Melena

黑斑
  • 文章类型: Case Reports
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  • 文章类型: Case Reports
    肾细胞癌(RCC)是一种常见的肾脏恶性肿瘤,胃转移是罕见的。我们报告了一例82岁的男性患者,该患者在最初诊断为RCC后12年发生胃转移。患者接受了内镜全层切除术(EFTR),胃转移灶被成功切除.术后病理及免疫组化显示胃转移起源于RCC。尽管RCC的胃转移很少见,有RCC病史或胃肠道症状的患者应怀疑。EFTR与减少的创伤和更大的胃组织和功能保留有关。这是比手术切除更合适的选择;然而,它需要更多的内窥镜医师。
    Renal cell carcinoma (RCC) is a common malignant kidney tumor; however, gastric metastasis is rare. We report the case of an 82-year-old male patient who developed gastric metastasis 12 years after an initial diagnosis of RCC. The patient underwent endoscopic full-thickness resection (EFTR), and the gastric metastatic focus was successfully removed. Postoperative pathology and immunohistochemistry showed that the gastric metastasis originated from RCC. Although gastric metastasis of RCC is rare, it should be suspected in patients with a history of RCC or gastrointestinal symptoms. EFTR is associated with reduced trauma and greater retention of gastric tissue and function. It is a more appropriate choice than surgical resection; however, it requires more endoscopists.
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  • 文章类型: Case Reports
    背景:由于十二指肠GIST的稀有性,临床医生对其临床特征的信息很少,诊断,管理和预后。
    方法:我们报告了一例61岁的埃及男子迅速诊断为十二指肠GIST的病例,他表现为呕血和黑便的严重发作。进行了胃十二指肠上段内镜检查,发现十二指肠第一部分有大量溃疡性出血,应用了4个血液夹,止血良好。剖腹探查术和远端胃切除术,进行十二指肠切除术和胃空肠造口术。肿块的形态结合免疫组织化学与高危类型的十二指肠胃肠道间质瘤(GIST)一致。患者每天服用阿马替尼一片,他没有肿瘤复发的迹象。
    结论:尽管很少见,突发严重的紧急情况,危及生命的出血性休克十二指肠GIST可能是潜在致命性的上消化道和下消化道大出血的原因,这是这种罕见且具有挑战性的肿瘤的关键特征。
    BACKGROUND: Due to rarity of duodenal GISTs, clinicians have few information about its clinical features, diagnosis, management and prognosis.
    METHODS: We report a case of promptly diagnosed duodenal GIST in a 61-year-old Egyptian man presented shocked with severe attack of hematemesis and melena. Upper gastroduodenal endoscopy was done and revealed a large ulcerating bleeding mass at first part of duodenum 4 hemo-clips were applied with good hemostasis. An exploratory laparotomy and distal gastrectomy, duodenectomy and gastrojejunostomy were performed. The morphology of the mass combined with immunohistochemistry was consistent with duodenal gastrointestinal stromal tumours (GISTs) of high risk type. The patient is on amatinib one tablet daily and he was well with no evidence of tumor recurrence.
    CONCLUSIONS: despite being rare, emergency presentation with sudden severe, life-threatening hemorrhagic shock duodenal GISTs might be a cause of potentially lethal massive combined upper and lower gastrointestinal bleeding which is the key feature of this rare and challenging tumor.
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  • 文章类型: Case Reports
    原发性胃伯基特淋巴瘤是一种侵袭性非霍奇金淋巴瘤,在文献中很少报道。大多数原发性胃淋巴瘤是弥漫性大B细胞淋巴瘤和粘膜相关淋巴组织(MALT)淋巴瘤。原发性胃伯基特淋巴瘤患者可表现为腹痛,呕血,Melena,穿孔,和阻塞。诊断是结合临床,放射学,和病理结果。由于报告的病例有限,治疗数据有限。我们介绍了一例47岁的女性,她表现为弥漫性腹痛,Melena,和咖啡磨呕吐,在上内窥镜检查发现的胃溃疡肿块进行活检后被诊断为原发性胃伯基特淋巴瘤。
    Primary gastric Burkitt\'s lymphoma is an aggressive non-Hodgkin\'s lymphoma that has been rarely reported in the literature. The majority of primary gastric lymphomas are diffuse large B-cell lymphomas and mucosa-associated lymphoid tissue (MALT) lymphomas. Patients with primary gastric Burkitt\'s lymphoma can present with abdominal pain, hematemesis, melena, perforation, and obstruction. Diagnosis is made with a combination of clinical, radiological, and pathological findings. Treatment data are limited due to the limited cases reported. We present a case of a 47-year-old female who presented with diffuse abdominal pain, melena, and coffee-ground emesis that was diagnosed with primary gastric Burkitt\'s lymphoma following biopsies taken from a gastric ulcerated mass found on upper endoscopy.
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  • 文章类型: Journal Article
    目的:消化道出血是一个主要的医疗负担,与显著的发病率和死亡率相关。这项研究旨在评估患病率,临床表现,急诊消化道出血患者的危险因素。
    方法:这项回顾性研究是在利雅得的两家三级医院进行的,沙特阿拉伯。回顾了2010年1月至2020年1月期间到急诊科就诊的消化道出血患者的病历。18岁或以上的患者,胃肠道出血(上或下),无论潜在原因,生活方式,出血部位,健康状况,或药物使用,包括在内。人口特征,初始生命体征,病史,体检结果,合并症,药物,实验室和放射学调查,肝病的病因和阶段,管理,并记录并发症。根据出现的症状收集出血部位的内镜检查结果和管理。
    结果:共纳入760例患者。平均年龄为62.7±17.8岁,男性占61.4%。最常见的合并症是高血压(54.1%),糖尿病(51.2%),和缺血性心脏病(18.2%)。出血的起源为52%的患者的下胃肠道和48%的患者的上消化道。
    结论:下消化道出血比上消化道出血更常见。痔疮,息肉,憩室病,结肠溃疡是下消化道出血的主要危险因素。相比之下,上消化道出血主要由食管静脉曲张引起,胃炎,和消化性溃疡.
