1.Massive gastrointestinal bleeding from Meckel diverticulum with ectopic pancreatic tissue.
Jian-feng YANG ; Lei-min SUN ; Xian-fa WANG ; Ning DAI
Chinese Medical Journal 2011;124(4):631-633
Meckel diverticulum (MD), a congenital gastrointestinal anomaly, is often involved in pediatrics, but less in the adult population. The patient in this report was a 69-year-old female presented with massive gastrointestinal bleeding causing hemorrhagic shock due to MD containing ectopic pancreatic tissue. A review of the literature revealed that gastrointestinal bleeding from MD containing ectopic pancreatic tissue is rare in adults and difficult to be identified preoperation. MD should be considered as one of the differential diagnosis for lower gastrointestinal bleeding, although scarce in adults, especially when the patient has massive painless bleeding.
Aged
;
Choristoma
;
diagnosis
;
physiopathology
;
Female
;
Gastrointestinal Hemorrhage
;
diagnosis
;
etiology
;
Humans
;
Meckel Diverticulum
;
diagnosis
;
physiopathology
;
Pancreas
;
pathology
2.Function of portal pressure during operation on the choice of surgical approaches in portal hypertension.
Wei CHEN ; Meng LUO ; Yong-wei SUN ; Qing XU ; Gang ZHAO ; Rong HUA ; Wei LIU ; Chun-hui JIANG ; Chang-ying SHI ; Zhi-yong WU
Chinese Journal of Surgery 2008;46(22):1703-1706
OBJECTIVETo investigate the relationship between perioperative free portal pressure (FPP) after devascularization or spleno-renal shunt operation added devascularization and rebleeding or encephalopathy in patients with portal hypertension, and evaluate the relationship between dynamic changes of FPP and surgical approaches.
METHODSThe clinical data of 170 patients with portal hypertension receiving devascularization or devascularization with spleno-renal shunt operation (combination group) from January 2001 to December 2007 were retrospectively analyzed. All patients were divided into three groups: low pressure group [L group, after devascularization FPP
RESULTSThe values of postoperative FPP were (27.1 +/- 1.9) mm Hg, (20.8 +/- 1.8) mm Hg and (21.5 +/- 2.2) mm Hg among the H group, L group and C group respectively. The rebleeding rates were 21.7%, 4.6% and 4.5% among the three groups respectively. All the values in H group were higher than those in L group and C group remarkably. The encephalopathy rate in C group (10.4%) was higher than that in L group (7.0%) or H group (3.3%), but there were no statistical significance (P > 0.05).
CONCLUSIONSFPP after splenectomy and devascularization may be a basis of choice of surgical approaches in portal hypertension. The spleno-renal shunt operation should be performed in the patients when FPP is over 22 mm Hg after devascularization.
Adult ; Aged ; Female ; Gastrointestinal Hemorrhage ; etiology ; Hepatic Encephalopathy ; etiology ; Humans ; Hypertension, Portal ; physiopathology ; surgery ; Male ; Middle Aged ; Monitoring, Intraoperative ; Portal Pressure ; physiology ; Postoperative Complications ; etiology ; Retrospective Studies
3.A prospective randomized trial of selective versus nonselective esophagogastric devascularization for portal hypertension.
