Massive hematemesis and melena stool: A case report of unusual manifestation of Cow’s milk protein intolerance

ABSTRACT Cow’s milk protein intolerance (CMPI) is a common condition that causes gastrointestinal bleeding in the first year of life. It is the most common cause of chronic blood loss and anemia; however, severe massive hematemesis is an uncommon condition. Herein, we present a case of severe massive hematemesis with melena stool in a six-month-old boy with cow’s milk protein intolerance. In this case, we described management used in poor developing countries.

Ten- Year-Old Female with Dieulafoy Lesion Treated with Therapeutic Endoscopy And Literature Review

Background There are many causes of sudden gastrointestinal bleeding in children, Dieulafoy lesion is very rare. This vascular abnormality can be fatal without appropriate treatment.Case presentation Retrospective analysis of the clinical manifestations, endoscopic features and treatment of a Chinese child with Dieulafoy lesion and review relevant literatures.Result A 10-year-old girl was admitted to hospital with sudden massive hematemesis and melena. Abdominal CT revealed suspected submucosal bleeding in the stomach. Finally the disease was diagnosed due to the typical manifestations with endoscopy. Meanwhile, we used electrocoagulation and hemoclips to hemostasis under endoscopy. No recurrence of hematemesis identified during the 4-weeks follow-up.Conclusion Dieulafoy lesion in children is rare cause of sudden gastrointestinal hemorrhage. But differential diagnosis cannot ignore it. Endoscope is the optimize choice for diagnosis and treatment.

Splenic Artery Pseudoaneurysm Causing Massive Hematemesis 10 Years After Necrotizing Pancreatitis

We report a case of a 54-year-old male presenting to a regional hospital with severe hematemesis and hemodynamic instability. His medical history was significant for a previous episode of alcoholic necrotizing pancreatitis and pseudocyst, requiring cystoenterostomy drainage and debridement 10 years prior. He underwent multiple gastroscopies and one emergency laparotomy which failed to definitively treat the bleeding. A splenic artery pseudoaneurysm was diagnosed with computed tomography angiography, adjacent to the previous cystoenterostomy site. The patient was transferred to a major tertiary center with access to interventional radiology and underwent successful embolization of the pseudoaneurysm.

A pilot study on using Suction-Assisted Laryngoscopy Airway Decontamination techniques to assist endotracheal intubation by GlideScope® in a manikin simulating massive hematemesis

Background: The Suction-Assisted Laryngoscopy and Airway Decontamination techniques are newly designed emergency airway management skills to assist endotracheal intubation with the complementary use of suction catheters and video laryngoscopes in patients with severe vomiting or massive hematemesis. Objectives: To evaluate the performance of emergency department doctors in using the two Suction-Assisted Laryngoscopy and Airway Decontamination techniques (level 1 and level 2) to assist endotracheal intubation by GlideScope® in an airway manikin simulating massive hematemesis, the Nasco airway decontamination simulator. Methods: A total of 30 emergency department doctors were recruited in a pilot study. Their performance of using two levels of Suction-Assisted Laryngoscopy and Airway Decontamination techniques (Suction-Assisted Laryngoscopy and Airway Decontamination 1 and Suction-Assisted Laryngoscopy and Airway Decontamination 2) with two different suction catheters, the DuCanto suction catheter and Yankauer suction catheter, were compared with the conventional suction technique. The failed endotracheal intubation rates, time for intubation and number of attempts, amount of aspirated fluid, and the subjective ease of different methods by the participants were compared. Results: Irrespective the choice of suction catheter, endotracheal intubation in the manikin by using Suction-Assisted Laryngoscopy and Airway Decontamination 1 had the lowest failure rate which is much better than conventional suction technique (p = 0.012), smaller amount of aspiration compared with the conventional suction technique (p = 0.027), and comparable intubation time with the conventional suction technique (p = 0.850). Most participants were able to intubate the manikin successfully in the first attempt by Suction-Assisted Laryngoscopy and Airway Decontamination 1 with the DuCanto suction catheter, and they were of the opinion that such combination was the most preferred in performing endotracheal intubation. Conclusion: Suction-Assisted Laryngoscopy and Airway Decontamination 1 has the best performance in this manikin study, and Suction-Assisted Laryngoscopy and Airway Decontamination 1 with the DuCanto suction catheter was the most favorable method for endotracheal intubation in this manikin study by the participants.

P186 CAROTID-GASTROPLASTY FISTULA: AN UNCOMMON CAUSE OF HEMATEMESIS IN THE DELAYED POSTOPERATIVE PERIOD AFTER ESOPHAGECTOMY

Aim To describe a case report of a carotid-gastroplasty fistula post esophagectomy with a successful result. Background & Methods Upper gastrointestinal bleeding due to a fistula between esophagus or gastroplasty and carotid vessels is infrequent. It is usually due to malignant tumors, penetrating trauma, foreign bodies or radiotherapy. Results A 55-year-old man, with background of laryngeal squamous cell carcinoma that was treated with total laryngectomy and tracheostomy followed by radiotherapy, and posterior recurrence of squamous cell carcinoma at the upper esophagus required total esophagectomy with pharynguectomy and lymphadenectomy, and reconstruction with gastroplasty with anastomosis to the floor of the mouth and pectoralis muscle flap. During this second postoperative period, patient developed a left hemiplegia secondary to thrombosis of the right common carotid artery. After recovery, the patient had repeated episodes of hematemesis that required hospital admission and blood transfusion. After several episodes with conservative management, upper endoscopy revealed blood oozing close to the anastomosis with no other findings. Once again, the patient returned to the emergency department with massive hematemesis, being visualized by endoscopy a high-flow arterial bleeding close to the anastomosis of the floor of the mouth. Arteriography showed the already known thrombosis of the right common carotid artery and the origin of the bleeding distal to that occlusion, where it was repermeabilized by a branch of the right vertebral artery. Given the inability of selective embolization by interventional radiology, urgent surgical approach was decided, performing a right lateral cervicotomy and identifying a fistula that communicated the common carotid artery with gastroplasty. It proceeded to close the fistulous orifice of the arteria and the gastroplasty with a continuous suture. A partial sternocleidomastoid muscle flap was interposed between the two sutures. The postoperative evolution was satisfactory. Patient was discharged 16 days after surgery and being currently stable without signs of hemorrhagic neither oncological recurrence. Conclusion Carotid-gastroplasty fistula is a rare complication with high mortality rate due to its more frequent presentation: the massive hematemesis. Gastrointestinal endoscopy and angiography allow us to diagnose and treat this complication, however in massive and uncontrollable bleeding, surgical approach is indicated. Prognosis will depend on the early diagnosis and a therapeutic individualization is required.