Vasculopathy is rarely reported in neurofibromatosis type 1, but when it occurs it primarily involves the aorta and its main branches. Among vasculopathies, aneurysmal dilatation is the most common form. Although several case reports concerning aneurysms or pseudoaneurysms of visceral arteries in neurofibromatosis type 1 patients have been reported, there are no reports describing gastroduodenal artery aneurysms associated with neurofibromatosis type 1. We experienced a case of life-threatening duodenal ulcer bleeding from a ruptured gastroduodenal artery aneurysm associated with neurofibromatosis type 1. We treated our patient by transarterial embolization after initial endoscopic hemostasis. To our knowledge, this is the first reported case of its type. High levels of suspicion and prompt diagnosis are required to select appropriate treatment options for patients with neurofibromatosis type 1 experiencing upper gastrointestinal bleeding. Embolization of the involved arteries should be considered an essential treatment over endoscopic hemostasis alone to achieve complete hemostasis and to prevent rebleeding.
Adult ; Aneurysm/*diagnosis/etiology ; Arteries ; Embolization, Therapeutic ; Gastroscopy ; Head and Neck Neoplasms/complications/*diagnosis ; Hepatic Artery/diagnostic imaging ; Humans ; Male ; Neurofibromatosis 1/complications/*diagnosis ; Peptic Ulcer Hemorrhage/*etiology ; Radiography

Behcet's disease (BD) has been recognized as multi-systemic chronic vasculitic disorder of recurrent inflammation, characterized by the involvement of multiple organs and resulting in orogenital ulcers, uveitis, and skin lesions. Involvement of the central nervous system, vessels, and intestines in BD often leads to a poor prognosis. Digestive manifestations in BD have been reported in up to 1-60% of cases, although the rate varies in different countries. The most frequent extra-oral sites of gastrointestinal involvement are the ileocecal region and the colon. Gastric or esophageal involvement is reported to be very rare. Moreover, there have been no reports on the simultaneous involvement of the esophagus, stomach, ileum, and colon. Here, we present a 55-year-old Korean man with intestinal BD and multiple ileal and colonic ulcerations complicated by perforation, gastric ulcer with bleeding followed by perforation, and esophageal ulcers with bleeding.
Behcet Syndrome/complications/*diagnosis/pathology ; Cecal Diseases/complications/pathology ; Diagnosis, Differential ; Endoscopy, Digestive System ; Gastrointestinal Diseases/complications/*diagnosis ; Gastrointestinal Hemorrhage ; Humans ; Intestinal Perforation/*diagnosis/etiology/pathology ; Male ; Middle Aged ; Peptic Ulcer Perforation/pathology ; Stomach Ulcer/complications/pathology

Gastric ulcer bleeding in neonatal period, mainly in preterm newborn babies or in neonates treated in intensive care units, is relatively frequent, However the occurrence of significant gastric ulcer bleeding in healthy full term infants is unusual. We experienced a case of massive upper gastrointestinal (GI) bleeding in a 3-day-old healthy full term infant. Endoscopic examination confirmed the presence of gastric ulcerations. Treatment was initiated with transfusion and histamine 2 receptor antagonist, and the clinical signs resolved. Mother's serum antibody to Helicobacter pylori (H. pylori) was positive. We collected stool of the patient including other 17 infants in the intensive care unit. A highly sensitive semi-nested PCR for H. pylori DNA was performed, but all infants including the patient revealed negative. H. pylori infection is not related with upper GI bleeding in healthy full term infants. In conclusion, the diagnosis of upper GI bleeding in infant can be easily made by means of pediatric endoscopy, which is a simple and a well tolerated examination.
Blood Transfusion ; Endoscopy, Gastrointestinal ; Female ; Histamine Antagonists/therapeutic use ; Humans ; Infant, Newborn ; Peptic Ulcer Hemorrhage/*diagnosis/drug therapy/therapy ; Stomach Ulcer/*complications