    OBJECTIVE: Gastrointestinal bleeding is a major healthcare burden and is associated with significant morbidity and mortality. This study aimed to assess the prevalence, clinical presentation, and risk factors of patients presenting with gastrointestinal bleeding in the emergency department.
    METHODS: This retrospective study was conducted in two tertiary care hospitals in Riyadh, Saudi Arabia. The medical records of patients who presented to the emergency department with gastrointestinal bleeding between January 2010 and January 2020 were reviewed. Patients aged 18 years or older, with gastrointestinal bleeding (upper or lower) regardless of underlying cause, lifestyle, location of bleeding, health status, or medication use, were included. Demographic characteristics, initial vital signs, medical history, physical examination findings, comorbidities, medications, laboratory and radiological investigations, cause and stage of liver disease, management, and complications were recorded. Endoscopic findings and management of the bleeding site were collected according to the presenting symptoms.
    RESULTS: A total of 760 patients were included. The mean age was 62.7 ± 17.8 years, and 61.4% were males. The most common comorbidities at presentation were hypertension (54.1%), diabetes mellitus (51.2%), and ischemic heart disease (18.2%). The origins of the bleeding were lower gastrointestinal in 52% and upper gastrointestinal in 48% of patients.
    CONCLUSIONS: Lower gastrointestinal bleeding was found to be more common than upper gastrointestinal bleeding. Hemorrhoids, polyps, diverticular disease, and colonic ulcers were the major risk factors for lower gastrointestinal bleeding. In contrast, upper gastrointestinal bleeding was predominantly caused by esophageal varices, gastritis, and peptic ulcers.
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  • 文章类型: Case Reports
    胃畸胎瘤是一种极为罕见的肿瘤,占所有小儿畸胎瘤的1%,通常表现为可触及的腹部肿块。新生儿和婴儿的上消化道出血很少见,主要由良性病变引起。
    我们介绍了一个3个月大的男孩,他经常出现呕血,呕吐,黑便在检查中发现了胃畸胎瘤。
    由于该实体的独特特征和极端稀有,准确的术前诊断仍然难以捉摸。
    UNASSIGNED: Gastric teratoma is an extremely rare tumor, representing <1% of all pediatric teratomas, and commonly manifests as a palpable abdominal mass. Upper gastrointestinal tract bleeding in newborns and infants is rare and is mostly caused by a benign lesion.
    UNASSIGNED: We present a 3-month-old boy who presented with recurrent attacks of hematemesis, vomiting, and melena which on work up revealed a gastric teratoma.
    UNASSIGNED: Owing to the unique characteristics and the extreme rarity of this entity, accurate preoperative diagnosis has remained elusive.
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  • 文章类型: Journal Article
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  • 文章类型: Case Reports
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    文章类型: Case Reports
    我们报告2例门静脉支架置入术治疗因胰腺癌复发伴门静脉高压症所致的恶性门静脉狭窄。病例1:患者为68岁女性。五年前,在胰腺癌的残余胰腺切除术后进行的计算机断层扫描(CT)扫描中,发现主动脉周围有肿块。诊断为淋巴结复发,开始S-1治疗。随着肿瘤进一步扩大导致门静脉受压,上升的空肠周围的静脉淤积,贫血,和黑色的凳子,放置门静脉支架.门静脉血流得到改善,侧支血管消失了,患者不再出现贫血或黑便。病例2:一名75岁的女性患者因胰头癌接受了保胃胰十二指肠切除术和门静脉联合切除术。在6个月后的术后CT扫描中,出现了一个压迫门静脉的肿块,被诊断为局部复发。由于观察到血小板减少症,在开始化疗前放置门静脉支架.门静脉血流和血小板计数改善。门静脉支架置入术是治疗恶性门静脉狭窄的有效方法,改善门静脉血流和临床症状。
    We report 2 cases of portal vein stent placement for malignant portal stenosis due to recurrence of pancreatic cancer with symptoms of portal hypertension. Case 1: The patient was a 68-year-old female. Five years ago, a mass was found around the aorta on a computerized tomography(CT)scan taken after a residual pancreatectomy for pancreatic cancer. It was diagnosed as lymph node recurrence and S-1 therapy was started. As further tumor enlargement led to portal vein compression, venostasis around the ascending jejunum, anemia, and black stools, a portal vein stent was placed. The portal vein blood flow was improved, the collateral vessels disappeared, and the patient no longer experienced anemia or black stool. Case 2: A 75-year-old female patient underwent a subtotal gastric-sparing pancreaticoduodenectomy and combined resection of the portal vein for pancreas head cancer. On a postoperative CT scan taken 6 months later, a mass compressing the portal vein appeared, which was diagnosed as a local recurrence. As thrombocytopenia was observed, a portal vein stent was placed before starting chemotherapy. The portal vein blood flow and the platelet count improved. Portal vein stenting is an effective procedure for malignant portal stenosis, improving portal blood flow and clinical symptoms.
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