Dieulafoy ulcer is an unusual cause of massive, recurrent and frequently fatal gastrointestinal hemorrhage that results from erosion of abnormally large submucosal artery. Although the lesion has been found throughout the gastrointestinal tract, it most commonly occurs in the proximal stomach. Diagnosis depends on the observation of protruding and eroded artery with pulsatile bleeding or adherent thrombus by endoscopy. Even during active bleeding, the endoseopic examination can be negative if intraluminal blood or clots obscure the source of bleeding. If the bleeding has stopped, the small mucosal lesion can be easily overlooked. Unlike peptic ulceration, there is no excavation of the mucosa. A 76-year-old man presented with massive hematemesis and melena. The patient had no previous history of peptic ulcer disease. He did not drink alcohol and use aspirin or NSAIDs. Physical examination revealed a pale, severely diaphoretic male with hypotension and melenic stools. He was found to have hemoglobin 4.0 g/dL and hematocrit 12.7%. We performed emergency endoscopy which showed a pulsatile and bleeding exposed artery without evidence of surrounding ulcerative lesion on the posterior wall of upper body of stomach. Endoscopic ligation using O ring of Stiegman-Goff endoscopic ligator kit was done successfully and the bleeding stopped immediately after ligation. Ten days after treatment, endoscopy showed artificial ulcerative lesion on previous ligated site and no evidence of bleeding. Another endoscopy four days later revealed healing ulcerative lesion. After improvement, the patient was discharged and rebleeding has not occurred to date.
Aged ; Anti-Inflammatory Agents, Non-Steroidal ; Arteries ; Aspirin ; Cytochrome P-450 CYP1A1 ; Diagnosis ; Emergencies ; Endoscopy ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Hematemesis ; Hematocrit ; Hemorrhage ; Humans ; Hypotension ; Ligation* ; Male ; Melena ; Mucous Membrane ; Peptic Ulcer ; Physical Examination ; Stomach ; Thrombosis ; Ulcer*

PURPOSE: The role of angiodysplasia as a main cause of upper gastrointestinal hemorrhage (UGH) in patients with chronic renal failure (CRF) is controversial. We investigated the sources of UGH and the clinical characteristics of UGH in patients with CRF. METHODS: We reviewed the medical and endoscopic records of 574 patients who were admitted to Gil Medical Center from November 1999 to November 2004. UGH was defined as hematemesis, or nasogastric aspirate showing fresh or old blood, or melena associated with acute drop in hematocrit. CRF was defined as a serum creatinine clearance < or =59 mL/min for at least 3 months before and after the bleeding episode or the patients who have undergone dialysis or received renal transplantation. RESULTS: Thirty-two of 574 patients were CRF group. 19 of the CRF patients have received dialysis (18 paitents-hemodialysis; 1 patient-peritoneal dialysis). The mean age of CRF group was 56+/-13.65 years old and 16 patients were male. The causes of UGH in CRF patients, in order of frequency, was duodenal ulcer (37.5%), gastric ulcer (34.4%), unknown (12.5%). No angiodyplasia was found in CRF group. The sources of bleeding did not differ significantly between the two groups. The prevalence of taking ulcerogenic drugs in CRF patients was higher than that in control group (59.4% vs 29.7%, p=0.001). The prevalence of Helicobacter pylori (H. pylori) infection in CRF patients with peptic ulcer and gastritis was lower than that in control group (16.7% vs 42.3%, p=0.017). The mean length of hospital stay and the mean numbers of blood transfusions required were higher in the CRF group than control group. However, no differences were seen between the two groups in mortality, recurrent bleeding and surgery for control of bleeding. CONCLUSION: The common cause of UGH in patients with CRF was peptic ulcer disease and no angiodysplasia was found.
Angiodysplasia* ; Blood Transfusion ; Creatinine ; Dialysis ; Duodenal Ulcer ; Gastritis ; Gastrointestinal Hemorrhage* ; Helicobacter pylori ; Hematemesis ; Hematocrit ; Hemorrhage ; Humans ; Kidney Failure, Chronic* ; Kidney Transplantation ; Length of Stay ; Male ; Melena ; Mortality ; Peptic Ulcer ; Prevalence ; Stomach Ulcer

