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1/59. A case of intra-abdominal multiple lymphangiomas in an adult in whom the immunological evaluation supported the diagnosis.

    A 60-year-old patient with intra-abdominal lymphangiomatosis is described. He presented with anaemia due to enteric haemorrhage, hypoproteinaemia with heavy hypogammaglobulinaemia and T-cell lymphopenia. Duodenal biopsy showed lymphangiectasia while a small bowel study revealed several filling defects in the terminal ileum. On exploratory laparotomy, numerous inoperable lymphangio-haemangiomata were found, involving the small and large intestine, appendix, mesenterium, gallbladder and main biliary tract. The importance of T-cell lymphopenia and hypogammaglobulinaemia in the diagnosis of intra-abdominal lymphangiomatosis with lymphangiectasia is stressed.
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keywords = anaemia
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2/59. Gastro-intestinal bleeding caused by leiomyoma of the small intestine in a child with neurofibromatosis.

    Gastro-intestinal bleeding is an uncommon presentation in children with neurofibromatosis. Gastro-intestinal involvement caused by jejunal leiomyoma has only been described in adults. To the best of our knowledge, this is the first paediatric case of jejunal leiomyoma associated with neurofibromatosis. We present a 10-year-old girl with a 9-month history of anaemia and low gastro-intestinal bleeding. Abdominal sonography and small bowel series showed a submucosal mass in the proximal jejunum. On surgery, a submucosal tumour was excised and histological examination suggested a diagnosis of "smooth muscle tumour of undetermined malignant potential". There were no recurrence of symptoms for 4 years after the operation. CONCLUSION: Jejunal leiomyoma should be considered in a child with neurofibromatosis presenting with gastro-intestinal bleeding.
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ranking = 1
keywords = anaemia
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3/59. Splenic angiosarcoma--an unusual cause of bleeding gastrointestinal tract.

    Splenic angiosarcoma is a rare malignant vascular tumour with about 100 reported cases to date. The presentation of splenic angiosarcoma is highly variable, frequently causing diagnostic difficulty. It usually presents with splenomegaly, abdominal pain and occasionally with a microangiopathic type of anaemia. Here we report an additional case of primary angiosarcoma of the spleen presenting as a problem of bleeding from the gastrointestinal tract.
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keywords = anaemia
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4/59. Lymphocytic venulitis: an unusual association with microscopic colitis.

    A 79 year old man presented with occult gastrointestinal bleeds and anaemia for two years. He had received 40 units of blood over a period of one year, following which he had a subtotal colectomy as no definite cause of the bleeding was apparent. Macroscopically the colon appeared unremarkable. light microscopy showed prominent lymphocytic venulitis in the proximal portion, gradually merging into lymphocytic and collagenous colitis distally.
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keywords = anaemia
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5/59. endoscopy as a tool for diagnosing and treating gastrointestinal angiodysplasia in haemodialysis patients.

    Gastroenteric angiodysplasia is an important cause of haemorrhage in chronic renal failure patients. This paper reports on 2 patients on maintenance haemodialysis with upper gastrointestinal bleeding due to different manifestations of angiodysplasic lesions (sudden appearance of haematemesis and melaena in one case, progressive anaemia with apparent resistance to erythropoietin in the other case). Exploratory endoscope examination of the first digestive tract showed in both cases the presence of bleeding angiodysplasic lesions. Both patients were there and then submitted to surgical endoscopy, during which the bleeding angiodysplasic lesion was sclerosed with physiological salt solution plus adrenaline 1/10000 and 1% polydocanol. In one patient, bleeding occurred again ten days later, making renewed surgical endoscopy necessary. In the course of this an elastic ligature was made to the superangular angiodysplasia. A year later in both cases there were no direct or indirect signs of further bleeding; an endoscopic check-up showed the treated lesions to be sclerosed. endoscopy offers the unique possibility of being used for both diagnostic and therapeutic purposes in a single session. In expert hands, endoscope therapy is effective and markedly reduces the risk of side effects.
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keywords = anaemia
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6/59. Metastatic melanoma of the small bowel as a cause of occult intestinal bleeding.

    Metastatic melanoma of the small bowel is a pathological entity that is not frequently reported but may present with features of unexplained anaemia. We report a case of a 51-year-old man with occult intestinal bleeding due to metastatic melanoma of the small bowel. Although the diagnosis was somewhat delayed, the patient was managed successfully by small bowel resection. Careful investigation of melanoma patients with gastrointestinal symptoms is important as surgical intervention often results in improved quality of life and survival.
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keywords = anaemia
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7/59. Gastric neurofibroma in a patient with von Reklinghausen's disease: a cause of upper gastrointestinal hemorrhage.