Intramural duodenal hematoma is an uncommon condition, which usually develops after blunt abdominal trauma. It is also reported as a complication of anticoagulant therapy, blood dyscrasia, pancreatic disease, and diagnostic and therapeutic endoscopy. The typical clinical pictures of intramural duodenal hematoma consist of upper abdominal pain, vomiting, fever, and hematochezia, and it is rarely accompanied by intestinal obstruction, peritonitis, and pancreatitis as its complication. We report a case of intramural duodenal hematoma extended to peritoneal cavity, and accompanied by acute pancreatitis following therapeutic endoscopy for duodenal ulcer bleeding in a 32-year-old man who was on maintenance of anti-coagulation therapy after valvular heart surgery.
Acute Disease ; Adult ; Diagnosis, Differential ; Duodenal Diseases/*diagnosis/pathology/surgery ; Duodenal Ulcer/*complications ; Hematoma/*diagnosis/pathology/surgery ; *Hemostasis, Endoscopic ; Humans ; Male ; Pancreatitis/complications/*diagnosis ; Peptic Ulcer Hemorrhage/*therapy ; Postoperative Complications ; Tomography, X-Ray Computed

Mesenteric venous thrombosis is a clinically very rare disease, and may cause bowel infarction and gangrene. Difficulty in the dignosis the disease due to its non-specific symptoms and low prevalence can cause a clinically fatal situation. Mesenteric venous thrombosis may be caused by both congenital and acquired factors, and protein C deficiency, which is a very rare genetic disorder, is one of many causes of mesenteric thrombosis. The authors experienced a case of mesenteric venous thrombosis caused by protein C deficiency in a patient with duodenal ulcer bleeding, so here we report a case together with literature review.
Duodenal Ulcer/*complications/diagnosis ; Endoscopy, Gastrointestinal ; Humans ; Male ; *Mesenteric Veins ; Middle Aged ; Peptic Ulcer Hemorrhage/*complications ; Protein C Deficiency/*complications/diagnosis ; Tomography, X-Ray Computed ; Venous Thrombosis/*diagnosis/etiology/ultrasonography

BACKGROUND: It has been debated which diagnostic test should be preferred for the diagnosis of Helicobacter pylori (HP) in patients with peptic ulcer diseases. Several limitations are reported in bleeding peptic ulcers because of intragastric blood and possibility of changed numbers of organisms by medication. This study was designed to find out the best method for diagnosis of HP infection, in aspect of deciding the times of detection and the specific tests in bleeding peptic ulcers. METHODS: We prospectively examined histology, rapid urease test (CLO test), urea breath test (13C-UBT) and serology in HP diagnostics in 32 patients with bleeding peptic ulcers to detect HP infection. Each test was performed two times (four methods at first 24 hours and former three methods at 7th day after initial therapeutic endoscopy). We evaluated the sensitivity of each test, compared the two-times results and evaluated the effect of these tests to an outcome of endoscopic hemostasis. RESULTS: Diagnostic sensitivities of histology, CLO test, 13C-UBT and serology are 75%, 67.8%, 100% and 100% at first endoscopy, and 71.4%, 78.5%, 89.3% at 7th day endoscopy, respectively. Histologic study and CLO test had diagnostic limitation at emergent first endoscopy contrary to UBT (p < 0.01). Histologic study, CLO test and UBT have limitations at 7th day endoscopy. Only 3 patients (9.4%) rebled with subsequent complete endoscopic hemostasis and all diagnostic tests at initial endoscopy did not influence the outcome of hemostasis. CONCLUSION: First day histologic and CLO tests are inadequate methods in detecting HP infection in patients with bleeding peptic ulcers. 7-day histologic, CLO test and UBT have a low sensitivity. First-day UBT can be a standard test to diagnose HP infection in patients with bleeding peptic ulcers.
Biopsy, Needle ; *Breath Tests ; Chi-Square Distribution ; Comparative Study ; Female ; Gastroscopy ; Helicobacter Infections/complications/*diagnosis ; Helicobacter pylori/*isolation & purification ; Human ; Korea ; Male ; Peptic Ulcer Hemorrhage/complications/*diagnosis ; Prospective Studies ; Sensitivity and Specificity ; Serologic Tests ; Stomach Ulcer/complications/*diagnosis ; Urea/*analysis/metabolism

OBJECTIVEAccuracy of diagnostic methods for detecting Helicobacter pylori (H. pylori) infection among patients with bleeding peptic ulcers has not been thoroughly investigated. The aim of this study was to compare the diagnostic tests and their combined usage in detection of H. pylori infection in patients with bleeding gastric ulcers and without the use of nonsteroidal anti-inflammatory drugs.

