Cases reported "Duodenal Ulcer"

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1/19. Postbulbar duodenal ulcer.

    Postbulbar duodenal ulceration is not common, but when present is difficult to diagnose and treat. Between January 1965 and September 1971, 1,080 patients with duodenal ulcers were treated surgically at St James Hospital. Forty-one ulcers were found at operation to lie distal to the duodenal bulb. Pain was the most common indication for surgery. In six-patients it was clinically indistinguishable from biliary pain, giving rise to diagnostic difficulty. Twelve patients (29%) presented with haemorrhage, a percentage similar to the 25% of bulbar ulcers presenting with this complication over the period of this study. This is contrary to the finding in most other series, that postbulbar ulceration is more frequently complicated by haemorrhage than is bulbar ulceration. Perforation and stenosis are uncommon complications. Postbulbar ulceration is easily overlooked in conventional barium studies. Only one-third of the patients subjected to barium meal x-ray examination had their ulcers identified in the first study. In a further third the presence of an ulcer was suspected, and the remainder required multiple investigations for undiagnosed symptoms before the condition was demonstrated. duodenoscopy was not performed in a sufficient number of patients for its value to be assessed, but other reports indicate that it should be a valuable manoeuvre. The technical difficulties and potential hazards of Polya gastrectomy are discussed and special reference is made to the surgical management of bleeding postbulbar ulcers.
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ranking = 1
keywords = haemorrhage
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2/19. blindness following gastrointestinal haemorrhage.

    Loss of vision is a rare but well known complication of distant and recurrent haemorrhage. It shares a poor prognosis, with only 10-14% of cases likely to make a complete recovery. Visual symptoms, due to ischaemic anterior optic neuropathy, vary from blurred vision to complete loss of vision in one or both eyes. The pathogenesis of such ischaemia remains unclear. Gastrointestinal bleeding seems to be the leading cause of loss of vision secondary to haemorrhage. However, complete and permanent blindness following gastrointestinal bleeding has rarely been reported. We report the case of a 51 -year-old woman who complained of complete blindness following blood loss, secondary to peptic ulcer, and discuss the pathogenesis of such a complication.
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ranking = 4.0046923359234
keywords = blood loss, haemorrhage
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3/19. Post-tonsillectomy bleed: a delayed diagnosis of duodenal ulceration.

    Post-operative haemorrhage is one of the commonest complications of tonsillectomy. We report a case of a 36-year-old lady who presented with three haemorrhagic episodes following tonsillectomy. Although initially treated as secondary tonsillar haemorrhage, the actual cause of the bleeding was later identified to be a duodenal ulcer. The case is presented with a review of the literature.
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ranking = 1
keywords = haemorrhage
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4/19. porphyria cutanea tarda associated with an acute gastrointestinal bleed: the roles of supplemental iron and blood transfusion.

    We describe a case of porphyria cutanea tarda (PCT) induced by blood transfusion and oral iron supplementation in an 80-year-old white woman. The patient experienced acute blood loss from 2 duodenal ulcers 2 months prior to presentation. During her hospitalization for the gastrointestinal bleed, her anemia was treated with blood transfusion, iron supplementation, and erythropoietin. Multiple blistering lesions developed on her skin 2 months after hospital discharge. Clinical and laboratory findings were consistent with a diagnosis of porphyria cutanea tarda. Treatment included discontinuation of iron therapy, local skin care, and phlebotomy, which prevented the development of more lesions. The roles of iron overload and chronic renal disease in the pathogenesis of the porphyria are discussed.
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ranking = 1.0046923359234
keywords = blood loss
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5/19. duodenal ulcer and pancreatitis associated with pancreatic arteriovenous malformation.

    Arteriovenous malformation (AVM) of the pancreas is a rare condition that may cause severe gastrointestinal bleeding. We describe a 54-year-old man with a 7-year history of recurrent duodenal ulcer due to AVM in the pancreatic head. We recommended pancreatoduodenectomy because of recurrent haemorrhage from the duodenal ulcer, but the patient refused surgery on several occasions. He was admitted to our hospital complaining of severe upper abdominal pain radiating to the back and was diagnosed with acute pancreatitis. He agreed at that stage to the surgical treatment. The resected specimen contained a highly vascular malformation in the pancreatic head and ulceration in the adjacent descending duodenum. Histopathological examination revealed numerous vascular structures with dilated and tortuous vessels in the pancreatic head, confirming the presence of AVM. Moreover, oedema, inflammatory cell infiltration, haemorrhage and necrosis were evident, confirming the presence of acute pancreatitis.
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ranking = 1
keywords = haemorrhage
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6/19. Management of massive upper gastrointestinal haemorrhage from multiple sites of peptic ulceration with somatostatin and octreotide--a report of five cases.

