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11/26. Colonic varices. Report of a case.

    A 14-year-old girl who had colonic bleeding caused by colonic varices is described. Upper gastrointestinal endoscopy, radiography of the small and large bowel, and vascular studies of the superior and inferior mesenteric arteries and the portal vein were all reported to be normal. Submucosal varices, however, were identified colonoscopically in relation to the hepatic flexure and the sigmoid colon. dilatation of subserosal right colonic vascular channels was identified at operation. Right hemicolectomy was performed and there has been no further bleeding. No obvious mesenteric arteriovenous communications were identified histologically.
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12/26. Hereditary haemorrhagic telangiectasia: the use of H2 receptor antagonist in symptomatic gastric telangiectasia.

    Hereditary haemorrhagic telangiectasia is an autosomal dominant disorder characterized by the presence of mucocutaneous dilatation of capillaries and venules. The underlying defect, a deficiency of vascular elastic tissue and muscle, predisposes these vessels to injury and inadequate contractility. Recurrent epistaxis or gastrointestinal haemorrhage is the clinical hallmark of the symptomatic patient. Management is frequently individualized as no modality of therapy has been found to be universally effective. The purpose of this communication is to discuss the use of H2 receptor antagonist in symptomatic gastric telangiectasia.
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13/26. hemobilia from ruptured hepatic artery aneurysm. Report of a case and review of the literature.

    hepatic artery aneurysm is a rare vascular disease associated with high mortality caused by massive hemorrhage or by complications following surgical treatment. Over the past twenty-five years it has been managed surgically with increasing success. Eighty reported cases of hepatic artery aneurysms ruptured into the biliary tree were reviewed and the etiology, clinical signs, diagnosis, and treatment of such an aneurysm are discussed. A personal case with an aneurysm of the right hepatic artery ruptured into the common hepatic duct is reported. The diagnosis was made before surgery by arteriography and the aneurysm was successfully managed by ligation of the right hepatic artery both proximal and distal to the aneurysm, closure of the communication between the common hepatic duct and the aneurysm, and choledochal drainage. hemobilia secondary to hepatic artery aneurysm must be considered in thedifferential diagnosis of unexplained gastrointestinal hemorrhage.
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14/26. Paraprosthetic-enteric fistula.

    A case of paraprosthetic-enteric fistula is presented and the total reported literature of 21 cases is reviewed. Paraprosthetic-enteric fistula is a complication of aortic revascularization with synthetic prostheses. The entity is characterized by erosion of the gastrointestinal tract by an underlying prosthesis but absence of a true fistulous communication with the aortic lumen. It is both a distinct pathologic entity and a step in the formation of a true aortoenteric fistula with suture line involvement. The most frequent clinical manifestations are sepsis and gastrointestinal bleeding, but nonspecific abdominal pain is present occasionally as well. The distal duodenum is the portion of the gastrointestinal tract involved most commonly. Diagnostic evaluation should include endoscopy, aortography, and barium contrast studies. Venous and femoral arterial blood cultures also should be done in patients presenting with sepsis. Treatment should consist of either graft excision with extra-anatomic revascularization or graft excision alone when dealing with a previously thrombosed prosthesis.
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15/26. Bleeding intestinal varices associated with portal hypertension and previous abdominal surgery.

    patients with portal hypertension may develop portasystemic communication in adhesions formed after earlier surgery. This condition causes localized mesenteric and intestinal varices which may lead to significant gastrointestinal hemorrhage. Two patients with this disease spectrum are discussed. The recommended treatment was resection of the involved intestine and formation of a portacaval shunt to eliminate recurrence of the varices and subsequent hemorrhage.
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16/26. Differential diagnosis of early opacification of the portal vein and its tributaries during arteriography.

    Twenty-two cases with communication of an artery and the portal vein or one of its tributaries are discussed. Four conditions in which relatively significant arterio-portal shunts may exist can be differentiated: (1) angiodysplasias or arteriovenous malformations, (2) cirrhosis of the liver and inflammatory lesions, (3) traumatic and postoperative lesions, and (4) benign and malignant tumors. The significance of the portal vein's early opacification during arteriographic examinations of the abdominal organs is discussed, and the findings are compared to those reported in the literature.
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17/26. Principles for use of intraoperative enteroscopy for hemorrhage from the small bowel.

    Most patients with bleeding from the small bowel are frequently difficult to diagnose and treat because the rate of bleeding is slow and because this is the "blind area" of gastrointestinal endoscopy. We used a colonoscope passed by mouth intraoperatively in order to determine the site of bleeding in four patients. All patients required resection with one requiring laser therapy as well. We found that the following principles were important in maximizing the value of this technique: (1) Good communication between the endoscopist and operating surgeon during the procedure, (2) clamping the distal small bowel to prevent air accumulation in the colon (3) examining the bowel on the way in and avoiding the use of suction to minimize scope trauma artifact, (4) turning off the room lights in order to examine the transilluminated bowel externally, (5) examining the entire small bowel if possible, and (6) marking each site externally with a suture as it is identified.
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18/26. Hemosuccus pancreaticus: CT manifestations.

    A case of severe gastrointestinal bleeding due to rupture of a splenic artery aneurysm into the pancreatic duct (hemosuccus pancreaticus) was encountered. Contrast enhanced CT revealed a low-density mass containing an enhancing central area in the pancreatic tail. Arteriography demonstrated a splenic artery aneurysm. Postoperative pathological review revealed a communication between the ruptured splenic artery aneurysm and the pancreatic duct.
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19/26. An unusual complication of chronic pancreatitis: a recanalized portal tree communicating with a pancreatic pseudocyst.

    A patient with chronic pancreatitis was admitted for digestive bleeding from esophageal varices. Portal thrombosis and cavernomatous periportal collateral circulation were found at laparotomy. The partially recanalized portal tree was excluded from the portal circulation and filled with pancreatic juice due to a communication with a pancreatic pseudocyst. splenectomy, partial left pancreatectomy, Roux en Y pancreatico-cysto-jejunostomy, and external drainage of the portal tree were performed. The postoperative course was uneventful and the patient is symptom-free and doing well 2 yr after surgery.
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20/26. bronchopulmonary sequestration as a rare cause of acute, massive intraesophageal bleeding.

    We have described a 69-year-old woman with sequestered segment of lung located in the right upper lobe, with open communication with the esophagus. Investigation of the acute anemia produced by acute blood loss into the gastrointestinal tract led to the diagnosis and treatment of this rare condition.
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