Colonoscopy-induced right superior rectal artery tear: A case report (original) (raw)
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Evaluation of Lower Gastrointestinal Bleeding with Special Reference to Colonoscopy
Journal of Evidence Based Medicine and Healthcare, 2019
BACKGROUND We wanted to evaluate the aetiology, age incidence, histopathology, site of occurrence of lower gastrointestinal bleeding using colonoscope. We also wanted to study the clinical presentations of different types of lower gastrointestinal bleeding along with effect of diet on it. MATERIALS AND METHODS 134 patients were selected for the study who had complained of per rectal bleeding. After bowel preparation using colonoscope Olympus CV-170, both macroscopic & histopathological diagnosis, most common site involved and age of incidence were determined. RESULTS This study of 134 cases shows that the mean age of diagnosis was 44.40 years. For all types of lower gastrointestinal bleeding, the age range was (2-83) years. The most common aetiology of lower gastrointestinal bleeding is internal haemorrhoids-45 (33.58%), followed by normal mucosa in 33 (24.62%) cases and the least common is lax anal canal with posterior anal fissure 1 case (0.74%). Colorectal masses, inflammatory and/or ulcerative colonic lesions & polyps were found in 15 (11.19%), 18 (13.43%) and 13 (9.70%) cases respectively. 15 (11.19%) cases had colorectal cancer. Male 8 (5.97%) cases have higher percentage of cancer than female 7 (5.22%) cases. Mean age of diagnosis of colorectal cancer in this series is 45.13±18.05 years. Rectum (58.20%) is the most common site involved followed by whole colon (24.62%). The study carried out had bleeding per rectum (100%) & constipation (100%) in all patients. Dehydration (11.19%) and anorexia (11.19%) were the least common clinical presentations. Biopsy was done in 27 (20.14%) cases, which revealed adenocarcinoma in 14 (10.44%) cases followed by mucinous adenocarcinoma in 1 (0.74%) case. Rectal polyps were found in 12 (8.95%) cases. Dietary habit has definitive role as shown by non-vegetarian/vegetarian ratio 5.06. Only 54 (40.44%) cases had definite family history. Rectal polyps in this set up were more commonly seen in younger age (22.23 ± 20.63 years) group, in whom histopathological evaluation was done to rule out future possibility of malignancy. In many cases of colonoscopy, no abnormality was detected. The most common aetiology of lower gastrointestinal bleeding in these cases was irritable bowel syndrome which was further evaluated by esophago-dudenoscopy and enteroscopy. CONCLUSION Colonoscopy is one of the best modalities to diagnose causes of lower gastrointestinal bleeding. It will be better to have screening colonoscopy after age of 50.
A Rare Cause of Hemoperitoneum: A Case Report of Ruptured Ileocolic Artery Aneurysm
Turkish Journal of Trauma and Emergency Surgery
Visceral artery aneurysm (VAA) is very rare among vascular pathologies. Incidence reported in autopsy series and angiographic studies varies between 0.1% and 0.2%. Most cases are asymptomatic and are diagnosed as result of complications, or incidentally, when imaging is performed for another reason. Three percent of VAAs are superior mesenteric artery (SMA) terminal branch aneurysms. Intra-and/ or extraperitoneal bleeding due to ruptured aneurysm is life-threatening condition and requires emergent intervention. Therefore, surgical or endovascular interventional treatment must be performed rapidly after diagnosis. Presently described is case of ileocolic artery aneurysm in a patient admitted with abdominal pain, nausea, and vomiting. Endovascular intervention had been planned; however, during hospitalization, aneurysm ruptured and emergent surgery was performed. Review of the literature is also presented.
Inferior mesenteric artery aneurysm revealed by massif rectal bleeding, case report
Annals of Medicine & Surgery
Inferior mesenteric aneurysms are rare, usually asymptomatic. Their diagnostic is challenging based on clinical examination, ultrasonography, and abdominal CT scan; surgery remains the gold standard of treatment. Case report: In this paper, we will report a clinical case of 62 years old man admitted to the emergency department for massif rectal bleeding due to inferior mesenteric aneurysm fistulization in the transversal colon one month after a left colectomy; the treatment was surgical consisted of a Ligation. Conclusion: IMA aneurysm is a rare condition, usually asymptomatic, and it might be revealed by various symptoms, including massif rectal bleeding.
Surgical case reports, 2015
Superior mesenteric artery syndrome (SMAS) after a surgical operation is very rare. We experienced an extremely rare case of ileal pouch-anal anastomosis with subsequent development of SMAS requiring duodenojejunostomy. A 74-year-old Asian woman underwent total colectomy, ileal pouch-anal anastomosis (J-pouch), covering ileostomy, splenectomy, and distal pancreatectomy for treatment of descending colon cancer associated with ulcerative colitis. She complained of abdominal discomfort and vomiting 17 days postoperatively. Computed tomography (CT) revealed fluid collection at the pancreatic stump. We diagnosed a pancreatic fistula and performed CT-guided drainage. SMAS was thereafter diagnosed by contrast-enhanced CT, which revealed a narrow aortomesenteric angle of 36° and short aortomesenteric distance of 2 mm. The SMAS did not respond to conservative therapy. Finally, we performed duodenojejunostomy. This case illustrates that ileal pouch-anal anastomosis might induce relative stret...
