock due to bleeding from a duodenal ulcer. Esophagogastroduodenoscopy failed to achieve hemostasis because of restriction of the view by massive hemorrhage. Transcatheter arterial embolization cannot achieve endovascular hemostasis due to the vascular anatomy. Therefore, surgical hemostasis was achieved. Intestinal malrotation due to heterotaxy syndrome is a risk factor for gastrointestinal bleeding. Severe gastrointestinal bleeding in patients with intestinal malrotation is difficult to control with endoscopy alone. Therefore, combined therapies with endoscopy, interventional radiology, surgical procedures, and intensive care are vital for achieving a better prognosis.
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Affiliation(s)
- Daichi Yomogida
- Department of Intensive Care Medicine, Toyama Prefectural Central Hospital, Japan
| | - Hiroyuki Kuwano
- Department of Intensive Care Medicine, Toyama Prefectural Central Hospital, Japan
| | - Tatsuya Miyakoshi
- Department of Intensive Care Medicine, Toyama Prefectural Central Hospital, Japan
| | - Shiori Mizuta
- Department of Intensive Care Medicine, Toyama Prefectural Central Hospital, Japan
| | - Shinjiro Horikawa
- Department of Intensive Care Medicine, Toyama Prefectural Central Hospital, Japan
| | - Yoshinao Koshida
- Department of Intensive Care Medicine, Toyama Prefectural Central Hospital, Japan
| | - Kentaro Mochizuki
- Department of Diagnostic Radiology, Toyama Prefectural Central Hospital, Japan
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Cazacu SM, Parscoveanu M, Rogoveanu I, Goganau A, Vieru A, Moraru E, Cartu D. Trends for Admission, Mortality and Emergency Surgery in Upper Gastrointestinal Bleeding: A Study of Eight Years of Admissions in a Tertiary Care Hospital. Int J Gen Med 2024; 17:6171-6184. [PMID: 39691837 PMCID: PMC11651075 DOI: 10.2147/ijgm.s496966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Accepted: 12/09/2024] [Indexed: 12/19/2024] Open
Abstract
Introduction Most studies have shown a declining incidence of upper gastrointestinal bleeding (UGIB) in recent years. Data regarding mortality were controversial; in non-variceal bleeding, the increasing age of the population, increased use of anti-thrombotic and anticoagulant therapy in patients with cardiovascular diseases, and the use of non-steroidal anti-inflammatory drugs are counterbalanced by the progress in endoscopic therapy with stable mortality. Material and Method We performed a retrospective, cross-sectional study that included patients admitted with UGIB in Clinical Emergency Hospital Craiova during 2013-2020. Results 3571 patients with UGIB were selected; a trend toward increased admission for UGIB from 2013 to 2019 was noted, with a significant decrease in 2020. Non-variceal bleeding remains the most frequent form, with a slight increase in variceal bleeding, of Mallory-Weiss syndrome and angiodysplasia, and a 3-fold decrease for unknown etiology bleeding (with no endoscopy performed) during the 2017-2020 period as compared to 2013-2016. There was a trend toward decreased mortality, with lower mortality in 2017-2020 (12.83%) compared to 2013-2016 (17.41%). The mortality for variceal bleeding and peptic ulcer bleeding has declined, but mortality for non-variceal bleeding has slightly increased during 2013-2020. Mortality has decreased in admissions during regular hours/after hours and weekdays/weekends, but the difference (off-hours and weekend effects) had increased. The percentage of endoscopies performed in the first 24 hours after admission and the rate of therapeutic endoscopy increased during 2017-2020; the median time between admission and endoscopy was 17.0 hours during 2017-2020 and 59.1 hours during 2013-2016. The proportion of patients who needed emergency surgery for uncontrolled bleeding has significantly declined since 2013-2015, with an average value of 1% in the last 5 years of the study. Conclusion Increased admissions for UGIB, with lower mortality, especially for peptic ulcer bleeding and variceal bleeding were noted; higher percentages of therapeutic endoscopies and endoscopies performed during the first 24 hours after admission were also recorded.
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Affiliation(s)
- Sergiu Marian Cazacu
- Gastroenterology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Mircea Parscoveanu
- Surgery Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Ion Rogoveanu
- Gastroenterology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Alexandru Goganau
- Surgery Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Alexandru Vieru
- Doctoral School, University of Medicine and Pharmacy of Craiova, Emergency County Hospital Craiova, Craiova, Romania
| | - Emil Moraru
- Surgery Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Dan Cartu
- Surgery Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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Weissman S, Aziz M, Bangolo AI, Ehrlich D, Forlemu A, Willie A, Gangwani MK, Waqar D, Terefe H, Singh A, Gonzalez DMC, Sajja J, Emiroglu FL, Dinko N, Mohamed A, Fallorina MA, Kosoy D, Shenoy A, Nanavati A, Feuerstein JD, Tabibian JH. Relationships of hospitalization outcomes and timing to endoscopy in non-variceal upper gastrointestinal bleeding: A nationwide analysis. World J Gastrointest Endosc 2023; 15:285-296. [PMID: 37138938 PMCID: PMC10150287 DOI: 10.4253/wjge.v15.i4.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/22/2023] [Accepted: 03/15/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The optimal timing of esophagogastroduodenoscopy (EGD) and the impact of clinico-demographic factors on hospitalization outcomes in non-variceal upper gastrointestinal bleeding (NVUGIB) remains an area of active research.
