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Jejunal Vascular Anomaly with Hemorrhage


Presentation

  • With a central motif of the biologic dichotomy of vascular tumors and vascular malformations, this book is organized into chapters which address clinical presentation, diagnostic imaging, molecular genetics, pathogenesis, histopathology, and management[books.google.de]
  • We present a case of 12-year-old boy presenting with recurrent lower gastrointestinal bleeding simulating ulcerative colitis.[jpss.eu]
  • We report a 39-year-old Egyptian man presenting with multiple jejunal phlebectasia, liver haemangioma and port-wine naevus.[ncbi.nlm.nih.gov]
  • Patients usually present in infancy. Features are often unilateral and typically affect one limb 2. It may be diagnosed in utero 11. Genetics Most cases are considered sporadic.[radiopaedia.org]
  • Common presentation is malena or hematochezia as bleeding is usually low grade.[saudijgastro.com]
Pallor
  • Her clinical examination was noncontributory except for the presence of mild pallor. The hematological examination was suggestive of iron deficiency anemia with a normal platelet count and coagulation profile.[pancreas.imedpub.com]
  • Case report In the first sub-acute presentation, a previously fit and well 12-year-old boy presented with a 2 week history of painless passing of altered blood per rectum, pallor and easy fatigability.[jpss.eu]
Pathologist
  • Vascular Anomalies: Hemangiomas and Malformations is a comprehensive and interdisciplinary textbook ideal for dermatologists, interventional radiologists, surgical specialists, ophthalmologists, pathologists, geneticists, paediatricians, hematologic-oncologists[books.google.de]
  • The term hereditary hemorrhagic telangiectasia (HHT) was coined by the pathologist Hanes in 1909. With the development of gastrointestinal endoscopy, Renshaw described the "millet seed to pinhe. Video Endoscopic Sequence 7 of 40.[gastrointestinalatlas.com]
Blood in Stool
  • ., blood in stool). Accompanying symptoms vary, but may include epigastric and diffuse abdominal pain, pale skin, shortness of breath, and alterations of consciousness.[news-medical.net]
  • Appearances suggestive of cavernous type of venous vascular malformation (venous phlebectasia) Discussion There are several causes of altered lower gastrointestinal blood in stool in a child [2].[jpss.eu]
  • All surviving patients were discharged when surgically stable and they were followed up in the outpatient clinic for at least 2 months postoperatively and checked for overt or occult blood in stool.[ejs.eg.net]
Intestinal Disease
  • Capsule endoscopy has improved our ability to diagnose small intestinal diseases and has thus helped considerably in the management of patients with obscure gastrointestinal bleeding [ 16 ].[pancreas.imedpub.com]

Workup

  • During workup, packed red blood cells (RBCs) were transfused. The level of hemoglobin increased to 9.3 g/dL and remained stable. Dyspnea was relieved, with stable vital signs. He was discharged with the instruction to take aspirin only.[e-sciencecentral.org]

Treatment

  • Angiodysplasia Treatment The treatment of angiodysplasia depends on the nature of symptoms, the hemodynamic stability and the severity of bleeding from the rectum.[primehealthchannel.com]
  • For patients who cannot undergo endoscopic treatment, transcatheter angiography and embolization are encouraged as alternative treatments [ 13 ].[e-sciencecentral.org]
  • Large AVMs may require multiple embolization procedures on separate days for complete treatment. For example, two or three treatments may be given at intervals of two to six weeks.[radiologyinfo.org]
  • Hereditary Hemorrhagic Telangiectasia The treatment was successful, the patient stopped bleeding, we expect the long-term outcome. These treatments were successful and the Gi bleeding stopped, pending treatment to stop nosebleeds.[gastrointestinalatlas.com]
  • Treatment [ edit ] It is diagnosed and treated endoscopically; however, endoscopic ultrasound or angiography can be of benefit.[en.wikipedia.org]