Diagnostic evaluation of patients presenting with bleeding per rectum by colonoscopy
PubMed, 2008
Background: Rectal bleeding is a manifestation of lower gastrointestinal bleed, which means bleeding from a site distal to ligament of Treitz. Annual incidence of this problem has been estimated to be 20% and mortality as 11%. Patients complaining of haematochezia are suspected of having lower GI bleeding and proctosigmoidoscopy followed by colonoscopy is the examination of choice for diagnosis and treatment. Previous evidence suggested that in our country, frequencies of different aetiologies of lower GI bleed are different from the West. This study validated the previous findings. The Objective of this study was to determine the causes of rectal bleeding in adult patients at Military Hospital, Rawalpindi. Methods: One hundred and five adult patients with visible rectal bleed, irrespective of their gender were selected by non-probability convenient sampling from general medical OPD and general medical wards. Patients with suspected upper GI source of bleeding; haemorrhoidal bleed and acute infectious diarrhoea were excluded from the study. All patients were subjected to fibre-optic colonoscopy after necessary preparation and findings were recorded. Biopsies taken from suspected lesions were clinically indicated. Diagnosis was based on colonoscopic and histopathologic findings. Results: A total of 105 patients (77 male and 28 female) with mean age 41.04 yrs were part of the study. Colonoscopy showed abnormal findings in 85 (84%) patients. The commonest diagnosis was ulcerative colitis, which was found in 48 (46%) patients. It was followed by colorectal carcinoma, 11 (10%) patients, and non-specific colitis, 9 (8%) patients. Other less frequent findings were colonic diverticuli, 7 (6%) patients, solitary rectal ulcer, 5 (4%) patients, colonic polyps in 3 (2.5%) patients and one case each of telangiectasia and Crohn's disease. Conclusion: Colonoscopy has very high diagnostic yield and would be recommended in the workup of patients presenting with bleeding per rectum. Ulcerative colitis was the leading cause of bleeding per rectum in this study; while infrequent findings of Crohn's disease, polyps and diverticuli indicate that these are uncommon in this region.
Journal of Coloproctology, 2016
A total of 38,686 colonoscopies were performed between January 1985 and December 2012 at Hospital Sírio-Libanês, in São Paulo, Brazil. Two hundred thirty-four patients (0.6%) had acute lower gastrointestinal bleeding of moderate or severe intensity. A definitive diagnosis was possible in 151 cases, 64.5% of these patients.This study was approved by the Institutional Review Board. Medical charts were reviewed.All examinations were done under sedation by the same medical team.The predominant sources of bleeding were colonic diverticula (73 patients; 31%), ischemic or infectious colitis (18 patients; 7.7%) and radiation proctitis (18 patients; 7.7%).A specific therapeutic intervention was performed on 61 of the 151 patients who had the diagnosis confirmed (40.4%), according to the source of bleeding. Most patients with postpolypectomy bleeding were treated with injection of epinephrine (40%) and clipping (40%). Patients with angiodysplasia were treated predominantly with argon plasma c...
Case reports in medicine, 2010
A 66-year-old man underwent abdominoperineal resection for advanced rectal cancer. On day 3 post surgery, a decompression tube was placed for postoperative ileus. Symptoms associated with ileus immediately disappeared. On day 7 post surgery, the patient vomited large amounts of fresh blood and became hemodynamically unstable. An emergency angiography revealed active bleeding from the stump of the superior rectal artery communicating with the third portion of the duodenum. Complete obliteration of the stump by proximal coil embolization was performed to achieve successful hemostasis. The postclinical course was uneventful and the patient was discharged on day 40 post surgery.
The efficacy of selective arterial embolization in the management of colonic bleeding
Background The aim of the present study was to determine the efficacy of mesenteric embolization in the management of acute haemorrhage from the colon. Methods A retrospective review was performed of a consecutive series of patients who underwent selective arterial embolization between 2002 and 2010 at two Australian institutions. An analysis was performed of each patient's present and past medical history, procedural details and subsequent post-procedural recovery. Results Seventy-one patients were reviewed in the study. Sixty-one patients (86 %) had immediate cessation of bleeding following embolization. In total, 20 % had some form of morbidity due to mesenteric embolization being performed, the three most common being worsening renal function, groin haematoma and contrast allergy (11, 9 and 7 %, respectively). Only one patient developed superficial bowel ischaemia. Overall, 11 patients (18 %) had recurrent bleeding. Of these patients, five had repeat embolization. Of the patients who underwent re-embolization, three stopped bleeding. Surgery was required in 5 patients 2 of whom died postoperatively of systemic complications.