Gastrointestinal bleeding is a common complication of hepatocellular carcinoma, and the most common causes are esophageal varix, gastric varix and a bleeding ulcer. Hepatocellular carcinoma rarely invades the gastrointestinal tract, and this has been shown to occur in 0.7~2% of the clinical hepatocellular carcinoma cases. A 52-year old male who had a history of a huge hepatocellular carcinoma on the left lobe of the liver and this had been by chemoembolization was admitted due to hematemesis and melena. Esophagogastroduodenoscopy showed a huge fungating mass with easy contact bleeding in the lesser curvature of the gastric body. The histology was consistent with the diagnosis of metastatic hepatocellular carcinoma and results of the CT scan supported this finding. This case illustrates a rare event of direct invasion of hepatocellular carcinoma into the stomach and this was followed by gastrointestinal hemorrhage.
Carcinoma, Hepatocellular ; Endoscopy, Digestive System ; Esophageal and Gastric Varices ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Hematemesis ; Hemorrhage ; Humans ; Liver ; Male ; Melena ; Stomach ; Ulcer

Gastric teratoma is an extremely rare tumor that accounts for less than 1% of all teratomas. Gastric teratoma is mostly presented as a palpable abdominal mass, and is rarely accompanied with gastrointestinal bleeding such as melena or hematemesis. A 5-month-old male infant was brought with a history of pale facial color and dark-colored stool. The hemoglobin level was at 6.1 g/dL, with melena having begun 1 month previous. Upper gastrointestinal endoscopy revealed a polypoid mass with bleeding at the upper body and lesser curvature of the stomach. Wedge resection of the stomach was performed and histopathological analysis confirmed the mass to be a mature cystic teratoma. There was no recurrence after the operation during follow-up.
Endoscopy, Gastrointestinal ; Follow-Up Studies ; Hematemesis ; Hemorrhage* ; Humans ; Infant* ; Male ; Melena ; Recurrence ; Stomach ; Teratoma*

Esophageal and duodenal tuberculosis are rare form of gastrointestinal tuberculosis. The common complications due to esophageal and duodenal tuberculosis are fistulous communications with the adjacent structures, perforation, obstruction, and upper gastrointestinal bleeding. Massive bleeding in esophageal and duodenal tuberculosis is quite rare. We encountered a case of a 55-year-old male who presented with hematemesis and melena. Esophageal and Duodenal tuberculosis with a duodenal fistula was diagnosed by an endoscopic and radiology examination. He improved after treatment with anti-tuberculosis medication over a 9 month period. We report this case of esophageal and duodenal tuberculosis associated with pulmonary tuberculosis with a review of the relevant literature.
Duodenum* ; Esophagus* ; Fistula ; Hematemesis ; Hemorrhage ; Humans ; Male ; Melena ; Middle Aged ; Tuberculosis* ; Tuberculosis, Gastrointestinal ; Tuberculosis, Pulmonary*

BACKGROUND/AIMS: The aim of this study was to compare the effects of erythromycin infusion and gastric lavage in order to improve the quality of visualization during emergency upper endoscopy. METHODS: We performed a prospective randomized pilot study. Patients presented with hematemesis or melena within 12 hours and were randomly assigned to the erythromycin group (intravenous infusion of erythromycin), gastric lavage group (nasogastric tube placement with gastric lavage), or erythromycin + gastric lavage group (both erythromycin infusion and gastric lavage). The primary outcome was satisfactory visualization. Secondary outcomes included identification of a bleeding source, the success rate of hemostasis, duration of endoscopy, complications related to erythromycin infusion or gastric lavage, number of transfused blood units, rebleeding rate, and bleeding-related mortality. RESULTS: A total of 43 patients were randomly assigned: 14 patients in the erythromycin group; 15 patients in the gastric lavage group; and 14 patients in the erythromycin + gastric lavage group. Overall satisfactory visualization was achieved in 81% of patients: 92.8% in the erythromycin group; 60.0% in the gastric lavage group; and 92.9% in the erythromycin + gastric lavage group, respectively (p = 0.055). The identification of a bleeding source was possible in all cases. The success rate of hemostasis, duration of endoscopy, and number of transfused blood units did not significantly differ between groups. There were no complications. Rebleeding occurred in three patients (7.0%). Bleeding-related mortality was not reported. CONCLUSIONS: Intravenous erythromycin infusion prior to emergency endoscopy for acute nonvariceal upper gastrointestinal bleeding seems to provide satisfactory endoscopic visualization.
Emergencies ; Endoscopy* ; Erythromycin* ; Gastric Lavage ; Gastrointestinal Hemorrhage ; Hematemesis ; Hemorrhage* ; Hemostasis ; Humans ; Melena ; Mortality ; Pilot Projects ; Prospective Studies

