1. A PARTICULAR CASE OF DIGESTIVE BLEEDING MANIFESTED - FROM NORMAL TO THE UNUSUAL - A CASE REPORT.
- Author
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Huiban, Laura, Sîngeap, Ana Maria, Muzîca, Cristina Maria, Zenovia, Sebastian, Cuciureanu, Tudor, Petrea, Oana, Chiriac, Ștefan, Gîrleanu, Irina, Sfarti, Cătălin, Stanciu, Carol, and Trifan, Anca
- Subjects
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DIVERTICULOSIS , *GASTROINTESTINAL hemorrhage , *HEMORRHAGE , *BIOMARKERS , *ARGON plasmas , *MUCOUS membranes , *HEART sounds - Abstract
Introduction. Digestive bleeding is a challenge in daily practice, being one of the main reasons for addressability in a gastroenterology center, which requires hospitalization and investigations to determine the cause and whose treatment depends on the source of the bleeding. Case report. A 61-year-old patient from a urban area, with associated cardio-vascular pathology, with an initial address in the territory for digestive bleeding (melena), without highlight a source with potential for bleeding at endoscopic examinations, presents for the persistence of stools melenic, dizziness, marked physical asthenia and diffuse abdominal pain. Clinical examination reveals: good general condition, afebrile, teguments and pale mucous membranes, normal heart auscultation, bilateral basal tightened vesicular murmur. Laboratory findings show normochromic normocyte anemia, hyponatremia, important enzymatic cholestasis (increased isolated alkaline phosphatase), negative viral and autoimmunity markers, normal tumor markers, except increased PSA (3160 ng/ml), normal kidney function. Abdominal ultrasound: hyperreflective liver, with normal structure and size, at rest, without other pathological changes. The upper digestive endoscopy does not reveal any source with bleeding potential. Colonoscopy show small diverticula throughout the colic, red blood coming from the level of the small intestine, check with bleeding, no lesions. Because the colonoscopy revealed red blood from the small intestine, the exploration was continued with the investigation of this segment, with the help of the capsule endoscopy, which immediately describes after passing through the ileocecal valve, in the vesicle, a vascular lesion with central ulceration, and in nearby - red blood, with an ulcerated venous angiodysplasia aspect. Treatment of hydroelectrolytic rebalancing and blood transfusion was initiated, the main therapeutic measure being the endoscopic coagulation with argon plasma, with the bleeding stopping. In view of the increased PSA marker, abdominal-pelvic TC was performed, which revealed a tumor formation in the prostate and secondary bone lesions (which explains the increase of AP), the histological result being of prostate acinar adenocarcinoma. The particularity of the case is the overlap of an increased isolated AP that together with the increased PSA, directs the diagnosis to prostate neoplasm with secondary bone lesions. Conclusions. The explorations performed out in the patient presented with digestive bleeding offered the explanation of the symptomatology, together with the modified biological parameters, further investigations being required. The manifestation of the digestive haemorrhage was masked by the colonic diverticulosis and the biological picture of the neoplastic pathology, the difficulty of the diagnosis being determined by the overlapping of the clinico-biological manifestations. [ABSTRACT FROM AUTHOR]
- Published
- 2023