MyMedR

Fulltext An unusual cause of efferent loop obstruction

Sukumar N, Shukri J, Jegan T, Tee SS

Med J Malaysia, 2002 Jun;57(2):221-4.

A patient who presented with massive upper gastrointestinal hemorrhage underwent a Billroth II partial gastrectomy. He developed efferent loop obstruction due to a retained abdominal drain. Relaparotomy for removal of drain was performed. Retained drains are known complications but rarely, it is cause of efferent loop obstruction.

Matched MeSH terms: Gastrointestinal Hemorrhage*

Comment to: Diagnostic Value of Serum Gastrin and Epidermal Growth Factor to the Gastric Ulcer Complicated with Upper Gastrointestinal Hemorrhage

Hayati F, Abdul Rahim MA, Abdul Rahim SSS

J Coll Physicians Surg Pak, 2021 Dec;31(12):1522-1523.

PMID: 34794305 DOI: 10.29271/jcpsp.2021.12.1522

Null.

Matched MeSH terms: Gastrointestinal Hemorrhage/etiology

Fulltext Jejunal diverticulosis as the obscure cause of overt gastrointestinal bleeding

Nyin LY, Zainun AR, Tee HP

Med J Malaysia, 2011 Aug;66(3):257-8.

PMID: 22111453 MyJurnal

Jejunal diverticulosis is a rare gastrointestinal condition manifested as benign outpouching from the jejunal wall. It is usually asymptomatic, but may present as obscure gastrointestinal bleeding. This condition is often found incidentally in the imaging work-up of patients with other gastrointestinal conditions. We present a case of jejunal diverticulosis in a 65-year-old gentleman with obscure overt gastrointestinal bleed.

Matched MeSH terms: Gastrointestinal Hemorrhage/diagnosis*; Gastrointestinal Hemorrhage/etiology*; Gastrointestinal Hemorrhage/therapy

Achalasia cardia presenting with haemetemesis. [Abstract]

Ganesananthan S, Ngau YY, Menon J, Kew ST

Med J Malaysia, 2002;57 Suppl A:47.

Matched MeSH terms: Gastrointestinal Hemorrhage

Fulltext A study into the characteristics and outcome of variceal bleeding in a tertiary hospital in Southeast Asia

Yew BS, Ong WC, Chow WC, Lui HF

Med J Malaysia, 2007 Aug;62(3):201-5.

PMID: 18246907

This retrospective study evaluated patients admitted to the Department of Gastroenterology, Singapore General Hospital for variceal bleeding in the year 2004. Improvement in outcome of variceal bleeding has been reported in the West. There is no regional data on this condition. This study aims to determine the characteristics and outcome of variceal bleeding in a tertiary hospital in Southeast Asia. Twenty-two patients were eligible. The main aetiologies of liver cirrhosis were chronic hepatitis B (38%) and alcohol (33%). Child's A, B and C were 29%, 48% and 24% respectively. Nineteen patients (86%) had bleeding oesophageal varices (band ligation performed). The remaining three patients (14%) had bleeding gastric varices (N-butyl-2-cyanoacrylate injection performed). Detailed description of certain endoscopic findings was absent in up to 18 patients (82%). All patients received antibiotics and vasoactive drug. In-hospital mortality and rebleeding were 9% and 18% respectively. We conclude that the relatively low in-hospital mortality and rebleeding rates in our series are most probably due to the smaller proportion of patients with severe liver dysfunction and management which adhered to recommendations. Documentation of endoscopic findings needs to be improved to facilitate the continuation of care.

Matched MeSH terms: Gastrointestinal Hemorrhage/drug therapy; Gastrointestinal Hemorrhage/mortality; Gastrointestinal Hemorrhage/physiopathology*; Gastrointestinal Hemorrhage/therapy

Fulltext Upper gastrointestinal bleeding in Kuala Lumpur Hospital, Malaysia

Lakhwani MN, Ismail AR, Barras CDJ, Tan WJ

Med J Malaysia, 2000 Dec;55(4):498-505.