    Gastric neurofibroma associated with von Reklinghausen's disease is a rare clinical entity. We report a case of gastric neurofibroma with gastrointestinal bleeding and severe anaemia. Surgical resection is the treatment of choice. The recommended follow-up is an annual complete cell blood count and stool testing for occult blood.
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keywords = anaemia
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8/59. Enteroscopy as a tool for diagnosing gastrointestinal bleeding requiring blood transfusion.

    iron-deficiency anemia secondary to gastrointestinal blood loss is a common cause of hospitalization. In many cases, the bleeding site cannot be defined despite thorough routine examination of the gastrointestinal tract. The aim of this study was to evaluate push enteroscopy as a diagnostic tool in patients with severe anemia, secondary to recurrent gastrointestinal bleeding, that required management by transfusion. Thirty-five consecutive push enteroscopy investigations were performed in 1998 and 1999 on 25 patients (15 men, 10 women). Mean age was 57 /- 16 years (range, 33-83). All patients had received blood transfusions because of pronounced anemia secondary to gastrointestinal bleeding. Before push enteroscopy, all patients had been investigated with esophagogastroduodenoscopy, colonoscopy, and small-bowel radiography using the double contrast technique; no bleeding site was found. In addition, 10 of 25 patients had been investigated beforehand with 99mTc-labelled red blood cell scintigraphy, and 5 of 25 with scintigraphy for meckel diverticulum. Two patients were also investigated with angiography before the push enteroscopy, and in six patients an additional total intraoperative enteroscopy was performed, preceded by a new colonoscopy, esophagogastroduodenoscopy, and push enteroscopy. A bleeding site was disclosed in 15 of 25 (60%) patients. In 7 of 25 patients (28%) the bleeding site was found in the stomach or esophagus. even though the patients had undergone one or two esophagogastroduodenoscopies earlier with normal findings. Total intraoperative enteroscopy identified a bleeding site in four of six (67%) patients studied. Two patients had bleeding hemangiomas that were resected surgically. Two patients had small intestinal adenomas, one with adenocarcinoma in situ. Push enteroscopy performed with an overtube inserted under fluoroscopic guidance is an important diagnostic tool in patients in whom conventional examinations do not disclose bleeding sites. Interestingly, 28% of patients had bleeding within reach of the gastroscope, indicating that a new upper endoscopy should be recommended before push enteroscopy is performed. When no positive findings are seen on push enteroscopy and the patient is affected by severe, recurrent iron-deficiency anemia, total intraoperative enteroscopy should be considered.
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ranking = 142.88222654699
keywords = iron-deficiency
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9/59. Blue rubber bleb nevus syndrome: a case report with long-term follow-up.

    Blue rubber bleb nevus syndrome is an uncommon condition manifested by gastrointestinal and skin hemangiomas that lead to gastrointestinal bleeding and anemia. The purpose of this report is to present a case with long-term follow-up. The patient is a 37-year-old female with a life-long history of blue rubber bleb nevus syndrome. She underwent multiple resectional operations that combined to give her a partial gastrectomy, partial small bowel resection, total abdominal colectomy, and end ileostomy. She continues to need endoscopy with sclerotherapy. In addition, she has iron-deficiency anemia, nephrolithiasis, major depression, and malnutrition despite vitamin and caloric supplements. There are no other reports showing these complications of blue rubber bleb nevus syndrome or with this length of follow-up. Therapy for blue rubber bleb nevus syndrome should be conservative if possible, because operative therapy may lead to significant long-term complications.
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ranking = 142.88222654699
keywords = iron-deficiency
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10/59. The radiographic appearances of non-specific small intestinal ulceration.

    AIM: To determine the imaging characteristics of non-specific ulceration of the small intestine. MATERIALS AND methods: The radiographic investigations undertaken in three patients originally referred for visceral angiography in whom a histological diagnosis of non-specific ulceration of the small bowel was subsequently made were retrospectively reviewed. Two men and one woman aged from 17 to 24 years all presented with anaemia requiring blood transfusion. Visceral angiography was available for review in all three patients, abdominal computed tomography in two, and a small bowel enema and white cell scintigraphy in one. RESULTS: In all three patients an angiographic abnormality was present within the ileum consisting of irregularity of the vasa recta, an area of subtle increased vascularity and early venous return. A long, non-branching vessel interpreted as a persistent vitello-intestinal artery was seen in two of these patients. A CT abnormality was present in two individuals consisting of a focal area of thickened small bowel. The single small bowel enema demonstrated a focal stricture and the white cell scan showed localized accumulation of radioactivity within the pelvis. CONCLUSION: Non-specific small intestinal ulceration may produce abnormalities that are discernible on barium studies, computed tomography, radiolabelled white cell scanning and visceral angiography. Recognition of these findings may allow a pre-operative diagnosis of this condition.
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ranking = 1
keywords = anaemia
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