AIM To identify independent predictors of outcomes in patients with NVUGIB, with a particular focus on EGD timing, anticoagulation (AC) status, and demographic features.
METHODS A retrospective analysis of adult patients with NVUGIB from 2009 to 2014 was performed using validated ICD-9 codes from the National Inpatient Sample database. Patients were stratified by EGD timing relative to hospital admission (≤ 24 h, 24-48 h, 48-72 h, and > 72 h) and then by AC status (yes/no). The primary outcome was all-cause inpatient mortality. Secondary outcomes included healthcare usage.
RESULTS Of the 1082516 patients admitted for NVUGIB, 553186 (51.1%) underwent EGD. The mean time to EGD was 52.8 h. Early (< 24 h from admission) EGD was associated with significantly decreased mortality, less frequent intensive care unit admission, shorter length of hospital stays, lower hospital costs, and an increased likelihood of discharge to home (all with P < 0.001). AC status was not associated with mortality among patients who underwent early EGD (aOR 0.88, P = 0.193). Male sex (OR 1.30) and Hispanic (OR 1.10) or Asian (aOR 1.38) race were also independent predictors of adverse hospitalization outcomes in NVUGIB.
CONCLUSION Based on this large, nationwide study, early EGD in NVUGIB is associated with lower mortality and decreased healthcare usage, irrespective of AC status. These findings may help guide clinical management and would benefit from prospective validation.
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Affiliation(s)
- Simcha Weissman
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Muhammad Aziz
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, OH 43614, United States
| | - Ayrton I Bangolo
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Dean Ehrlich
- Division of Digestive Diseases, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA 90095, United States
| | - Arnold Forlemu
- Department of Internal Medicine, Creighton University School of Medicine, Phoenix, AZ 85012, United States
| | - Anthony Willie
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Manesh K Gangwani
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, OH 43614, United States
| | - Danish Waqar
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Hannah Terefe
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Amritpal Singh
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Diego MC Gonzalez
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Jayadev Sajja
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Fatma L Emiroglu
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Nicholas Dinko
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Ahmed Mohamed
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Mark A Fallorina
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - David Kosoy
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Ankita Shenoy
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Anvit Nanavati
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - James H Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View- University of California at Los Angeles Medical Center, Sylmar, CA 91342, United States
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Żyluk A, Zeair S, Kordowski J, Gabrysz-Trybek E. Persisting bleeding from the duodenal ulcer in patients with occlusion of the celiac trunk: a case report. POLISH JOURNAL OF SURGERY 2020; 93:1-5. [PMID: 34057429 DOI: 10.5604/01.3001.0014.8072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Endoscopic measures have continued to be the primary procedures in the management of ulcer bleeding. Nevertheless, in cases of failed endoscopic hemostasis and re-bleedings, endovascular techniques have gradually gained increased acceptance as an alternative to surgery, allowing to avoid surgical intervention in some cases. <br/> Case report: A case of a 42-year-old patient presenting to the authors' institution with massive bleeding from the duodenal ulcer, sprang from a pathologically enlarged gastroduodenal artery is reported. This vascular anomaly was a consequence of occlusion of the coeliac trunk (Dunbar syndrome), which was shown on an angio-CT scan. In spite of several endoscopic and endovascular measures, as well as three operations, the bleeding persistently recurred (a total of 6 episodes) and the patient eventually died. The article presents details of operative and endovascular treatments. Contemporary trends in management in cases of failed endoscopic interventions and re-bleedings form peptic ulcers are shown in the discussion.
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Affiliation(s)
- Andrzej Żyluk
- Department of General and Hand Surgery, Pomeranian Medical University in Szczecin, Poland
| | - Samir Zeair
- Department of General, Vascular and Transplant Surgery, Independent Provincial Complex Hospital Maria Curie-Skłodowska in Szczecin, Poland
| | - Janusz Kordowski
- Department of Imaging Diagnostics and Interventional Radiology, Pomeranian Medical University in Szczecin, Poland
| | - Ewa Gabrysz-Trybek
- Department of Imaging Diagnostics and Interventional Radiology, Pomeranian Medical University in Szczecin, Poland
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