Chao WANG ; Liang XIAO ; Juan HAN ; Chang-e JIN ; Yin PENG ; Zhen YANG
Journal of Huazhong University of Science and Technology (Medical Sciences) 2014;34(4):563-568
Cirrhosis with portal hypertension is a common disease which has a significant impact on the quality of patients' life. Esophagogastric devascularization (EGDV) has been demonstrated to be an effective method to treat portal hypertension, however certain complications are associated with it. The purpose of this study was to evaluate the effectiveness and clinical outcome of the selective EGDV (sEGDV) for the treatment of portal hypertension. The study was conducted prospectively from Jan. 1 2011 to Dec. 31, 2012, and 180 patients were randomized to the sEGDV group (n=90) or the non-sEGDV (n-sEGDV) group (n=90). Patients' demographics, preoperative lab test results and operative details were comparable between the two groups. Postoperative and short-term complications were analyzed in two groups. There was statistically significant difference (P<0.01) in the PVF reduction between the two groups. Post-operative complications showed no statistically significant difference between the two groups in the incidence of bleeding, ascites, acute portal vein thrombosis, fever and hepatic encephalopathy. Mortality between two groups was comparable. The incidence of splenic fossa effusion after the surgery was lower in sEGDV group than in n-sEGDV group. There were no significant differences in the short-term follow-up data such as esophageal varices and portal hypertensive gastropathy (P>0.05). It is suggested that sEGDV is a safe, simple and effective surgical procedure. It has both the advantages of the shunt and devascularization because it preserves body's voluntary diversion. With the advantage of low incidence of postoperative complications, it is an ideal surgical approach for the treatment of portal hypertension.
Adult
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Esophagus
;
blood supply
;
surgery
;
Female
;
Gastrointestinal Hemorrhage
;
etiology
;
pathology
;
physiopathology
;
Hepatic Encephalopathy
;
pathology
;
physiopathology
;
Humans
;
Hypertension, Portal
;
pathology
;
physiopathology
;
surgery
;
In Vitro Techniques
;
Male
;
Middle Aged
;
Postoperative Complications
;
pathology
;
physiopathology
;
Prospective Studies
;
Stomach
;
blood supply
;
surgery
;
Thrombosis
;
etiology
;
pathology
;
physiopathology
4.Spontaneous regression of hepatocellular carcinoma in a cirrhotic patient: possible vascular hypothesis.
Sarah BASTAWROUS ; Matthew J KOGUT ; Puneet BHARGAVA
Singapore medical journal 2012;53(10):e218-21
Spontaneous regression of hepatocellular carcinoma is extremely rare, and the exact pathogenesis leading to this remarkable phenomenon remains unclear. We describe a case of spontaneous regression of an incidentally discovered hepatocellular carcinoma in a 63-year-old man with hepatitis C cirrhosis. The regression followed a series of events, in particular, an upper gastrointestinal haemorrhage. Ischaemic insult may be a major pathway leading to tumour regression. As limited data is available in the literature, knowledge and recognition of this rare event will have implications for patient management and may alter treatment. Further, data may be useful to assess if these patients have an altered prognosis with improved survival.
Carcinoma, Hepatocellular
;
blood supply
;
complications
;
pathology
;
physiopathology
;
Gastrointestinal Hemorrhage
;
etiology
;
physiopathology
;
Humans
;
Incidental Findings
;
Liver Cirrhosis
;
complications
;
pathology
;
physiopathology
;
Liver Neoplasms
;
blood supply
;
complications
;
pathology
;
physiopathology
;
Male
;
Middle Aged
;
Neoplasm Regression, Spontaneous
;
pathology
;
physiopathology
;
Tomography, X-Ray Computed
5.Influence of endoscopic variceal ligation on liver function and risk factors of rebleeding.
Fen WANG ; Guangkui BU ; Shourong SHEN ; Wuliang TANG ; Canxia XU
Journal of Central South University(Medical Sciences) 2013;38(5):521-525
OBJECTIVE:
To investigate the influence of endoscopic variceal ligation (EVL) on liver function and analyze the risk factors of rebleeding after EVL.
METHODS:
A total of 137 cirrhotic patients with esophageal varices who received EVL were retrospectively analyzed, and divided into group A, B, and C according to the Child-Pugh scores of liver function. We compared the liver function 1 week preoperatively and postoperatively. The patients were further divided into a rebleeding group and a non-rebleeding group after the EVL, and risk factors about rebleeding were analyzed.
RESULTS:
There was no significant difference on ALT, AST, T-Bil, and D-Bil either preoperatively or postoperatively in group A, B, and C (P>0.05). Thirteen patients (9.49%) rebled after the EVL. The course of disease, liver function, prothrombin time, and mass ascites were the risk factors of rebleeding.