Gastric tuberculosis accounts for approximately 2% of all cases of gastrointestinal tuberculosis. Diagnosis of gastric tuberculosis is challenging because it can present with various clinical, endoscopic, and radiologic features. Tuberculosis manifesting as a gastric subepithelial tumor is exceedingly rare; only several dozen cases have been reported. A 30-year-old male visited emergency room of our hospital with hematemesis and melena. Abdominal CT revealed a 2.5 cm mass in the gastric antrum, and endoscopy revealed a subepithelial mass with a visible vessel at its center on gastric antrum. Primary gastric tuberculosis was diagnosed by surgical wedge resection. We report a rare case of gastric tuberculosis mimicking a subepithelial tumor with acute gastric ulcer bleeding.
Adult ; Diagnosis ; Emergency Service, Hospital ; Endoscopy ; Gastrointestinal Hemorrhage ; Hematemesis ; Hemorrhage* ; Humans ; Male ; Melena ; Pyloric Antrum ; Stomach Ulcer ; Tomography, X-Ray Computed ; Tuberculosis* ; Tuberculosis, Gastrointestinal

Dieulafoy lesions, vascular anomalies typically found along the gastrointestinal tract, have been viewed as rare and obscure causes of sudden intestinal bleeding, especially in pediatric patients. Since their discovery in the late 19th century, the reported incidence has increased. This is due to an increased awareness of, and knowledge about, their presentation and to advanced endoscopic diagnosis and therapy. Our patient was a three-year-old male, without a complex medical history. He presented to the emergency department with acute hematemesis with blood clots and acute anemia requiring blood transfusion. Endoscopy revealed four isolated Dieulafoy lesions along the lesser curvature of the stomach, which were treated with an epinephrine injection. The Dieulafoy lesion, although thought to be rare, should be considered when investigating an acute gastrointestinal bleed. These lesions have been successfully treated endoscopically. Appropriate anticipation and preparation for diagnosis and therapy can lead to optimal outcomes for the pediatric patient.
Anemia ; Blood Transfusion ; Diagnosis ; Emergency Service, Hospital ; Endoscopy* ; Epinephrine* ; Gastrointestinal Tract ; Hematemesis ; Hemorrhage ; Humans ; Incidence ; Male* ; Melena ; Stomach

Upper gastrointestinal bleeding is a common condition and has various clinical courses and prognosis. End stage renal disease (ESRD) patients receiving hemodialysis have a high risk of vascular complications and increased risk of ischemic colitis. A 59-year-old male patient with ESRD receiving hemodialysis visited due to hematemesis. After admission, he showed recurrent hematemesis and hypovolemic shock. Upper esophagogastroduodenoscopy revealed gastric ulcer bleeding and endoscopic hemostasis was successfully performed. Blood transfusion and norepinephrine was administered for hypovolemic shock during initial 3 days. Ten days later, he exhibited hematochezia. Sigmoidoscopy revealed necrotic ischemic colitis in sigmoid colon and segmental colectomy was performed. However, recurrent leakage and ischemia were developed in colon as well as small bowel, and he finally died after 55 hospital days in spite of additional operations. Here, we report a case of peptic ulcer bleeding in patient with ESRD who suffered a severe form of ischemic colitis with transmural necrosis.
Blood Transfusion ; Colectomy ; Colitis, Ischemic* ; Colon ; Colon, Sigmoid ; Endoscopy, Digestive System ; Gastrointestinal Hemorrhage ; Hematemesis ; Hemorrhage ; Hemostasis, Endoscopic ; Humans ; Ischemia ; Kidney Failure, Chronic* ; Male ; Middle Aged ; Necrosis ; Norepinephrine ; Peptic Ulcer ; Prognosis ; Renal Dialysis* ; Shock* ; Sigmoidoscopy ; Stomach Ulcer*

Aortoenteric fistula is a rare and life-threatening cause of upper gastrointestinal hemorrhage. Fistulas may be classified as primary or secondary. Secondary aortoenteric fistulas usually occur at the suture line following arterial reconstruction with prosthetic material and developed in 0.5~2.4% of the patients. The incidence of primary fistulas was reported in 0.04~0.07% in a large autopsy series and is 0.69~2.36% in patients with abdominal aortic aneurysm. Atherosclerosis is now the dominant cause. The mortality rate of patients with primary aortoduodenal fistula (ADF) is extremely high, principally because the diagnosis is difficult and seldomly established before the massive bleeding results in emergency operation or death. This occurs predominantly in the third and fourth parts of the duodenum. Symptoms of ADF consist of flank pain or abdominal pain, hematemesis, melena, and an abdominal mass. ADF is curable, if diagnosed and treated with surgical intervention before the onset of lethal massive hemorrhage. We report a case of primary ADF with a review of the literatures.
Abdominal Pain ; Aortic Aneurysm, Abdominal ; Atherosclerosis ; Autopsy ; Diagnosis ; Duodenum ; Emergencies ; Fistula* ; Flank Pain ; Gastrointestinal Hemorrhage ; Hematemesis ; Hemorrhage ; Humans ; Incidence ; Melena ; Mortality ; Sutures