PMID: 11221164

Despite advancements in endoscopy and pharmacology in the treatment of peptic ulcer disease the overall mortality has remained constant at 10% for the past four decades. The aim of this study was to determine the age, gender, racial distribution, incidence and causes of endoscopically diagnosed cases of upper gastrointestinal (UGI) bleeding to summarise treatments undertaken and to report their outcome. A prospective study of UGI bleeding in 128 patients was performed in two surgical wards of Kuala Lumpur Hospital, involving both elective and emergency admissions. The study group comprised of 113 (88.2%) males and 15 (11.7%) females. The mean age was 51.9 years (range 14 to 85 years) and 37.5% (48 of 128 patients) were older than 60 years. The Indian race was over-represented in all disease categories. Smoking (50.1%), alcohol consumption (37.5%), non-steroidal anti-inflammatory drugs (NSAIDs) (17.2%), traditional remedies (5.5%), anti-coagulants (2.3%) and steroids (0.8%) were among the risk factors reported. Common presenting symptoms and signs included malaena (68.8%), haematemesis (59.4%) and fresh per rectal bleeding (33.6%). The commonest causes of UGI bleeding were duodenal ulcer (32%), gastric ulcer (29.7%), erosions (duodenal and gastric) (21.9%), oesophageal varices (10.9%) and malignancy (3.9%). UGI bleeding was treated non-surgically in 90.6% of cases. Blood transfusions were required in 62.6% (67/107) of peptic ulcer disease patients. Surgical intervention for bleeding peptic ulcer occurred in around 10% of cases and involved under-running of the bleeding vessel in most high risk duodenal and gastric ulcer patients. The overall mortality from bleeding peptic ulcer disease was 4.7%. Six patients died from torrential UGI haemorrhage soon after presentation, without the establishment of a cause. Active resuscitative protocols, early endoscopy, more aggressive interventional therapy, early surgery by more senior surgeons, increasing intensive care unit beds and more active participation of multidisciplinary teams in co-ordinating management are among remedial measures advocated. Broader educational preventive strategies should target the causes of UGI bleeding.

Matched MeSH terms: Gastrointestinal Hemorrhage/etiology; Gastrointestinal Hemorrhage/mortality; Gastrointestinal Hemorrhage/epidemiology*; Gastrointestinal Hemorrhage/therapy*

Fulltext Role of primary prophylaxis in preventing variceal bleeding in children with gastroesophageal varices

Lee WS, Song ZL, Em JM, Chew KS, Ng RT

Pediatr Neonatol, 2021 05;62(3):249-257.

PMID: 33546933 DOI: 10.1016/j.pedneo.2021.01.002

BACKGROUND: Primary endoscopic prophylaxis in pediatric gastroesophageal varices is not universally practiced. We aimed to determine the role of primary endoscopic prophylaxis in preventing variceal bleeding in gastroesophageal varices in children.

METHODS: We reviewed all children with gastroesophageal varices seen in our unit from 2000 to 2019. Primary prophylaxis was defined as endoscopic procedure without a preceding spontaneous bleeding and secondary prophylaxis as preceded by spontaneous bleeding. High-risk varices were defined as presence of grade III esophageal varices, cardia gastric varices or cherry red spots on the varices. Outcome measures (spontaneous rebleeding within 3 months after endoscopic procedure, number of additional procedures to eradicate varices, liver transplant [LT], death) were ascertained.

RESULTS: Sixteen of 62 (26%) patients (median [± S.D.] age at diagnosis = 5.0 ± 4.3 years) with varices had primary prophylaxis, 38 (61%) had secondary prophylaxis while 8 (13%) had no prophylaxis. No difference in the proportion of patients with high-risk varices was observed between primary (88%) and secondary (92%; P = 0.62) prophylaxis. As compared to secondary prophylaxis, children who had primary prophylaxis were significantly less likely to have spontaneous rebleeding (6% vs. 38%; P = 0.022) and needed significantly fewer repeated endoscopic procedures (0.9 ± 1.0 vs. 3.1 ± 2.5; P = 0.021). After 8.9 ± 5.5 years of follow-up, overall survival was 85%; survival with native liver was 73%. No statistical difference was observed in the eventual outcome (alive with native liver) between primary and secondary (71% vs. 78%, P = 0.78).

CONCLUSION: Children with PHT who had primary prophylaxis had less subsequent spontaneous rebleeding and needed fewer additional endoscopic procedures as compared to secondary prophylaxis but did not have an improved eventual outcome. Screening endoscopy in all children who have signs of PHT and primary prophylaxis in high-risk esophageal varices should be considered before eventual LT.

Matched MeSH terms: Gastrointestinal Hemorrhage/etiology; Gastrointestinal Hemorrhage/prevention & control

Fulltext Management of bleeding pseudoaneurysm of gastroduodenal artery secondary to chronic pancreatitis

Leow VM, Siam F, Kannan S, Sari Baharudin M, Raman K, Singh H

Med J Malaysia, 2013 Jun;68(3):271-2.

PMID: 23749023 MyJurnal

A bleeding pseudoaneurysm of the peripancreatic artery can present with massive upper gastrointestinal hemorrhage. History of pancreatitis and urgent imaging are crucial in the making of the diagnosis. Here, we report a patient with alcoholic chronic pancreatitis presented with ruptured pseudoaneurysm of gastroduodenal artery (GDA). He was treated with percutaneous angiographic embolisation.

Matched MeSH terms: Gastrointestinal Hemorrhage/therapy

Fulltext Chronic rectal bleeding in Proteus syndrome

Siow SL, Sim NK

Med J Malaysia, 2010 Dec;65(4):313-4.