CONCLUSION
EVL has no obvious effect on liver function, and the course of disease, liver function, prothrombin time and mass ascites are risk factors of rebleeding after EVL.
Adult
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Endoscopy
;
methods
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Esophageal and Gastric Varices
;
etiology
;
surgery
;
Female
;
Gastrointestinal Hemorrhage
;
etiology
;
prevention & control
;
surgery
;
Humans
;
Ligation
;
methods
;
Liver
;
physiopathology
;
Liver Cirrhosis
;
complications
;
etiology
;
physiopathology
;
Logistic Models
;
Male
;
Middle Aged
;
Recurrence
;
Risk Factors
;
Secondary Prevention
6.Application of a standardised protocol for hepatic venous pressure gradient measurement improves quality of readings and facilitates reduction of variceal bleeding in cirrhotics.
Tze Tong TEY ; Apoorva GOGNA ; Farah Gillan IRANI ; Chow Wei TOO ; Hoau Gong Richard LO ; Bien Soo TAN ; Kiang Hiong TAY ; Hock Foong LUI ; Pik Eu Jason CHANG
Singapore medical journal 2016;57(3):132-137
INTRODUCTIONHepatic venous pressure gradient (HVPG) measurement is recommended for prognostic and therapeutic indications in centres with adequate resources and expertise. Our study aimed to evaluate the quality of HVPG measurements at our centre before and after introduction of a standardised protocol, and the clinical relevance of the HVPG to variceal bleeding in cirrhotics.
METHODSHVPG measurements performed at Singapore General Hospital from 2005-2013 were retrospectively reviewed. Criteria for quality HVPG readings were triplicate readings, absence of negative pressure values and variability of ≤ 2 mmHg. The rate of variceal bleeding was compared in cirrhotics who achieved a HVPG response to pharmacotherapy (reduction of the HVPG to < 12 mmHg or by ≥ 20% of baseline) and those who did not.
RESULTS126 HVPG measurements were performed in 105 patients (mean age 54.7 ± 11.4 years; 55.2% men). 80% had liver cirrhosis and 20% had non-cirrhotic portal hypertension (NCPH). The mean overall HVPG was 13.5 ± 7.2 mmHg, with a significant difference between the cirrhosis and NCPH groups (p < 0.001). The proportion of quality readings significantly improved after the protocol was introduced. HVPG response was achieved in 28 (33.3%, n = 84) cirrhotics. Nine had variceal bleeding over a median follow-up of 29 months. The rate of variceal bleeding was significantly lower in HVPG responders compared to nonresponders (p = 0.025).
CONCLUSIONThe quality of HVPG measurements in our centre improved after the introduction of a standardised protocol. A HVPG response can prognosticate the risk of variceal bleeding in cirrhotics.
Esophageal and Gastric Varices ; complications ; physiopathology ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; etiology ; physiopathology ; prevention & control ; Humans ; Hypertension, Portal ; complications ; physiopathology ; Liver Cirrhosis ; complications ; physiopathology ; Male ; Middle Aged ; Portal Pressure ; physiology ; Prognosis ; Retrospective Studies
7.Acute Variceal Hemorrhage in Patients with Liver Cirrhosis: Weekend versus Weekday Admissions.
