Diagnosis of gastrointestinal bleeding: A practical guide for clinicians

Kim, Bong Sik Matthew; Li, Bob T.; Engel, Alexander; Samra, Jaswinder S.; Clarke, Stephen; Norton, Ian D.; Li, Angela E.

doi:10.4291/wjgp.v5.i4.467

Cited by 197 publications

(192 citation statements)

References 80 publications

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“…Once the cancer was resected, the patient's anemia resolved. E mergency department management of lower gastrointestinal bleeding, anemia, fatigue, and orthostasis are common (1)(2)(3)(4)(5). We report the lowest hemoglobin of which we are aware, at 1.8 g/dL, in a patient with lower gastrointestinal bleeding.…”

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confidence: 87%

Extreme Anemia (Hemoglobin 1.8 G/Dl) Secondary to Colon Cancer

Schmitt¹,

Buckley²

2016

Baylor University Medical Center Proceedings

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We present the case of a 34-year-old man who presented to the emergency department with complaints of generalized fatigue and palpitations, with a heart rate of approximately 100 beats per minute and an orthostatic blood pressure of 80/30 mm Hg upon standing. A hemoglobin of 1.8 g/dL was discovered. A positive fecal occult blood test led to the diagnosis of colon cancer. Once the cancer was resected, the patient's anemia resolved. E mergency department management of lower gastrointestinal bleeding, anemia, fatigue, and orthostasis are common ( 1-5 ). We report the lowest hemoglobin of which we are aware, at 1.8 g/dL, in a patient with lower gastrointestinal bleeding. CASE REPORTA 34-year-old previously healthy black man presented to the emergency department with a complaint of generalized fatigue and palpitations that had progressively increased over the last 6 months. Th e patient's heart rate was 100 to 105 beats/minute, and his blood pressure was 110/74 mm Hg when supine but 80/30 mm Hg upon standing. He was found to have marked conjunctival pallor with moist mucous membranes. He had generalized abdominal tenderness and a briskly positive fecal occult blood test absent of melena or overt blood. Electrocardiogram analysis showed Q waves in V1 to V3 with inverted T waves in V4 and lead III.Th e patient had had anemia as a child. He had no history of sickle cell or other hematopoietic disorders. He denied melenic or bloody stools. He indicated that he had been intermittently homeless over the prior 6 months. He denied a history of hepatitis, intravenous drug use, prosthetic valves, or hemoptysis.Initial laboratory evaluation was complicated by standard laboratory protocols rejecting the patient's complete blood count due to machine error, citing a "dilute" specimen. A call by the emergency physician requesting the release of the results after two rejected attempts showed on the third specimen severe anemia with a hemoglobin of 1.8 g/dL (Tables 1 and 2) .He was transfused with a total of 5 units of blood over 2 days, reaching a hemoglobin level of 7.6 g/dL, and provided Extreme anemia (hemoglobin 1.8 g/dL) secondary to colon cancer Rob E. Schmitt, MD, and Clifford J. Buckley II, MD, MBA with intravenous and oral iron and cholecalciferol supplementation. He underwent esophagogastroduodenoscopy as well as colonoscopy with biopsies showing extensive carcinoma of the colon. Th is was followed by a right hemi-and transverse colectomy with an ileostomy placement. Ultimately, the surgical specimen revealed a 13 × 11 × 4 cm 100% encircling high-grade, poorly diff erentiated adenocarcinoma. Th e patient, now 36 years old, had complete resolution of his anemia, with the most recent hemoglobin level being 14.0 g/dL just under 2 years after his colectomy. Proc (Bayl Univ Med

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confidence: 87%

Extreme Anemia (Hemoglobin 1.8 G/Dl) Secondary to Colon Cancer

Schmitt¹,

Buckley²

2016

Baylor University Medical Center Proceedings

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“…However, the sensitivity of angiography is low for detecting active bleeding, and many factors may be attributed to this low sensitivity, including intermittent bleeding, vascular spasm, administration of vasoconstrictor drugs, and slow arterial (< 0.5-1.5 mL/min), venous, or small vessel bleeding (3)(4)(5).…”