PMID: 21901955

Proteus Syndrome is a rare congenital hamartomatous disorder that typically manifests itself in overgrowth, vascular malformation and disregulation of fatty tissue. The tissues affected are commonly the limbs but can be of any tissue. Vascular anomalies are common and appear at random sites on the body. Diagnosis is often difficult leading to wrong treatment. We describe a case of a 17-year-old girl with Proteus syndrome presented with symptomatic anaemia secondary to chronic rectal bleeding. Computed Tomography Angiogram of Abdomen and Pelvis confirmed the presence of rectal vascular malformations.

Matched MeSH terms: Gastrointestinal Hemorrhage/etiology*

Fulltext Treatment of bleeding gastroesophageal varices

Kyaw K, Raj SM

Med J Malaysia, 1993 Sep;48(3):377-8.

PMID: 8183158

Matched MeSH terms: Gastrointestinal Hemorrhage/therapy*

Necrotizing enteritis

Mukherjee AP, Foong WC, Ferguson BR

Med J Malaya, 1971 Jun;25(4):285-7.

PMID: 4261302

Matched MeSH terms: Gastrointestinal Hemorrhage/etiology

Virus haemorrhagic fever

Reid HA

Bull Soc Pathol Exot Filiales, 1969;62(2):263-6.

PMID: 4397208

Matched MeSH terms: Gastrointestinal Hemorrhage/etiology*

Fulltext Gastrointestinal bleeding caused by epitheloid sarcoma: A case report

Lee FY, Lim L, Gee T

Med J Malaysia, 2016 Aug;71(4):215-216.

PMID: 27770126 MyJurnal

Epithelioid sarcoma (ES) of the small bowel is a rare gastrointestinal tumour. We report a case of gastrointestinal bleeding secondary to small bowel ES in a 55-year-old gentleman. After gastroscopy and colonoscopy failed to identify the source of bleeding, we proceeded with computed tomography angiogram of the mesentery, which revealed intraluminal blood clot in the distal jejunum with features of obstruction. This is a rare cause of obscure gastrointestinal bleeding and emphasises the need for additional evaluation in the presence of negative endoscopic findings.

Matched MeSH terms: Gastrointestinal Hemorrhage*

Fulltext A rare case of fulminant hemobilia resulting from gallstone erosion of the right hepatic artery

Jee SL, Lim KF, Krishnan R

Med J Malaysia, 2014 Aug;69(4):191-2.

PMID: 25500850 MyJurnal

Hemobilia is a rare but potentially lethal condition. The commonest cause of hemobilia is trauma, accounting up to 85% of all cases. Hemobilia caused by gallstones is very rare. Most of the cases of hemobilia are either managed conservatively or treated by embolization. Surgery is indicated only when there is an associated surgical condition or when embolization fails. We report a case of a 72-year-old patient with massive hemobilia caused by gallstone erosion to the adjacent artery, diagnosed intraoperatively. The complication was successfully managed by cholecystectomy and repair of the bleeding vessel. This case highlights the importance that hemobilia should be suspected in patients presenting with upper gastrointestinal bleeding. Although rare, massive hemobilia can be life threatening, leading to significant morbidity and mortality. Therefore, a high index of suspicion and timely intervention are important.

Matched MeSH terms: Gastrointestinal Hemorrhage

Fulltext Spontaneous intramural oesophageal haematoma: a case report

Seneviratne SA, Kumara DS, Drahaman A

Med J Malaysia, 2012 Oct;67(5):536-7.

PMID: 23770878

Spontaneous intramural oesophageal haematoma is a rare disease and presents with the classic triad of symptoms of chest pain, dysphagia and haematemesis. Flexible oesophagoscopy and contrast enhanced CT scan is helpful in the diagnosis and also to exclude other sinister pathologies. Most are managed conservatively and the patient we report also was managed conservatively with a successful outcome.

Matched MeSH terms: Gastrointestinal Hemorrhage

Fulltext Massive lower gastrointestinal bleeding secondary to colonic mucormycosis

Anand J, Ghazala K, Chong VH

Med J Malaysia, 2011 Aug;66(3):266-7.

PMID: 22111457

Lower gastrointestinal bleeding is usually due to haemorrhoids, diverticular disease, or colorectal cancer. Infective causes of gastrointestinal bleeding are rare. A 70-year-old lady was admitted with septic shock secondary to community acquired pneumonia. She later developed massive lower gastrointestinal bleeding secondary to colonic mucormycosis. Her condition deteriorated rapidly and she died of septicemia. Mucormycosis of the colon is extremely rare and is still associated with a high mortality.

