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Although the diagnosis of visceral pseudoaneurysm is unusual, it requires emergent attention due to the risk of rupture. We describe a 70-year-old man with a gastroduodenal artery pseudoaneurysm that manifested as recurrent hemorrhage. We highlight the possible etiologies, clinical presentations, diagnostic tools, and treatment options for this condition. In this instance, the patient was successfully treated by selective angioembolization. A visceral pseudoaneurysm should be considered in patients with abdominal pain and GI hemorrhage. At present, angioembolization is a first-line therapy.

Background The Forrest classification is widely applied to guide endoscopic hemostasis for peptic ulcer bleeding. Accordingly, practice guidelines suggest medical treatment only for ulcer with a Forrest IIc lesion because it has low rebleeding risk even without endoscopic therapy, ranging from 0 to 13%. However, the risk ranges widely and it is unclear who is at risk of rebleeding with such a lesion. This study assessed whether the Rockall score, which evaluates patients holistically, could indicate the risk of recurrent bleeding among patients with a Forrest IIc lesion at the second-look endoscopy. Methods Patients who had peptic ulcer bleeding with Ia-IIb lesions received endoscopic hemostasis at the primary endoscopy, and they were enrolled if their Ia-IIb lesions had been fading to IIc at the second-look endoscopy after 48- to 72-h intravenous proton pump inhibitor (PPI) infusion. Primary outcomes were rebleeding during the 4th–14th day and 4th–28th day after the first bleeding episode. Results The prospective cohort study enrolled 140 patients, who were divided into a Rockall scores ≥ 6 group or a Rockall scores

A number of hemostatic agents such as porcine collagen, topical thrombin, and SURGICEL (oxidized cellulose) can be used to achieve homeostasis in liver laceration. This study aims to compare stereological findings in using SURGICEL vs. gauze packing in grade 4 liver lacerations in Wistar rats. In this experimental study, 20 male Wistar-albino rats weighing 250–300 g were purchased from Shiraz University of Medical Sciences animal laboratory. At the beginning of the study, a 1-cm length and 0.5-cm depth linear laceration was made on the large lobe of the liver in all rats through laparotomy. At least one or more liver tissue samples were obtained from live rats to compare the efficacy of SURGICEL vs. gauze packing. According to our stereological results, normal liver tissue in the SURGICEL group (0.882 ± 0.146) was significantly lower than the controls (0.994 ± 0.007) (p value

Bleeding is a feared complication in patients who are treated with antithrombotic therapy (oral anticoagulation or antiplatelet therapy). Management of antithrombotic therapy after bleeding poses a dilemma where restarting the crucial medication could lead to recurrent bleeding, while interrupting or even discontinuing treatment could increase the thrombotic risk. In this review, we provide recommendations regarding the treatment of patients with a bleeding event while on oral antithrombotic therapy, based on the literature and expert opinion.

An adult male presented to us with a recurrent, large bleeding tumour in the neck. We describe our approach to the patient, whose tumour was labelled as an atypical glomus on final histopathology. They are relatively uncommon in the head neck, and this case report with literature review is expected to add to our knowledge.

Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting approximately 7 million individuals in USA. It is one of the most significant arrhythmias, which accounts for a majority of embolic strokes, especially in elderly individuals. Although oral anti-coagulation is beneficial in lowering the risk of stroke, 1 in 10 patients have a contra-indication to warfarin therapy. Among patients who do tolerate either warfarin or novel oral anticoagulant (NOAC), major or recurrent bleeding, intracranial bleeds, etc. often lead to interruption of anti-coagulation. Previous studies have reported that >90% of cardioemboli in non-valvular atrial fibrillation (NVAF) originate in the left atrial appendage. Left atrial appendage occlusion (LAAO) is currently covered by the Centers for Medicare & Medicaid Services (CMS) as an alternative for stroke prevention in patients with an elevated stroke risk (CHADS2 ≥2 or CHA2DS2-VASc score ≥3) who have appropriate rational for avoiding long-term oral anticoagulation following a shared-decision making process. In this review, we discuss the currently available LAAO devices and more importantly, appropriate patient selection for this strategy.

The benefit of routine repeat endoscopy after endoscopic hemostasis in the management of peptic ulcer bleeding is controversial. The aim of this Review is to evaluate the efficacy of second-look endoscopy by examining the evidence from published, randomized, clinical trials. Outcome measurements included recurrent bleeding, surgery, mortality, blood transfusion, and length of hospital stay. Studies were categorized into those in which endoscopy was performed with endoscopic injection or thermal coagulation. On the basis of existing evidence, second-look endoscopy with heater probe reduces the risk of recurrent bleeding, but has no effect on overall mortality or the need for surgery. Therefore, routine second-look endoscopy cannot be recommended. Selected high-risk patients may benefit from second-look endoscopy, but the use of high-dose intravenous PPIs may obviate the need for this procedure.