Sun Jeong BYUN ; Seung Up KIM ; Jun Yong PARK ; Beom Kyung KIM ; Do Young KIM ; Kwang Hyub HAN ; Chae Yoon CHON ; Sang Hoon AHN
Yonsei Medical Journal 2012;53(2):318-327
PURPOSE: Little is known about the impact of weekend admission on acute variceal hemorrhage (AVH). Thus, we investigated whether day of admission due to AVH influenced in-hospital mortality. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 294 patients with cirrhosis admitted between January 2005 and February 2009 for the management of AVH. Clinical characteristics were compared between patients with weekend and weekday admission, and independent risk factors for in-hospital mortality were determined by multivariate binary logistic regression analysis. RESULTS: No demographic differences were observed between patients according to admission day or in the clinical course during hospitalization. Seventeen (23.0%) of 74 patients with weekend admission and 48 (21.8%) of 220 with weekday admission died during hospitalization (p=0.872). Univariate and subsequent multivariate analysis showed that initial presentation with hematochezia [p=0.042; hazard ratio (HR), 2.605; 95% confidence interval (CI), 1.038-6.541], in-patient status at the time of bleeding (p=0.003; HR, 4.084; 95% CI, 1.598-10.435), Child-Pugh score (p<0.001; HR, 1.877; 95% CI, 1.516-2.324), and number of endoscopy sessions for complete hemostasis (p=0.001; HR, 3.864; 95% CI, 1.802-8.288) were independent predictors for in-hospital mortality. CONCLUSION: Weekend admission did not influence in-hospital mortality in patients with cirrhosis who presented AVH.
Adult
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Aged
;
Aged, 80 and over
;
Endoscopy, Gastrointestinal
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Female
;
Gastrointestinal Hemorrhage/etiology/mortality/*physiopathology
;
Hospitalization/*statistics & numerical data
;
Humans
;
Liver Cirrhosis/*complications/mortality/*physiopathology
;
Logistic Models
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Male
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Middle Aged
;
Retrospective Studies
;
Risk Factors
;
Time Factors
8.The Risk Factors for Bleeding of Fundal Varices in Patients with Liver Cirrhosis.
Eui Ju PARK ; Jae Young JANG ; Ji Eun LEE ; Soung Won JEONG ; Sae Hwan LEE ; Sang Gyune KIM ; Sang Woo CHA ; Young Seok KIM ; Young Deok CHO ; Joo Young CHO ; Hong Soo KIM ; Boo Sung KIM ; Yong Jae KIM
Gut and Liver 2013;7(6):704-711
BACKGROUND/AIMS: The relationship between portal hemodynamics and fundal varices has not been well documented. The purpose of this study was to understand the pathophysiology of fundal varices and to investigate bleeding risk factors related to the presence of spontaneous portosystemic shunts, and to examine the hepatic venous pressure gradient (HVPG) between fundal varices and other varices. METHODS: In total, 85 patients with cirrhosis who underwent HVPG and gastroscopic examination between July 2009 and March 2011 were included in this study. The interrelationship between HVPG and the types of varices or the presence of spontaneous portosystemic shunts was studied. RESULTS: There was no significant difference in the HVPG between fundal varices (n=12) and esophageal varices and gastroesophageal varices type 1 (GOV1) groups (n=73) (17.1+/-7.7 mm Hg vs 19.7+/-5.3 mm Hg). Additionally, there was no significant difference in the HVPG between varices with spontaneous portosystemic shunts (n=28) and varices without these shunts (n=57) (18.3+/-5.8 mm Hg vs 17.0+/-8.1 mm Hg). Spontaneous portosystemic shunts increased in fundal varices compared with esophageal varices and GOV1 (8/12 patients [66.7%] vs 20/73 patients [27.4%]; p=0.016). CONCLUSIONS: Fundal varices had a high prevalence of spontaneous portosystemic shunts compared with other varices. However, the portal pressure in fundal varices was not different from the pressure in esophageal varices and GOV1.
Adult
;
Aged
;
Endoscopy, Gastrointestinal
;
Esophageal and Gastric Varices/etiology/*physiopathology
;
Esophagus
;
Female
;
Gastric Fundus
;
Gastrointestinal Hemorrhage/etiology/*physiopathology
;
Humans
;
Hypertension, Portal/complications/*physiopathology
;
Liver Cirrhosis/complications/*physiopathology
;
Male
;
Middle Aged
;
*Portal Pressure
;
*Renal Veins
;
Risk Factors
;
*Splenic Vein
;
Stomach/*blood supply
;
Vascular Fistula/complications/*physiopathology
9.Colonic Mucosal Necrosis Following Administration of Calcium Polystryrene Sulfonate (Kalimate) in a Uremic Patient.
