11/225. Trans-anastomotic porto-portal varices in patients with gastrointestinal haemorrhage.AIM: Porto-portal varices are commonly seen in patients with segmental extra-hepatic portal hypertension and develop to provide a collateral circulation around an area of portal venous obstruction. It is not well recognized that such communications may also develop across surgical anastomoses and be the source of gastrointestinal haemorrhage. The possible mode of development of such communications has not been previously discussed. MATERIALS AND methods: Over a 3-year period between 1995 and 1998, porto-portal varices were demonstrated across surgical anastomoses in four patients who were referred for the investigation of acute (two), acute-on-chronic (one) and chronic gastrointestinal bleeding (one). Their medical notes and the findings at angiography were reviewed. RESULTS: Three patients had segmental portal hypertension due to extra-hepatic portal vein (one) or superior mesenteric vein (two) stenosis/occlusion. One patient had mild portal hypertension due to hepatic fibrosis secondary to congenital biliary atresia. At angiography all patients were shown to have varices crossing previous surgical anastomoses. These varices were presumed to be the cause of bleeding in three of the four patients; the site of bleeding in the fourth individual was not determined. CONCLUSIONS: Trans-anastomotic porto-portal varices are rare. They develop in the presence of extra-hepatic portal hypertension and presumably arise within peri-anastomotic inflammatory tissue. Such varices may be difficult to manage and their prognosis is poor when bleeding occurs.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
12/225. Loss of vision from distant haemorrhage: report of four cases.To describe the occurrence of visual loss from ischaemia of the optic nerve following distant haemorrhages. Four patients who sustained vision loss following distant haemorrhage, presenting to the neuro-ophthalmic clinic of the department of ophthalmology, Addis Ababa University, from 1995 to 1997 were evaluated. The clinical presentation, management and prognosis are discussed. Post-haemorrhagic vision loss, other than being a rare occurrence, is under-reported due to the fact that these patients are very sick with massive blood loss and hence little attention is given to the vision loss by attending physicians and sometimes even the patients themselves. It is hoped that this paper will increase awareness about this condition among physicians attending to patients with severe bleeding and thus facilitate early diagnosis and referral.- - - - - - - - - - ranking = 1.2keywords = haemorrhage (Clic here for more details about this article) |
13/225. life-threatening digestive haemorrhage from duodenal recurrence of gastric cancer.Invasion of the duodenum by gastric carcinoma is not uncommon. The duodenal invasion by transpiloric infiltration through the submucosal layer or lymphatic spread frequently being microscopic and in minimal number of cases involving the mucosa, is generally asymptomatic and detected only in postmortem examinations. We report a case of life-threatening gastrointestinal bleeding from cancer recurrence at duodenal stump after subtotal gastrectomy for gastric carcinoma. In such cases it can be very hard to find the haemorrhagic source because of the difficulties encountered in endoscopic and radiological evaluation of the duodenal stump.- - - - - - - - - - ranking = 0.8keywords = haemorrhage (Clic here for more details about this article) |
14/225. Haemobilia from pancreatic cystadenoma.Hamobilia from a pancreatic source is a rare cause of gastrointestinal haemorrhage. Most of the reported cases have arisen from haemorrhage into a pancreatic pseudocyst, which is frequently fatal. This report describes a patient with gastrointestinal haemorrhage arising from a pancreatic cystadenoma.- - - - - - - - - - ranking = 0.6keywords = haemorrhage (Clic here for more details about this article) |
