Background: Massive esophageal variceal bleeding can be catastrophic, leading to high morbidity and mortality. Patients experiencing massive esophageal variceal bleeding are at high risk of aspiration and hemorrhagic shock in acute episodes. Intubation and bleeding control are the two essential steps for resuscitation of these patients.
Case Summary: A 47-year-old male patient was admitted to our hospital with upper digestive tract bleeding. He was diagnosed with alcohol-induced liver cirrhosis and consequent esophagogastric varices. As he did not show a good response to somatostatin and Sengstaken-Blakemore tube placement, the patient was scheduled for endoscopic angiotherapy under anesthesia. Preoperative assessment showed an ASA physical status of III and Child-Pugh classification B. However, massive hemorrhage occurred just after induction of anesthesia. Intubation by video-guided laryngoscopy in the lateral decubitus position was attempted twice and was successful. After that, an experienced endoscopic ultrasound (EUS) specialist performed angiotherapy and occluded the culprit vessel. An ultra-thin gastroscope was then inserted into the endotracheal tube to extract the blood observed in the lobar bronchi. The patient suffered hemorrhagic shock with an estimated blood loss of 1500 mL in 20 min and remained in the intensive care unit for two days. The patient was discharged from our hospital eight days later without major complications.
Conclusion: Intubation in the lateral decubitus position and EUS-guided treatment can be life-saving procedures in patients with massive upper gastrointestinal hemorrhage.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812882 | PMC |
http://dx.doi.org/10.12998/wjcc.v9.i2.372 | DOI Listing |
Eur Radiol
December 2024
Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Objective: To develop and compare machine learning models based on CT morphology features, serum biomarkers, and basic physical conditions to predict esophageal variceal bleeding.
Materials And Methods: Two hundred twenty-four cirrhotic patients with esophageal variceal bleeding and non-bleeding were included in the retrospective study. Clinical and serum biomarkers were used in our study.
Pediatr Surg Int
December 2024
Cerrahpasa Faculty of Medicine, Department of Pediatric Surgery, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Aim: This study aims to evaluate the outcomes of endoscopic sclerotherapy (EST) in the treatment of esophagogastric varices in cases of extrahepatic portal hypertension (EHPH) secondary to portal vein thrombosis.
Materials And Methods: Records of cases that underwent endoscopic sclerotherapy for esophagogastric varices between 1990 and 2022 in our clinic were retrospectively reviewed. The age, gender, symptomatology, etiology, clinical, laboratory, and radiological data of the patients, as well as treatment outcomes, were evaluated.
Endoscopy
January 2025
Gastroenterology, Shanghai Jiaotong University School of Medicine Xinhua Hospital, Shanghai, China.
Transfus Apher Sci
December 2024
Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address:
The Rh blood type has 57 antigens, including D, C, E, c, and e. This blood type is clinically significant, alongside the ABO blood type. The anti-f(ce) antibody is an unexpected antibody that targets an antigen composed of the c and e antigens.
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November 2024
Internal Medicine, North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, GBR.
Parastomal varices are an uncommon but significant source of hemorrhage in patients with portal hypertension, often posing diagnostic and therapeutic challenges. We report the case of a 73-year-old male with a history of alcoholic liver disease and a urostomy following cystoprostatectomy for bladder cancer. The patient presented with profuse bleeding from his urostomy site.
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