Section: Discussionmentioning

confidence: 99%

“…Contrast extravasation is direct evidence of active bleeding; however, it only occurs in a minority of patients who have GI bleeding and requires a bleeding rate of at least 0.5 mL/min for visualization (3,7,8). Commonly encountered indirect angiographic signs of bleeding include delayed focal contrast stasis, intramural pooling, aneurysm, pseudoaneurysm, arteriovenous shunt, submucosal vessel and early venous drainage of angiodysplasia, neovascularity, mucosal or extramucosal hyperemia, or arterial wall abnormalities (9).…”

Section: Discussionmentioning

confidence: 99%

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Abrupt occlusion of right gastroepiploic artery as an angiographic evidence of gastrointestinal hemorrhage

et al. 2016

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Angiography plays an important role in both diagnosis and treatment of gastrointestinal (GI) bleeding; however, the sensitivity is low for diagnosis. We report a case of a 38-year-old woman who presented with recurrent upper GI bleeding following central pancreatectomy. Multiple selective arteriograms failed to reveal any active bleeding or other common signs of bleeding. There was an abrupt occlusion of the right gastroepiploic artery initially interpreted to be a surgical ligation. Upon direct superselective injection near the occlusion, an area of frank contrast extravasation was demonstrated immediately beyond the occlusion. The underlying vessel was embolized with n-butyl cyanoacrylate without recurrent bleeding up to 3-month follow-up.

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“…Upper gastrointestinal bleeding (UGIB) is a common medical emergency with an estimated incidence rate of 150 per 100,000 person years and mortality ranging between 2 and 10% [1-3]. Some 60–80% of acute gastrointestinal (GI) bleeding constitutes of upper GI tract and is caused mainly by peptic ulcer disease, variceal hemorrhage, Mallory-Weiss tear, gastroduodenal erosions, or erosive esophagitis [3, 4].…”

Section: Introductionmentioning

confidence: 99%

Need of Emergency Surgery in Elderly Patients with Upper Gastrointestinal Bleeding: Survival Analysis during 2009–2015

et al. 2018

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Background/Aims: The role of emergency surgery is decreasing in the treatment of patients with upper gastrointestinal bleeding (UGIB). We investigated the need of urgent surgery and outcome of elderly UGIB patients who often have cardiovascular comorbidities with antithrombotic medication. Methods: All consecutive adult patients who received emergency treatment for suspected gastrointestinal bleeding between January 2009 and December 2011 were registered in an electronic database (n = 1,643). A total of 569 patients with a first-time UGIB were identified, of whom 282 were ≥70 years old. Age-specific incidence rates, risk factors for bleeding and need of endoscopic or emergency surgery were studied. Long-term mortality was compared to age-adjusted control subjects (n = 569) without bleeding. Results: The age-specific incidence of UGIB increased from 156 to 401 cases per 100,000 inhabitants from age 60–69 to 80–89 years, respectively. Cardiovascular comorbidities and antithrombotic therapies (acetosalicylic acid 51 vs. 27%; warfarins 25 vs. 11%) related to UGIB were more common in patients over than under 70 years of age (p < 0.0001). Early endoscopic therapy was successful in over 95% of patients, whereas emergency surgery was needed only in 6 (2%) patients ≥70 years old. Hospital mortality (7.8%) was acceptable in these patients, but the 5-year mortality (40%) was significantly higher than in controls (20%, p < 0.001). Conclusion: Today, emergency surgery is seldom needed in the patients with UGIB. In comparison to the age-matched control population, long-term survival was significantly lower after UGIB in the elderly.

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Diagnosis of gastrointestinal bleeding: A practical guide for clinicians

Cited by 197 publications

References 80 publications

Extreme Anemia (Hemoglobin 1.8 G/Dl) Secondary to Colon Cancer

Extreme Anemia (Hemoglobin 1.8 G/Dl) Secondary to Colon Cancer

Abrupt occlusion of right gastroepiploic artery as an angiographic evidence of gastrointestinal hemorrhage

Need of Emergency Surgery in Elderly Patients with Upper Gastrointestinal Bleeding: Survival Analysis during 2009–2015

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