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1/120. Massive gastrointestinal hemorrhage after transoesophageal echocardiography probe insertion.

    PURPOSE: To describe a case of a massive gastric bleeding following emergency coronary artery bypass surgery associated with transoesophageal echocardiographic (TEE) examination. CLINICAL FEATURES: A 50-yr-old man was referred for an acute myocardial infarction and pulmonary edema (Killip class 3). Twelve hours after his myocardial infarction, he was still having chest pain despite an i.v. heparin infusion. coronary angiography revealed severe three-vessel disease with multifocal stenosis of the left anterior descending, circumflex and total occlusion of the right coronary artery. The patient was transferred to the operating room for emergency coronary artery bypass graft surgery. After total systemic heparinization (3 mg.kg-1) was obtained for cardiopulmonary bypass, a multiplane TEE probe was inserted without difficulty to monitor myocardial contractility during weaning from CPB. During sternal closure, the TEE probe was removed and an orogastric tube was inserted with immediate drainage of 1,200 ml red blood. Endoscopic examination demonstrated a mucosal tear near the gastro-oesophageal junction and multiple erosions were seen in the oesophagus. These lesions were successfully treated with submucosal epinephrine injections and the patient was discharged from the hospital eight days after surgery. CONCLUSION: This is a report of severe gastrointestinal hemorrhage following TEE examination in a fully heparinized patient. This incident suggest that, if the use of TEE is expected, the probe should preferably be inserted before the administration of heparin and the beginning of CPB.
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ranking = 1
keywords = esophagus
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2/120. endosonography in the diagnosis of "blue rubber bleb nevus syndrome": an uncommon cause of gastrointestinal tract bleeding.

    Blue rubber bleb nevus syndrome is a rare condition characterized by the presence of multiple angiomatic lesions of the skin. These are associated with similar lesions in other organs, namely in the gastrointestinal tract, causing anemia through chronic bleeding. We describe the case of a 72-year-old woman with microcytic anemia. A barium study revealed irregular lacunae in the distal esophagus. A subsequent endoscopy showed blue nodular lesions similar to angiomas of the esophagus and stomach fundus. endosonography confirmed its angiomatic nature. Exploration of other organs, using magnetic resonance and cranial computed tomography, did not reveal the presence of this type of lesion. In physical examination, two angiomatic lesions were observed on the face and lips, respectively. These were blue in color and compressible, leaving an empty wrinkled sac that rapidly refilled, typical of angiomas.
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ranking = 2
keywords = esophagus
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3/120. Anaplastic and sarcomatoid carcinoma of the small intestine: an unusual tumor.

    Primary malignant tumors of the small intestine are rare, and sarcomatoid carcinomas have rarely been reported at this site. Anaplastic and sarcomatoid carcinomas are well described in the upper aerodigestive tract, particularly in the esophagus and the larynx. The authors report a case of anaplastic and sarcomatoid carcinoma of the ileum presenting as gastrointestinal bleeding. Their patient and the literature suggest that these tumors are much more aggressive than other small intestinal tumors. The importance of a systematic diagnostic approach in diagnosing these tumors is also discussed.
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ranking = 1
keywords = esophagus
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4/120. Spontaneous intramural hematoma of the esophagus.

    Spontaneous intramural hematoma of the esophagus (SIHE) is a rare condition, usually presenting with severe acute chest pain. vomiting, dysphagia, odynophagia, and hematemesis may appear later. We herein report a case of this disease in a patient treated with low doses of aspirin, and review the literature for possible etiologies for this condition. In addition, we compare the utility of the various diagnostic modalities in this uncommon condition.
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ranking = 5
keywords = esophagus
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5/120. Rectal Dieulafoy's lesion: report of a case and review of the literature.

    Dieulafoy's lesion is an uncommon cause of gastrointestinal bleeding that occurs after rupture of an exposed submucosal artery. The vast majority of lesions are found in the stomach, but cases have been described in the esophagus, small intestine, colon, and rectum. We describe an elderly patient who presented with severe lower gastrointestinal bleeding caused by a rectal Dieulafoy's lesion. This is the first report of a rectal Dieulafoy's lesion treated successfully with endoscopic epinephrine injection followed by thermocoagulation. We review the physiopathology, clinical presentation, diagnosis, and treatment of this disease.
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ranking = 1
keywords = esophagus
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6/120. subclavian artery aneurysm with oesophagoarterial fistula.