Prognosis

  • Prognosis Life expectancy is largely normal, depending on the severity of the malformation and thus the likelihood of complications. [ 1 ] Possibly about 10% of patients develop a pulmonary embolism.[patient.info]
  • Alternatively, in patients with refractory bleeding Interventional Radiology may be consulted for an angiogram with subselective embolization. [7] Prognosis [ edit ] The mortality rate for Dieulafoy's was much higher before the era of endoscopy, where[en.wikipedia.org]
  • […] gastrointestinal or genitourinary hemorrhage if there is visceral involvement (see above) If capillary malformations are large enough, they may sequester platelets, possibly leading to the Kasabach-Merritt syndrome (consumptive coagulopathy) Treatment and prognosis[radiopaedia.org]
  • Among the treatment modalities, surgery can be considered when endoscopic or angiographic treatment is not suitable, or when the patient has poor prognosis factors.[e-sciencecentral.org]
  • Diagnosis (worst PROGNOSIS for advanced upper gastrointestinal malignancy)5. ENDOSCOPIC FINDINGS (active, spurting haemorrhage from peptic ulcer; non-bleeding visible vessel)6. RECURRENT BLEEDING (increases mortality 10 times) 32/81 32. 33/81 33.[slideshare.net]

Etiology

  • Boley SJ, Sammartano R, Adams A, Diliase A, Klinhaus S, Sprayregen S: On the nature and etiology of vascular ectasias of the colon. Degenerative lesions of aging. Gastroenterology 72:650–660, 1977 Google Scholar 14.[link.springer.com]
  • Selective arteriography of the celiac trunk and the superior mesenteric artery was performed in eight patients (89%) and enabled the etiological diagnosis in all cases.[em-consulte.com]
  • The most likely etiologies are broken down by age group.[wjes.biomedcentral.com]
  • The etiology of the Klippel-Trenaunay syndrome. Ann Surg . 1985; 202 :624-627.[wjgnet.com]
  • Even if active extravasation or bleeding is not visualized on the arterial phase images, the presence of substantial diverticulosis can be a potential clue as to the etiology of a patient’s bleeding.[ctisus.com]

Epidemiology

  • Bleeding Dieulafoy lesions of the small bowel: a systematic study on the epidemiology and efficacy of enteroscopic treatment. Gastrointest Endosc. 2011; 74 (3): 573-80[ DOI ][ PubMed ] 12. Prachayakul V, Deesomsak M, Aswakul P, Leelakusolvong S.[ijp.tums.pub]
  • Visceral involvement is thought to be more common than previously supposed, occurring in perhaps 20% of patients. [ 3 ] Aetiology and epidemiology The cause is is unknown.[patient.info]
  • EPIDEMIOLOGY • Upper GI bleed remains a major medical problem. • About 75% of patient presenting to the emergency room with GI bleeding have an upper source. • In-hospital mortality of 5% can be expected. • The most common cause are peptic ulcer, erosions[slideshare.net]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology [ edit ] Dieulafoy's lesions are characterized by a single large tortuous small artery [5] in the submucosa which does not undergo normal branching or a branch with caliber of 1–5 mm (more than 10 times the normal diameter of mucosal capillaries[en.wikipedia.org]
  • Boley SJ, Sprayregen S, Sammartano R, Adams A, Kleinhaus S: The pathophysiologic basis for the angiographic signs of vascular ectasias of the colon. Radiology 125:615–621, 1977 Google Scholar 9.[link.springer.com]

Prevention

  • Technically, successful embolization requires the catheter be placed in a precise position to prevent injuring normal tissue.[radiologyinfo.org]
  • However, our patient received surgery because the number and the location of the lesions—10 polypoid lesions between the proximal and distal jejunum—prevented endoscopic treatment.[e-sciencecentral.org]
  • One is also advised to refrain from using nonsteroidal anti-inflammatory drugs in this case to prevent the condition to aggravate.[primehealthchannel.com]
  • Endovascular treatment can control an unstable hemodynamic situation before elective surgery to prevent recurrence, which can be more severe than the first event.[em-consulte.com]
  • The catheters were secured to the thigh to prevent displacement and the patient was shifted to the operation theatre. On exploration, 1.5 feet of jejunum showed dilated submucosal vessels and increased vascularity. Rest of the bowel appeared normal.[saudijgastro.com]

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