No abstract available.
Acidosis ; Adult ; Colonic Diseases/radiography ; Gastrointestinal Tract/*surgery ; Humans ; Intestinal Fistula/*radiography/*surgery ; Male ; *Tomography, X-Ray Computed

Duodenal variceal bleeding in patients with portal hypertension due to cirrhosis or other causes is uncommon. We report on a case of a 55-year-old male with an ectopic variceal rupture at the distal fourth part of the duodenum who presented with massive hematochezia and shock. Shortly after achievement of hemodynamic stability, due to the limitation of an endoscopic procedure, we initially attempted to find the bleeding focus by abdominal computed tomography, which showed tortuous duodenal varices that drained into the left gonadal vein. He was treated with first-line balloon-occluded retrograde transvenous obliteration (BRTO), resulting in a favorable long-term outcome without rebleeding three years later. This case suggests that BRTO may be a first-line therapeutic option for control of ruptured duodenal varices, especially at a distal location.
Balloon Occlusion ; Duodenal Diseases/*diagnosis/radiography/therapy ; Embolization, Therapeutic ; Gastrointestinal Hemorrhage/therapy ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed

The Dieulafoy lesion is a rare cause of severe gastrointestinal hemorrhage. Although it may occur anywhere in the gastrointestinal tract, the lesion is most commonly located in the stomach, and the small bowel is an extremely uncommon site. Since Dieulafoy lesion in the small bowel is difficult to access by endoscopy, it seems impossible to diagnose and treat by initial endoscopy unlike the lesions in stomach. We experienced a case of Dieulafoy lesion of jejunum with massive hemorrhage in 54-year-old male. Active jejunal bleeding was shown by computed tomography scan and mesenteric angiography. Partial resection of the jejunum was performed. Final pathologic finding revealed Dieulafoy lesion of the jejunum.
Angiography ; Gastrointestinal Hemorrhage/complications/*diagnosis ; Humans ; Jejunal Diseases/complications/*diagnosis/surgery ; Male ; Mesenteric Arteries/radiography ; Middle Aged ; Tomography, X-Ray Computed

Aortoenteric fistula (AEF) developed after treatment for an abdominal aortic aneurysm (AAA) is a rare but usually fatal complication. We report a rare case of AEF bleeding after endovascular stent grafting for AAA which was managed angiographically. An 81-year-old man presented with hematochezia and acute abdominal pain for 1 day ago. Four years ago, an aortic stent was implanted in the infrarenal aorta for AAA. Endoscopies were performed to evaluate the hematochezia. Evidence of gastrointestinal bleeding was observed, but a clear bleeding point was not detected on upper endoscopy and colonoscopy. Contrast-enhanced computed tomography performed subsequently showed that the bleeding point was located in the fourth portion of the duodenum as an AEF caused by an inflammatory process in the stent-graft. Intra-arterial angiography showed a massive contrast leakage into the bowel via a small fistula from around the aortic stent graft site. Embolization was successfully performed by injecting a mixture of glue and lipiodol into the AEF tract. The patient was discharged with no evidence of gastrointestinal bleeding after the embolization.
Aged, 80 and over ; Angiography ; Aortic Aneurysm, Abdominal/*therapy ; Aortic Diseases/*etiology/radiography/therapy ; Embolization, Therapeutic ; Endoscopy, Gastrointestinal ; Fistula/*etiology/radiography/therapy ; Gastrointestinal Hemorrhage/therapy ; Humans ; Male ; Stents/*adverse effects ; Tomography, X-Ray Computed