METHODSA total of 57 patients who presented with bleeding gastric ulcers by endoscopy were enrolled. The status of H. pylori was identified by performing the rapid urease test (RUT), histology and (13)C-labeled urea breath test (UBT). The criteria for having H. pylori infection was a minimum of two positive tests.

RESULTSThe prevalence of H. pylori infection in our patient group was 80.7%. Among the three tests used: RUT, histology, and UBT, sensitivities were 56.5%, 97.8% and 100%, while specificities were 100%, 45.5% and 81.8%, respectively. The overall accuracies of the tests were 78.3%, 71.6% and 90.9%, respectively. Although UBT obtained significantly higher accuracy than histology (P = 0.02) as opposed to RUT (P = 0.11), UBT had significantly higher sensitivity than RUT (P < 0.001). In terms of combining any two of the three tests, more accuracy (98.9%) was achieved when both UBT and histology were used to confirm the diagnosis of the other. Conversely, failure to use combined tests generated the potential of missing a proper H. pylori diagnosis.

CONCLUSIONSUBT is superior to the other two tests in bleeding gastric ulcers. RUT lacks sensitivity for detection of H. pylori infection. However, the concomitant use of UBT and histology seems to be more accurate when gastric ulcers present with bleeding.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Breath Tests ; Female ; Helicobacter Infections ; diagnosis ; pathology ; Helicobacter pylori ; Humans ; Male ; Middle Aged ; Peptic Ulcer Hemorrhage ; complications ; Sensitivity and Specificity ; Stomach Ulcer ; complications ; Urea

PURPOSE: The current work is aimed at illustrating the feasibility and assessing the efficacy of laparoscopic surgery in the treatment of gastric and duodenal diseases. METHODS: 27 patients who suffered from various gastroduodenal diseases were operated on between Feb. 1996 and July 1997. Operating times, procedures associated with pathologic diagnosis, bleeding during operation, mean starting times of oral intake, postoperative hospital stays, and complications were examined using the operating records and the medical charts. RESULTS: The procedures and the associated pathologic conditions were a feeding jejunostomy (gastric cancer peritonei), 12 wedge resections (1 duodenal diverticulum, 1 Brunner's gland hyperplasia, 2 gastric polyps, 6 gastrointestinal stromal tumors, and 2 early gastric carcinomas, 3 gastrojejunostomies (unresectable gastric cancers), 10 subtotal gastrectomies (9 complicated peptic ulcers and early gastric cancer), and a radical (D1 alpha) subtotal gastrectomy. The average operating times were 85 minutes in the feeding jejunostomy, 132 minutes in the wedge resections, 95 minutes in the gastro jejunostomies, 208 minutes in the subtotal gastrectomies (Billroth-I: 160 min; Billroth-II: 262 min.), and 300 minutes in the radical operation. The mean intraoperative bleeding was 80-800 cc. The mean start ing time of solid oral intake and postopeative hospital stay were shorter than in open surgery (oral intake: 1-5 day; hospital stay: 6-9 days). There were six postoperative complications. One patient died due to a cerebral infarction during the operation. one wound infection, one stump leakage, one pulmonary edema, and two cases of postoperative bleeding occurred, but they were treated conventionally without reoperation. CONCLUSION: Minimally invasive surgery appears to be an invaluable tool for treating gastroduodenal diseases. Furthermore, it is a valid option in experienced hands and in selected cases of gastric cancer, allowing patients to benefit from a less cumbersome hospital stay and from more satisfaction.
Cerebral Infarction ; Diagnosis ; Diverticulum ; Duodenal Diseases* ; Gastrectomy ; Gastric Bypass ; Gastrointestinal Stromal Tumors ; Hand ; Hemorrhage ; Humans ; Hyperplasia ; Jejunostomy ; Laparoscopy* ; Length of Stay ; Peptic Ulcer ; Polyps ; Postoperative Complications ; Pulmonary Edema ; Reoperation ; Stomach Neoplasms ; Surgical Procedures, Minimally Invasive ; Wound Infection