Matched MeSH terms: Gastrointestinal Hemorrhage/diagnosis; Gastrointestinal Hemorrhage/microbiology*; Gastrointestinal Hemorrhage/therapy

Fulltext Arteriovenous malformation of the stomach: a rare cause of upper gastrointestinal bleeding

Latar NH, Phang KS, Yaakub JA, Muhammad R

Med J Malaysia, 2011 Jun;66(2):142-3.

PMID: 22106696 MyJurnal

Haemorrhage arising from gastric arteriovenous malformation (AVM) is rare and normally occurs in the elderly. Bleeding gastric AVM presenting in the younger age group is even rarer. We report a case of a 14 year old boy who presented with recurrent episodes of haematemesis. He subsequently underwent a proximal gastrectomy and the histological examination confirmed a gastric AVM. After reviewing the literature we believe this is the youngest ever reported case of bleeding gastric AVM reported in English literature.

Matched MeSH terms: Gastrointestinal Hemorrhage/etiology*; Gastrointestinal Hemorrhage/pathology; Gastrointestinal Hemorrhage/therapy

Fulltext An audit of upper gastrointestinal bleeding at Seremban Hospital

Lim TM, Lu PY, Meheshinder S, Selvindoss P, Balasingh D, Ramesh J, et al.

Med J Malaysia, 2003 Oct;58(4):522-5.

PMID: 15190627

We retrospectively analyzed all patients presenting with upper gastrointestinal bleeding to Seremban Hospital over a one-year period. A quarter of the oesophagogastro-duodenoscopies (OGD) performed were performed as emergency for upper gastrointestinal tract bleeding. Gastric ulcers and duodenal ulcers were the two most common findings. Our results suggest that there is a male preponderance of 2:1, the Chinese were more likely to be affected and the elderly (> 60 years) were at highest risk.

Matched MeSH terms: Gastrointestinal Hemorrhage/ethnology; Gastrointestinal Hemorrhage/etiology*; Gastrointestinal Hemorrhage/therapy

Demographics and characteristics of endoscopic findings among COVID-19 patients with upper gastrointestinal bleeding in a single centre

Mohamed AK, Tang YC

Med J Malaysia, 2023 Dec;78(7):893-896.

PMID: 38159924

INTRODUCTION: Novel coronavirus 19 disease (COVID-19) pandemic poses healthcare providers challenges in the endoscopic suite. It is unclear whether it affects the endoscopic manifestations of upper gastrointestinal (GI) bleeding. This retrospective study was done to review demographic data, site of lesions and need of interventions for those lesions.

MATERIALS AND METHODS: Oesophagoduodenoscopy (OGDS) reports of COVID-19 patients with indication of upper GI bleeding from March 2021 to April 2022 were reviewed. Data of 35 patients were then analysed.

RESULTS: Of the 35 patients, 8.6% (n = 3) were female and 91.4% (n = 32) were males. A total of 31.4% (n = 11) were below 50 years and 68.6% (n = 24) were 50 and above. 34.3% (n = 12) with lesions requiring endoscopic intervention, 34.3% (n = 12) with lesions not requiring endoscopic intervention, 31.4% (n = 11) has no significant stigmata of recent haemorrhage. Among subgroup requiring endoscopic intervention, 50% (n = 6) are non-variceal bleeding (NVUIB), and 50% (n = 6) are variceal bleeding (VUGIB). Among NVUGIB, 16.7% (n = 1) is gastric and duodenal angiodysplasia requiring argon plasma coagulation, 50% (n = 3) are duodenal F2A ulcer requiring thermoablation, 16.7% (n = 1) is gastric F2A ulcer requiring hemoclip, and 16.6% (n = 1) is Cameron's ulcer requiring hemoclip. Among VUGIB, 100% (n = 6) are oesophageal varices requiring endoscopic variceal banding (EVL).

CONCLUSIONS: Lower proportion of NVUGIB among COVID-19 patients raises hypothesis on whether prothrombotic state of COVID-19 is a protective factor of NVUGIB. Studies with larger sample size are needed to establish significance.

Matched MeSH terms: Gastrointestinal Hemorrhage/etiology; Gastrointestinal Hemorrhage/epidemiology; Gastrointestinal Hemorrhage/surgery

Fulltext Superselective embolisation in acute lower gastrointestinal haemorrhage: a single institution experience

Md Ralib AR, Zakaria R, Mohamad Z, Muda AS

Malays J Med Sci, 2009 Oct;16(4):34-41.

PMID: 22135510 MyJurnal

Superselective embolisation has been recognised as integral in the management of lower gastrointestinal haemorrhage. It has also reduced the need for emergency surgery. The objective of this case series was to describe the lower gastrointestinal haemorrhage cases seen in our centre, its diagnosis and the role of superselective embolisation in patient management.

Matched MeSH terms: Gastrointestinal Hemorrhage

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