OBJECTIVE: Suspicious incidental gastrointestinal FDG uptake during positron-emission tomography/computed tomography (PET/CT) examinations can be caused by different diseases, including malignancies. However, differentiation with PET alone is difficult. The aim of this study was to investigate the potential of PET alone, contrast-enhanced CT (ceCT), and low-dose CT (ldCT) in routine PET/CT protocols for differentiation of incidental gastrointestinal lesions. MATERIALS AND METHODS: Sixty patients with incidental gastrointestinal lesions who underwent a routine PET/CT protocol with ldCT and ceCT were retrospectively analysed. The PET lesions were evaluated regarding their FDG uptake patterns and the standard uptake value. The anatomical correlates in both CT protocols were compared in regard to the correct lesion classification with the reference standard endoscopy. RESULTS: Sixty-two lesions were found in 60 patients (17 malignant, 10 premalignant, 5 benign, 13 inflammatory, 17 physiological). The differentiation of the FDG uptake patterns did not enable reliable lesion classification. The positive predictive value for pathology was 0.81 for ceCT in PET/CT and 0.70 for ldCT. Malignancies were detected in 100% of the patients by ceCT vs. 29.4% by ldCT. The false negative rate of ceCT for all pathologies was 31.1%, vs. 68.9% for ldCT. False positive results (17/62) could not be excluded sufficiently by either CT protocol. CONCLUSION: PET/ceCT protocols provide additional benefit especially in detecting gastrointestinal malignancies as a cause of suspicious incidental gastrointestinal FDG uptake. However, since follow-up endoscopy cannot be forgone due to the considerable false negative rate even with ceCT, the addition of ceCT to a routine PET/ldCT protocol cannot be recommended for this purpose.
Adult ; Aged ; Aged, 80 and over ; Contrast Media/diagnostic use/pharmacokinetics ; Female ; Fluorodeoxyglucose F18/*diagnostic use/pharmacokinetics ; Follow-Up Studies ; Gastrointestinal Diseases/*diagnosis/metabolism ; Gastrointestinal Tract/*metabolism/radiography/radionuclide imaging ; Humans ; Male ; Middle Aged ; Positron-Emission Tomography/*methods ; Reproducibility of Results ; Retrospective Studies ; Tomography, X-Ray Computed/*methods

BACKGROUND/AIMS: The aim of this study was to identify the parameters that could noninvasively predict the presence of esophageal/gastric varices and portal hypertensive gastropathy (PHG) in patients with chronic liver disease (CLD), and to determine the accuracy of those parameters. METHODS: We retrospectively analyzed 232 patients with CLD who underwent both upper endoscopy and liver CT within an interval of 3 months. The multidimensional index (M-Index) for spleen volume was obtained from the multiplication of splenic length, width, and thickness, as measured by computer tomography. RESULTS: The multivariate analysis revealed that platelet, albumin, and M-Index were independently associated with the presence of varices and PHG. We combined three independent parameters, and developed a varices and portal hypertensive gastropathy (VAP) scoring system (=[platelet count (/mm3)xalbumin (g/dL)]/[M-Index (cm3)]). The area under the receiver operating characteristic curve of the VAP score was 0.850 (95% confidence interval, 0.801-0.899). The VAP cut-off value of 861 had a sensitivity of 85.3%, a positive likelihood ratio of 3.17, and a negative predictive value of 86.4%. For predicting high-risk lesions for bleeding, with a cut-off value of 861 the sensitivity was 92.0%, the positive likelihood ratio was 2.20, and the negative predictive value was 96.4%. CONCLUSIONS: The VAP score can predict the presence of varices and PHG in patients with CLD and may increase the cost-benefit of screening endoscopy in the clinical practice setting. A prospective validation study is necessary in the future.
Adult ; Aged ; Chronic Disease ; Endoscopy, Gastrointestinal ; Esophageal and Gastric Varices/complications/*diagnosis ; Female ; Humans ; Hypertension, Portal/complications/*diagnosis ; Liver Diseases/complications/*diagnosis ; Male ; Middle Aged ; Platelet Count ; Predictive Value of Tests ; ROC Curve ; Retrospective Studies ; Risk Factors ; Serum Albumin/analysis ; Severity of Illness Index ; Spleen/physiology/radiography ; Tomography, X-Ray Computed