To report the effect of intravitreal injection of bevacizumab and gas for the treatment of diabetic premacular hemorrhage with active fibrovascular proliferation. Six eyes of six consecutive patients with acute diabetic premacular hemorrhage and active fibrovascular proliferation received intravitreal injection of bevacizumab (1.25 mg in 0.05 mL) and C3F8 (0.2–0.3 mL) during the same setting. All six cases had panretinal photocoagulation prior to the procedure. After treatment, patients maintained a prone position for 3 days and were followed for an average of 8 months (range, 4–13 months). All six eyes had complete reabsorption of the hemorrhage and reduction of fibrovascular proliferation. Transient vitreous opacification from breakthrough of the blood were observed in all eyes. An average of 3.8 weeks (range, 1–6 weeks) was required for the clearing of preretinal hemorrhage. Visual acuity improved in all six eyes. No recurrent bleeding or other adverse events were encountered in all cases. Intravitreal injection of bevacizumab and gas may be an effective method for treating acute diabetic premacular hemorrhage with active fibrovascular proliferation.

Late complications of open gastric bypass can include malnutrition, weight gain, stomal stenosis, and recurrent bleeding ulcers. Herein, we describe the case of a woman who had recurrent bleeding ulcers, after an open revision of a stenotic gastric bypass. She now underwent an uneventful laparoscopic revision of her gastrojejunostomy and was discharged within 72 hours. Laparoscopic revision of a gastrojejunostomy, even after an open revision following an open gastric bypass, can be done safely.

Re-operative hip arthroplasty may be associated with life threatening vascular complications involving the iliac arteries and veins. The anatomic distortion and difficult surgical dissection in a re-operative field often contributes to iliac vascular injuries. Bleeding during removal of the acetabular component of the hip prosthesis is often the initial sign of a major intra-operative vascular injury, the external iliac artery being the most common injured vessel. Preoperative identification of patients at risk for vascular injury during revision of hip arthroplasty is currently feasible and advisable with the information provided by plain X-ray films, angiography, CT-scan and nowadays with the 3D-angio-CT. The traditional approach for intra-operative exposure, control and repair of iliac vascular injuries during re-operative hip arthroplasty has been a retroperitoneal abdomino-pelvic incision. We here present an endovascular approach for the pre-emptive percutaneous control and potential repair of vascular injuries during a second hip arthroplasty revision in a patient at high risk for recurrent bleeding following severe hemorrhage during the initial hip revision.

Objective: Acute upper gastrointestinal (UGI) hemorrhage is a common, often serious condition encountered in the emergency department (ED). Previous research has suggested that transfusion of blood products may interfere with the hypercoagulable state induced by significant blood loss. Our objective was to determine whether the frequency of rebleeding is higher in patients with UGI bleeding who have received early blood transfusion. Methods: The study was a retrospective chart review of patients admitted to hospital through the ED with a diagnosis of UGI hemorrhage. Inclusion criteria limited analysis to patients presenting with hematemesis, melena, or bloody nasogastric aspirate, in whom a UGI lesion was confirmed endoscopically during admission. Results: A total of 214 charts were analyzed. Baseline demographic characteristics were similar in transfused and non-transfused patients. Presenting hemoglobin level was lower in the transfused group (86.5 v. 119.2 g/L, p < 0.001). Recurrent bleeding occurred in 99 (46%) patients and was more common in transfused patients (67 [66%] v. 33 [29%], p < 0.001). Logistic regression analysis revealed that transfusion and presenting hemoglobin level were the only variables with a statistically significant independent association with bleeding recurrence (p < 0.001 and p < 0.05 respectively). Conclusions: Our results support previous research suggesting that transfused UGI bleed patients have a higher rate of rebleeding. However, because of the retrospective design, causality cannot be inferred.

Four patients with intracerebral vascular malformations underwent preoperative butylcyanoacrylate embolization via a calibrated leak catheter, in order to reduce the risks of surgery alone. In three cases the malformation was removed without causing neurological deficits. One patient died later from recurrent bleeding.

The efficacy of photocoagulation by the neodymium-doped yttrium aluminium garnet (Nd-YAG) laser in the endoscopic control of upper gastrointestinal bleeding has been demonstrated previously. Yet rebleeding remains possible. In the present report the results are presented of a histological study of resection specimens from patients who required emergency surgery for recurrent upper gastrointestinal bleeding after endoscopic laser treatment. The study was set up in order: (1) to describe the changes induced by laser treatment and (2) to identify possible causes of recurrent bleeding. The findings show that laser photocoagulation can induce major vascular changes but that these may be incomplete. Incomplete photocoagulation may be responsible for the rebleeding and may itself be caused by poor accessibility to the bleeding site.