    Surgical management of massive upper gastrointestinal bleeding after failed medical treatment may be hazardous because of diffuse bleeding from several sites, further complicated in some patients by intercurrent disease, age, or previous surgery. Experience with combined somatostatin and octreotide therapy in five such patients is described. All were treated initially with either intravenous somatostatin (250 micrograms/hour) or octreotide (Sandostatin) (50 micrograms/hour) for periods ranging from three to five days, after which they were given subcutaneous octreotide (50 or 100 micrograms three times daily). Bleeding was controlled by this regimen in all cases. The patients were all discharged from hospital on either ranitidine (n = 4) or omeprazole (n = 1). Repeat endoscopy at the end of the treatment period with somatostatin and octreotide (n = 1) or four weeks after discharge (n = 3) showed complete healing of the bleeding sites. somatostatin and octreotide may be of value in controlling severe upper gastrointestinal bleeding in patients in whom surgery is hazardous because of bleeding from several peptic lesions further complicated in some by intercurrent disease or age.
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ranking = 2
keywords = haemorrhage
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7/19. Laparoscopic billroth II gastrectomy for completely stricturing duodenal ulcer: technical details.

    BACKGROUND: The authors report a series of three patients who underwent laparoscopic gastrectomy for gastric outlet obstruction due to stricturing duodenal ulcer. MATERIALS AND methods: In all cases an intracorporeal resection of the antrum and an antecolic end to side gastrojejunostomy (Billroth II) were performed. Technical details are discussed in the paper. RESULTS: Mean operative time was 260 minutes, mean blood loss was 43 millilitres. There were no postoperative complications and all patients were discharged on the fifth postoperative day. A follow up of three years shows that no patient had recurrence and post-gastrectomy syndromes. CONCLUSIONS: Laparoscopic Billroth II gastrectomy is a safe and feasible procedure with benefits such as quick hospital stay, decreased postoperative pain, good cosmesis and reduced morbidity.
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ranking = 1.0046923359234
keywords = blood loss
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8/19. dexamethasone treatment during ventilator dependency: possible life threatening gastrointestinal complications.

    Corticosteroids in high doses have been used effectively to decrease the duration of ventilator dependency in very low birthweight infants at risk for chronic lung disease. Randomised prospective studies have shown benefit, with only minimal complications being reported. However, review of our experience over 2.5 years with high dose steroids in 80 premature neonates yielded three major complications: one case each of perforated duodenal ulcer, perforated gastric ulcer, and upper gastrointestinal haemorrhage. Two of the three patients died. Thus the use of steroids in neonates may not be without risk, and significant complications can occur. When high dose corticosteroids are to be used in very low birthweight neonates, H2 receptor antagonist treatment and gastric pH monitoring are recommended. The physician must remain alert to the possibilities of upper gastrointestinal bleeding and ulcer perforation in these patients.
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ranking = 0.5
keywords = haemorrhage
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9/19. plasma exchange as a treatment for endogenous glycosaminoglycan anticoagulant induced haemorrhage in a patient with myeloma kidney.

    A 57-year-old man with end-stage renal failure secondary to myeloma kidney developed haemorrhagic complications due to endogenous glycosaminoglycan anticoagulant production. Glycosaminoglycan levels and anticoagulant effect were reduced by plasma exchange and this contributed to control of the haemorrhagic manifestations.
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ranking = 2
keywords = haemorrhage
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10/19. pancreatic pseudocyst haemorrhage presenting as a bleeding duodenal ulcer.

    We present a case of upper gastrointestinal haemorrhage where the preoperative endoscopic findings suggested a duodenal ulcer as the cause. Although at operation this proved to be the site of bleeding, the source was found to be the splenic artery in the base of a pancreatic pseudocyst.
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ranking = 2.5
keywords = haemorrhage
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