OBJECTIVE: The objective of this study was to evaluate the technical aspects and clinical efficacy of selective embolization for post-endoscopic sphincterotomy bleeding. MATERIALS AND METHODS: We reviewed the records of 10 patients (3%; M:F = 6:4; mean age, 63.3 years) that underwent selective embolization for post-endoscopic sphincterotomy bleeding among 344 patients who received arteriography for nonvariceal upper gastrointestinal bleeding from 2000 to 2009. We analyzed the endoscopic procedure, onset of bleeding, underlying clinical condition, angiographic findings, interventional procedure, and outcomes in these patients. RESULTS: Among the 12 bleeding branches, primary success of hemostasis was achieved in 10 bleeding branches (83%). Secondary success occurred in two additional bleeding branches (100%) after repeated embolization. In 10 patients, post-endoscopic sphincterotomy bleedings were detected during the endoscopic procedure (n = 2, 20%) or later (n = 8, 80%), and the delay was from one to eight days (mean, 2.9 days; +/- 2.3). Coagulopathy was observed in three patients. Eight patients had a single bleeding branch, whereas two patients had two branches. On the selective arteriography, bleeding branches originated from the posterior pancreaticoduodenal artery (n = 8, 67%) and anterior pancreaticoduodenal artery (n = 4, 33%), respectively. Superselection was achieved in four branches and the embolization was performed with n-butyl cyanoacrylate. The eight branches were embolized by combined use of coil, n-butyl cyanoacrylate, or Gelfoam. After the last embolization, there was no rebleeding or complication related to embolization. CONCLUSION: Selective embolization is technically feasible and an effective procedure for post-endoscopic sphincterotomy bleeding. In addition, the posterior pancreaticoduodenal artery is the main origin of the causative vessels of post-endoscopic sphincterotomy bleeding.
Aged ; Aged, 80 and over ; Angiography, Digital Subtraction ; Biliary Tract Diseases/radiography/*surgery ; Cholangiopancreatography, Endoscopic Retrograde ; Embolization, Therapeutic/*methods ; Female ; Gastrointestinal Hemorrhage/*etiology/radiography/*therapy ; Humans ; Male ; Middle Aged ; Postoperative Complications/*etiology/radiography/*therapy ; Retrospective Studies ; *Sphincterotomy, Endoscopic ; Treatment Outcome

A Dieulafoy lesion in the rectum is a very rare and it can cause massive lower gastrointestinal bleeding. An 83-year-old man visited our hospital. He had chronic constipation and had taken aspirin for about 10 years because of a previous brain infarction. He was admitted because of a recent brain stroke. On the third hospital day, he had massive hematochezia and suddenly developed hypovolemic shock. Abdominal computed tomography showed active arterial bleeding on the left side of the mid-rectum. Emergency sigmoidoscopy showed an exposed vessel with blood spurting from the rectal wall. The active bleeding was controlled successfully by an injection of epinephrine and two hemoclippings. On the fourth day after the procedure, he had massive recurrent hematochezia, and his vital signs were unstable. Doppler-guided hemorrhoidal artery band ligation was performed urgently at two sites. However, he rebled on the third postoperative day. Selective inferior mesenteric angiography revealed an arterial pseudoaneurysm in a branch of the superior rectal artery, as the cause of rectal bleeding, and this was embolized successfully. We report a rare case of life-threatening rectal bleeding caused by a Dieulafoy lesion combined with pseudoaneurysm of the superior rectal artery which was treated successfully with embolization.
Aged, 80 and over ; Aneurysm/radiography ; Angiography ; Aspirin/therapeutic use ; Brain Infarction/drug therapy/prevention & control ; Embolization, Therapeutic ; Gastrointestinal Hemorrhage/*diagnosis/etiology/therapy ; Hemorrhoids/*complications ; Humans ; Male ; Mesenteric Artery, Inferior/radiography ; Platelet Aggregation Inhibitors/therapeutic use ; Rectal Diseases/complications/diagnosis/therapy ; Rectum/blood supply ; Sigmoidoscopy ; Tomography, X-Ray Computed