15/225. Emergency and elective surgical treatment of portal hypertension. A review of 23 years' experience.A retrospective review of surgical treatment for portal hypertension during a 23-year period in a regional unit is reported and the immediate and subsequent management of patients with bleeding oesophageal varices is discussed. Fifty-four patients with recurrent varix haemorrhage uncontrolled by conservative methods have been treated by oesophageal transection with a mortality of 22.2% (26.6% for cirrhotic patients). Thirty-two per cent of the cirrhotics were alive after 2 years. Only a minority (12%) of the survivors were considered suitable for a subsequent shunt procedure. Therapeutic portacaval anastomosis has been performed on 65 patients with a 51.2% 5-year survival (43-5% for cirrhotic patients). Further haemorrhage due to shunt thrombosis occurred in 5-3% of cases. The frequent occurrence of portal-systemic encephalopathy, increasing with duration of time following a shunt, is emphasized. The high morbidity and mortality in the poor-risk cirrhotic indicated that this type of patient is unsuitable for a portal-systemic shunt and is better treated by medical means.- - - - - - - - - - ranking = 0.4keywords = haemorrhage (Clic here for more details about this article) |
16/225. Pseudoxanthomatous mastocytosis.A case of xanthelasmoidea (pseudoxanthomatous mastocytosis) occurring in a 50-year-old Iranian man is described. The patient had a large upper gastrointestinal haemorrhage.- - - - - - - - - - ranking = 0.2keywords = haemorrhage (Clic here for more details about this article) |
17/225. Primary aortoduodenal fistula complicated by abdominal aortic aneurysm.A 74-year-old male patient was operated in Vakif Gureba Hospital for aortoduodenal fistula developing from abdominal aortic aneurysm. The patient was diagnosed as abdominal aortic aneurysm after physical examination and computed tomography in another center. Appearing of melena and hematemesis gastroduodenoscopy and radionuclide scanning was performed as diagnosis. After 6 days gastrointestinal bleeding recurred in massive haemorrhage and the patient was operated with a diagnosis of aortoenteric fistula as emergency. A midline laparotomy was performed. There was a fistula between infrarenal abdominal aortic aneurysm (with diameter 8x10 cm) and the 3rd portion of the duodenum. The duodenum was resected segmental and the fistula was disconnected. Following aneurysmotomy a prosthetic graft was placed in the aortobiiliac position. The patient was discharged at the 42nd postoperative day. Primary aortoenteric fistula is a very rare consequence of untreated abdominal aortic aneurysm. The segments of intestine most frequently involved in aortoenteric fistula are the 3rd and 4th portions of the duodenum. Clinical presentation is recurrent episodes of gross gastrointestinal haemorrhage. These cases have high mortality and morbidity unless evaluated as quickly as possible and appropriate surgical intervention performed.- - - - - - - - - - ranking = 0.4keywords = haemorrhage (Clic here for more details about this article) |
18/225. Digestive haemorrhages induced by traumatic cerebral lesions.Three cases of severe craniocerebral injuries are presented wherein haemorrhagic types of digestive lesions occured at various intervals. Commonly, the cerebral lesions involve manily the rhinencephalic structures, whereas the digestive disturbances consisted mainly of vasodilatation and vasparalysis. Thus, a relationship between rhiencephalic function and digestive haemorrhages is suggested.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
19/225. Haematemesis and Melaena: surgical management.A prospective study of the surgical management of 100 consecutive patients with benign, non-variceal upper gastrointestinal bleeding is presented. The manner of presentation, precipitating factors, investigations and associated medical problems are discussed. Chronic duodenal ulceration was the most common cause of haemorrhage. vagotomy and drainage with oversewing or excision of the bleeding ulcer was the surgical procedure performed in 71 of the patients in the series. The incidence of recurrent bleeding was 7%; no patient in this category required further operation. The mortality rate was 6%, and there were no deaths recorded in the patients who underwent vagotomy and drainage. The reasons for the relatively low surgical mortality are discussed.- - - - - - - - - - ranking = 0.2keywords = haemorrhage (Clic here for more details about this article) |
20/225. Control of duodenal haemorrhage with cyanoacrylate.Three cases of massive duodenal haemorrhage refractory to conventional therapy have been successfully treated by percutaneous selective intra-arterial injection of Isobutyl 2 cyanoacrylate. Case histories, injection technique and review of the literature are presented.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
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