PURPOSE: The current work is aimed at illustrating the feasibility and assessing the efficacy of laparoscopic surgery in the treatment of gastric and duodenal diseases. METHODS: 27 patients who suffered from various gastroduodenal diseases were operated on between Feb. 1996 and July 1997. Operating times, procedures associated with pathologic diagnosis, bleeding during operation, mean starting times of oral intake, postoperative hospital stays, and complications were examined using the operating records and the medical charts. RESULTS: The procedures and the associated pathologic conditions were a feeding jejunostomy (gastric cancer peritonei), 12 wedge resections (1 duodenal diverticulum, 1 Brunner's gland hyperplasia, 2 gastric polyps, 6 gastrointestinal stromal tumors, and 2 early gastric carcinomas, 3 gastrojejunostomies (unresectable gastric cancers), 10 subtotal gastrectomies (9 complicated peptic ulcers and early gastric cancer), and a radical (D1 alpha) subtotal gastrectomy. The average operating times were 85 minutes in the feeding jejunostomy, 132 minutes in the wedge resections, 95 minutes in the gastro jejunostomies, 208 minutes in the subtotal gastrectomies (Billroth-I: 160 min; Billroth-II: 262 min.), and 300 minutes in the radical operation. The mean intraoperative bleeding was 80-800 cc. The mean start ing time of solid oral intake and postopeative hospital stay were shorter than in open surgery (oral intake: 1-5 day; hospital stay: 6-9 days). There were six postoperative complications. One patient died due to a cerebral infarction during the operation. one wound infection, one stump leakage, one pulmonary edema, and two cases of postoperative bleeding occurred, but they were treated conventionally without reoperation. CONCLUSION: Minimally invasive surgery appears to be an invaluable tool for treating gastroduodenal diseases. Furthermore, it is a valid option in experienced hands and in selected cases of gastric cancer, allowing patients to benefit from a less cumbersome hospital stay and from more satisfaction.
Cerebral Infarction ; Diagnosis ; Diverticulum ; Duodenal Diseases* ; Gastrectomy ; Gastric Bypass ; Gastrointestinal Stromal Tumors ; Hand ; Hemorrhage ; Humans ; Hyperplasia ; Jejunostomy ; Laparoscopy* ; Length of Stay ; Peptic Ulcer ; Polyps ; Postoperative Complications ; Pulmonary Edema ; Reoperation ; Stomach Neoplasms ; Surgical Procedures, Minimally Invasive ; Wound Infection

BACKGROUND/AIMS: The optimal management of bleeding peptic ulcer with adherent clot remains controversial. The purpose of this study was to compare clinical outcome between endoscopic therapy and medical therapy. We also evaluated the risk factors of rebleeding in Forrest type IIB peptic ulcer. METHODS: Upper gastrointestinal (UGI) bleeding registry data from 8 hospitals in Korea between February 2011 and December 2013 were reviewed and categorized according to the Forrest classification. Patients with acute UGI bleeding from peptic ulcer with adherent clots were enrolled. RESULTS: Among a total of 1,101 patients diagnosed with peptic ulcer bleeding, 126 bleedings (11.4%) were classified as Forrest type IIB. Of the 126 patients with adherent clots, 84 (66.7%) received endoscopic therapy and 42 (33.3%) were managed with medical therapy alone. The baseline characteristics of patients in two groups were similar except for higher Glasgow Blatchford Score and pre-endoscopic Rockall score in medical therapy group. Bleeding related mortality (1.2% vs. 10%; p=0.018) and all cause mortality (3.7% vs. 20.0%; p=0.005) were significantly lower in the endoscopic therapy group. However, there was no difference between endoscopic therapy and medical therapy regarding rebleeding (7.1% vs. 9.5%; p=0.641). In multivariate analysis, independent risk factors of rebleeding were previous medication with aspirin and/or NSAID (OR, 13.1; p=0.025). CONCLUSIONS: In patients with Forrest type IIB peptic ulcer bleeding, endoscopic therapy was associated with a significant reduction in bleeding related mortality and all cause mortality compared with medical therapy alone. Important risk factor of rebleeding was use of aspirin and/or NSAID.
Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Aspirin/therapeutic use ; Cohort Studies ; Female ; *Hemostasis, Endoscopic ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Peptic Ulcer/complications/diagnosis ; Peptic Ulcer Hemorrhage/etiology/*therapy ; Prospective Studies ; Proton Pump Inhibitors/therapeutic use ; Recurrence ; Risk Factors ; Treatment Outcome