Mee JOO ; Won Ki BAE ; Nam Hoon KIM ; Seong Rok HAN
Journal of Korean Medical Science 2009;24(6):1207-1211
Colonic necrosis is known as a rare complication following the administration of Kayexalate (sodium polystryrene sulfonate) in sorbitol. We report a rare case of colonic mucosal necrosis following Kalimate (calcium polystryrene sulfonate), an analogue of Kayexalate without sorbitol in a 34-yr-old man. He had a history of hypertension and uremia. During the management of intracranial hemorrhage, hyperkalemia developed. Kalimate was administered orally and as an enema suspended in 20% dextrose water to treat hyperkalemia. Two days after administration of Kalimate enema, he had profuse hematochezia, and a sigmoidoscopy showed diffuse colonic mucosal necrosis in the rectum and sigmoid colon. Microscopic examination of random colonic biopsies by two consecutive sigmoidoscopies revealed angulated crystals with a characteristic crystalline mosaic pattern on the ulcerated mucosa, which were consistent with Kayexalate crystals. Hematochezia subsided with conservative treatment after a discontinuance of Kalimate administration.
Adult
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Colon/*pathology
;
Gastrointestinal Hemorrhage/etiology
;
Humans
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Hyperkalemia/drug therapy
;
Intestinal Mucosa/*pathology
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Male
;
Necrosis/*chemically induced/complications/pathology
;
Polystyrenes/*adverse effects/therapeutic use
;
Uremia/*physiopathology
10.The Prognosis of Liver Cirrhosis in Recent Years in Korea.
Young Sun KIM ; Soon Ho UM ; Ho Sang RYU ; Jung Bok LEE ; Jae Won LEE ; Dong Kyu PARK ; Yong Sik KIM ; Yoon Tae JIN ; Hoon Jai CHUN ; Hong Sik LEE ; Sang Woo LEE ; Jai Hyun CHOI ; Chang Duck KIM ; Jin Hai HYUN
Journal of Korean Medical Science 2003;18(6):833-841
The survival of a recent series of 823 cirrhosis patients who were followed up for a mean of 48 months was analyzed. Cirrhosis was ascribed to alcohol (26%), hepatitis virus B (58%), hepatitis virus C (11%) or both (2%), or was cryptogenic (3%). Features of decompensation were observed in 51% of the patients at entry, and newly developed in 44% of compensated patients within 5 yr. The 5-yr survival after decompensation was 25%. The leading causes of death were liver failure (53%), hepatocellular carcinoma (HCC, 23%), and variceal bleeding (10%). Early detection of HCC significantly improved the survival of cirrhosis patients. Biannual ultrasonography increased the detection rate of small HCC. Mortality of variceal hemorrhage was much lower in patients with Child-Pugh scores from 5 to 8 than in those with scores above 8 (5% vs. 52%). Endoscopic prophylaxis significantly decreased the incidence of first variceal hemorrhage, but the effect was insufficient to improve the rate of survival. Mortality of first spontaneous bacterial peritonitis was 18%. These data suggest that the mortality of major complications of liver cirrhosis has considerably decreased during the last two decades, while there was no remarkable improvement in long-term survival. More efficient management of etiologic factors would be required.
Adult
;
Aged
;
Carcinoma, Hepatocellular/etiology/physiopathology
;
Female
;
Gastrointestinal Hemorrhage
;
Human
;
Korea
;
Liver Cirrhosis/complications/*diagnosis/mortality/*physiopathology
;
Liver Neoplasms/etiology/pathology
;
Male
;
Middle Aged
;
Peritonitis
;
Prognosis
;
Retrospective Studies
;
*Survival Analysis
;
Survival Rate