Cases reported "Peptic Ulcer Hemorrhage"

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1/3. Extended surgery for the hepatic artery aneurysm involving duodenum and pancreas--a case report.

    hepatic artery aneurysms have been the most frequently reported splanchnic artery aneurysms in the past decade. Due to the complex anatomy and sensitivity of the liver to ischemic injury, a number of therapeutic alternatives exist in repairing aneurysmal hepatic arteries. Excision or obliteration of all hepatic artery aneurysms appears to be the management of choice. However, in managing aneurysms involving the proper hepatic artery and its extrahepatic branches, restoration of normal hepatic blood flow is most crucial. A 49-year-old man was found to have a huge extrahepatic artery aneurysm involving the area from the origin of the common hepatic artery to the distal proper hepatic artery. It ruptured into the duodenal bulb and firmly adhered to the surrounding structures including pancreas and common bile duct. Extended surgery with restoration of normal hepatic flow was performed safely. In cases with huge extrahepatic artery aneurysms, an aggressive approach to restore the hepatic arterial continuity seems appropriate for the prevention of ischemic damage to the liver.
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2/3. Endoscopic electrocoagulation: an alternative to operative therapy in bleeding peptic ulcer disease.

    Twelve patients with severely bleeding peptic ulcers (six duodenal, five gastric, and one esophageal) who were considered to be at high operative risk were treated instead by endoscopic electrocoagulation of the bleeding point. Arrest of the bleeding was permanent in ten, one bled again two days later, and one patient died of nonulcer disease one day later. Although this method to control bleeding from peptic ulceration is new, it seems to offer promise especially when treating desperately ill people.
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3/3. A pharmacological alternative for treatment of haemorrhage from a hiatus hernia gastric ulcer.

    Haematemesis in the elderly patient is a life-threatening condition. When the degree of blood loss is severe enough to warrant intervention by surgery or endoscopic means, the risk is even greater. We describe such a case, where treatment was further complicated as the bleeding point was in a hiatus hernia. The bleeding was successfully controlled by non-invasive means using an infusion of a somatostatin analogue.
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