    Aneurysms of the subclavian artery are rare. fistula formation between the subclavian artery and the oesophagus has been described in aberrant subclavian artery and oesophageal foreign body. However, a fistula between a non-aberrant subclavian artery aneurysm and the oesophagus has not been previously reported. In this report, an unusual case of subclavian artery aneurysm with a fistula to the oesophagus causing intractable haematemesis is presented with the angiographic findings.
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ranking = 3
keywords = esophagus
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7/120. Polypoid metastatic hepatocellular carcinoma of the esophagus occurring after endoscopic variceal band ligation.

    This report describes a rare case of metastatic hepatocellular carcinoma (HCC) presenting as a polypoid mass in the lower esophagus after endoscopic variceal band ligation (EVL). A 56-year-old man underwent EVL for variceal bleeding in September 1993. He presented with dysphagia and tarry stool in December 1993. An endoscopic examination revealed a semipedunculated polypoid mass at the lower part of the esophagus, where EVL had been performed 3 months previously. The histologic examination at autopsy revealed that the polypoid mass consisted of metastatic HCC that had spread via the retrograde portal flow.
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ranking = 6
keywords = esophagus
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8/120. Recurrent gastrointestinal bleeding and high output cardiac failure caused by hereditary hemorrhagic telangiectasia.

    Hereditary hemorrhagic telangiectasia, commonly known as Osler-Weber-Rendu disease, is a systemic autosomal dominant inherited disorder, that occurs in Caucasian populations. We report the case of a 56-year-old housewife who was admitted to the gastrointestinal and cardiovascular ward because she had suffered from recurrent gastrointestinal bleeding and heart failure from 1994 to 1997. Panendoscopy showed vascular ectasia scattered over the tongue, larynx, esophagus, and posterior wall of the gastric body. colonoscopy showed clusters of telangiectasia over the cecum and ascending colon. arteriovenous malformations (AVMs) were found in the liver and lungs on computerized tomography. Recurrent gastrointestinal bleeding was controlled by estrogen treatment during the follow-up period. In July 1997, the patient was readmitted to our cardiovascular section due to aggravated dyspnea, orthopnea and bilateral lower leg edema. cardiac catheterization showed a large fistula from the left pulmonary artery to the left atrium and left ventricle, pulmonary arterial pressure of 37/13 mmHg and cardiac output of 9.61/minute. Other studies excluded the possibility of sepsis, and high-output cardiac failure was suspected. The patient was discharged in a stable condition and scheduled for AVM embolization management. Unfortunately, she died of a suspected heart attack at home two weeks following discharge.
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ranking = 1
keywords = esophagus
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9/120. Primary aortoesophageal fistula: presenting as massive upper gastrointestinal hemorrhage.

    Primary aortoesophageal fistula is a rare cause of upper gastrointestinal bleeding. A six-year-old boy presented with massive upper gastrointestinal hemorrhage. endoscopy revealed a submucosal bulge in the esophagus with an ulcer and clot at the top. Lateral skiagram of the chest showed a posterior mediastinal mass. CT scan of the chest revealed a ruptured aortic aneurysm into the oesophagus, confirmed the diagnosis. The patient succumbed to the illness before he could be subjected to definitive treatment.
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ranking = 2
keywords = esophagus
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10/120. Fatal hemorrhage complicating carcinoma of the esophagus. Report of four cases.

    Four cases of esophageal carcinoma complicated by fatal hemorrhage are reported. All four patients had recently completed radiation therapy. An aortoesophageal fistula was present in two cases; fibrinoid necrosis of the esophageal arteries was present in the other two. The esophageal tumor was localized in two cases and had disappeared in one case. In one patient it had metastasized widely. Ninety-nine other reports of esophageal cancer and fatal hemorrhage are reviewed from the literature. Aortoesophageal fistula was the cause of hemorrhage in 78 cases. Occlusion of the vasa vasorum by thrombosis, inflammation, neoplastic cells or radiation injury appears to be the cause of aortic necrosis and fistula formation. Prompt surgical approach, if possible, should be used to control hemorrhage, as the primary tumor may be localized to the esophagus only.
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ranking = 5
keywords = esophagus
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