A Dieulafoy lesion in the rectum is a very rare and it can cause massive lower gastrointestinal bleeding. An 83-year-old man visited our hospital. He had chronic constipation and had taken aspirin for about 10 years because of a previous brain infarction. He was admitted because of a recent brain stroke. On the third hospital day, he had massive hematochezia and suddenly developed hypovolemic shock. Abdominal computed tomography showed active arterial bleeding on the left side of the mid-rectum. Emergency sigmoidoscopy showed an exposed vessel with blood spurting from the rectal wall. The active bleeding was controlled successfully by an injection of epinephrine and two hemoclippings. On the fourth day after the procedure, he had massive recurrent hematochezia, and his vital signs were unstable. Doppler-guided hemorrhoidal artery band ligation was performed urgently at two sites. However, he rebled on the third postoperative day. Selective inferior mesenteric angiography revealed an arterial pseudoaneurysm in a branch of the superior rectal artery, as the cause of rectal bleeding, and this was embolized successfully. We report a rare case of life-threatening rectal bleeding caused by a Dieulafoy lesion combined with pseudoaneurysm of the superior rectal artery which was treated successfully with embolization.
Aged, 80 and over ; Aneurysm/radiography ; Angiography ; Aspirin/therapeutic use ; Brain Infarction/drug therapy/prevention & control ; Embolization, Therapeutic ; Gastrointestinal Hemorrhage/*diagnosis/etiology/therapy ; Hemorrhoids/*complications ; Humans ; Male ; Mesenteric Artery, Inferior/radiography ; Platelet Aggregation Inhibitors/therapeutic use ; Rectal Diseases/complications/diagnosis/therapy ; Rectum/blood supply ; Sigmoidoscopy ; Tomography, X-Ray Computed

OBJECTIVE: We wanted to describe the computed tomography (CT) findings of gallbladder tuberculosis (TB) and to correlate them with pathologic findings. MATERIALS AND METHODS: There were seven patients (M:F = 3:4; mean age, 46.3 years; age range, 32 to 78 years) in whom gallbladder TB was eventually diagnosed. All of them underwent cross-sectional imaging with CT, a pathologic examination and a retrospective review. CT imaging evaluation was done in each case, including the findings of a mass versus nodule, wall thickening (uniform or irregular) and the enhancement patterns (homogeneous or heterogeneous). RESULTS: All the cases of gallbladder TB revealed the following three different CT findings: micronodular lesion of the gallbladder wall (n = 1), a thickened wall (n = 4) and a gallbladder mass (n = 2). There were three cases of homogeneous enhancement of the lesions, including homogeneous enhancement with nodular lesion, homogeneous uniform thickness enhancement and homogeneous thickness enhancement in one case each, and these cases pathology showed tuberculous granuloma with a little caseating necrosis in one case and tuberculous granuloma with rich fibrous tissue, but little or no evident caseating necrosis in two cases. Four cases of heterogeneous enhancement of the lesions, including heterogeneous uniform-thickness enhancement in two cases, heterogeneous enhancement with a local mass lesion in one case and heterogeneous enhancement with a mass that replaced the gallbladder in one case; in these cases, pathology showed tuberculous granuloma with marked caseation or liquefaction necrosis in three cases and tuberculous granuloma by fibrous and calcifications accompanied by caseating necrosis in one case. Among the seven cases of gallbladder TB, six cases were accompanied by abdominal extra-gallbladder TB, including abdominal lymph node TB in five cases and hepatic TB in four cases. CONCLUSION: Gallbladder TB has various CT manifestations, and the enhanced CT findings are well matched with pathological features. An irregularly thickened gallbladder wall or a gallbladder wall mass with multiple-focus necrosis or calcifications accompanied by the typical CT findings of abdominal extra-gallbladder TB should suggest the diagnosis of gallbladder TB.
Adult ; Aged ; Female ; Gallbladder Diseases/pathology/*radiography ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed/*methods ; Tuberculosis, Gastrointestinal/pathology/*radiography